Foodborne Illness and the Public Health Nurse
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Transcript of Foodborne Illness and the Public Health Nurse
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Foodborne Illness and the Public Health Nurse
Bureau of EpidemiologySally A. Bidol, MPH
Mark A. Schmidt, MPHOffice 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
Snack Dinner
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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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0123456789
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 4Salmonella 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?