foodborne illness and the public health nurse
DESCRIPTION
Foodborne Illness and the Public Health Nurse. Bureau of Epidemiology Sally A. Bidol, MPH Mark A. Schmidt, MPH Office of Public Health Preparedness Susan L. Shiflett. Michigan Department of Community Health. Day 1 Monday 06/07. - PowerPoint PPT PresentationTRANSCRIPT
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Foodborne Illness and the Public Health Nurse
Bureau of Epidemiology
Sally A. Bidol, MPH
Mark A. Schmidt, MPH
Office of Public Health Preparedness
Susan L. Shiflett
Michigan Department of Community Health
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Day 1Monday06/07
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Laboratory Report To: Local Health DepartmentFrom: HighTECH Labs, Inc
• Patient: Doe, Thomas
• DOB: 12/03/93
• Address: 300 Any Street, Anytown, Michigan
• Result: Presumptive E. coli O157:H7
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What would you do?
What information will you need to collect?
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Information Collected
• Onset: Sunday, 5/30• Bloody diarrhea, fever• No travel history• Municipal water• Not aware of any ill contacts• Mother shops at Grocery Store A• Boy Scout trip to petting zoo
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Pet
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Day 1
Breakfast
Lunch
Dinner
Snack
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Day 2
Lunch
Breakfast
Dinner
Snack
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Day 3
Breakfast
Lunch
SnackDinner
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What are the most likely causes of infection?
• Food history
• Pet
• Other exposures
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What is the major limitation of the data collected?
• Incubation of E. coli O157:H7:– Median 2 to 4 days– Up to 8 days
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Day 2Tuesday
06/08
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Laboratory Report To: Local Health Department From: HighTECH Labs, Inc
• Presumptive Positive E. coli O157:H7 – 2 Children
• 9 y/o attends same school as Thomas Doe• 5 y/o attends day care
– 1 Teenager• Works as a food handler at The Healthy Deli
– 1 Adult
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School Nurse Reports
• June 1 – 4, 30 children absent
• Typically 5 absent
• Most gave reason as “Stomach Flu”
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Group Questions • Is it time to activate your outbreak
team?– If no, what additional information needs to be
collected before you activate the team
• How would you go about:– Verifying the diagnosis– Searching for additional cases– Determining if cases are associated
• What is your initial hypothesis?
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Answers
• Is it time to activate your outbreak team?
– Yes
• Verify the diagnosis
– Contact students, ask about symptoms and clinical samples
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Answers
• Search for additional cases– Ask cases for others experiencing
symptoms– Contact medical facilities– Contact EH to check for unconfirmed
illness reports– Contact suspect facilities (EH) to ask about
complaints• Determine if cases are associated
– Person, Place, and Time
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More Patient Information
• Confirmatory reports from MDCH indicated that 4 patients are positive for E. coli O157:H7 and produce STX I and STX II. PFGE is performed and all isolates are identical.– 2 children on basketball team– Teenager is youth coach of team– Adult is parent of basketball player
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• One patient is positive for E. coli O26:NM– 1 child
– Not associated with basketball team
More Patient Information
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Interpreting Laboratory Reports
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E. coli Serotyping
• O = Somatic antigen in cell wall
• H= Flagellar antigens in the flagellar structure
• NM = non-motile, has lost the flagella
• Common serotypes include O157:H7
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E. coli Toxin Testing• Shiga-like toxin I and II (STX I, STX II)
• More important than serotyping
• Presence of STX causes illness• Cytotoxic effect, inflammation of
intestinal wall leading to death of cells• Results in:
–Hemorrhagic colitis–Hemolytic Uremic Syndrome (HUS)–Thrombotic Thrombocytopenic
Purpura (TTP)Website of Dr. Brett Finlay
Dept. of Microbiology and Immunology
Dept. of Biochemistry and Mol. Biology
University of British Columbia
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E. coli O157:H7 DNA Fingerprinting
• Pulsed-field gel electrophoresis (PFGE)
• PulseNET
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MDCH Laboratory Report
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MDCH Laboratory Report
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Website of Dr. Brett Finlay
Dept. of Microbiology and Immunology
Dept. of Biochemistry and Mol. Biology
University of British Columbia
What does this mean?
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Lab Testing Results
Does this change the direction of your investigation?
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0
1
2
3
4
5
6
7
8
9
May26
May27
May28
May29
May30
May31
Jun 1
Jun 2
Jun 3
Jun 4
Jun 5
Jun 6
Illness Onset Date
# of
Cas
es E. coli O157:H7 May - June 2003 (N=28)
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Summary of Outbreak
• Implicated meal--Steak House Buffet 5/27
• All confirmed E. coli O157:H7 cases consumed fruit from the salad bar
• Basketball team ate from the salad bar
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Loosely Based on Milwaukee Sizzler Restaurant Outbreak of 2000
• 736 cases, 63 culture confirmed
• 18 hospitalizations, 5 cases HUS, 1 fatality
• Sirloin tri-tips
• Meat ground within 1 foot of fruit and vegetable preparation table.
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Management of Food Handlers
• Michigan Food Law of 2000 – Regulates all food establishments in
Michigan
– Provides essential powers, duties, penalties
– Adoption of FDA Food Code (model)
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Exclusions and Restrictions - Definitions
Big 4
Salmonella TyphiShigella spp.E. coli O157:H7Hepatitis A virus (HAV)
• High infectivity• Severe medical consequences
High risk conditionsCaused, or exposed to, a confirmed Big 4 outbreak since person-
consumed implicated food, orconsumed food prepared by infected person, orconsumed food prepared by suspected shedder
Lives with someone diagnosed with Big 4Lives with someone who attended/worked at a confirmed Big 4 outbreak
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Exclusions and Restrictions ILL Employee Serving General
Population
Diagnosedwith Big 4
Jaundice >7 days
Exposed lesion,boil or wound
Persistent sneezing,coughing or runny nose
Asymptomatic& positive stool
Exclude
GI symptoms
Jaundice within 7 days
Restrict
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Child Care CenterAttendance
• E. coli O157 illness– spread is a major concern
• Infected child or care giver should be excluded until:– Diarrhea resolves– 2 negative stool cultures
• Early involvement of local health authorities can prevent further disease
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Points to Ponder: Conducting an Investigation
• Remember normal background activity • Teamwork between nursing and EH
essential • What information is pertinent in an
investigation?• How do you interpret the laboratory
results?• Don’t forget your epi tools
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Got Food
Poisoning?
Welcome to the
Foodborne Outbreak
Early Detection System (FOEDS) Forum
Web users share and
compare info
RUsick2 FORUM
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WWW.RUSick2.msu.edu
– Forum for people with suspected foodborne disease to share and compare their pre-illness food history and other factors. Objective: Did they eat the same food items? Identify common source outbreaks.
– Being pilot tested in Greater Lansing Area.
– “Delivers” foodborne disease reports to the LHD
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Holly Wethington165 Food Safety & Toxicology BldgMichigan State UniversityEast Lansing, MI 48824P: 517.432.7181 (#128)F: 517.432.2310Email: [email protected]
RUsick2 Contact Information (www.RUsick2.msu.edu) :
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Questions?