JANUARY 13, 2014

Controlling Vibrio Parahaemolyticus in

Massachusetts

SUZANNE K. CONDON, ASSOCIATE COMMISSIONERDIRECTOR, BUREAU OF ENVIRONMENTAL HEALTH

MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH

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Outline2

I. Introduction / Vibrio parahaemolyticus

II. ISSC / Model Ordinance

III. Roles of Shellfish Control Authority Relative to Vibrio Management

IV. Illness Investigation Procedures

V. 2013 MA Vp Control Plan

VI. Federal Proposals for North Atlantic 2014

I. Introduction/Vibrio parahaemolyticus (Vibrio)

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Vibrio is an emerging, naturally occurring bacterial pathogen often found in oysters harvested from warmer waters. It has caused illnesses in the Gulf Coast and West Coast of the United States for a number of years. It is not related to pollution of Massachusetts shellfish

  When ingested, Vibrio causes watery diarrhea, often with

abdominal cramping, nausea, vomiting, fever and chills. Usually these symptoms occur within 24 hours of ingestion and last three days. Severe disease is rare and occurs more commonly in people with weakened immune systems. About ten percent of cases will develop a blood infection that may require hospitalization

  Vibrio can also cause an infection of the skin when an open

wound is exposed to warm seawater

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II. Interstate Shellfish Sanitation Conference (ISSC)

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27 member states (including producers and shippers of shellfish), FDA, EPA, NOAA, academia, and industry

The Model Ordinance (MO) is developed by state regulators and industry members representing each ISSC region

FDA evaluates each member state for compliance with the MO on an annual basis

If states do not comply with the MO then the federal government intercedes

Model Ordinance6

According to the current Model Ordinance an outbreak of foodborne illness is defined as 2 or more cases (not from the same household) during the season from a growing area

Includes procedures for conducting investigations of shellfish-related illnesses and requires states to close growing areas once an outbreak has been associated with a specific growing area

The ISSC will be meeting on 1/25/14 – 1/31/14 and modifications to definitions and response actions have been proposed for adoption

DPHDPH DMFDMF Responsible for foodborne

illness investigations Licenses wholesale dealers Conducts shellfish dealer sanitary

inspections for Vp Control Plan compliance

Conducts trace back of shellfish in confirmed cases

Collects, reviews and interprets epidemiological data for confirmed Vp illnesses

Inspects all seafood dealers/distributers in MA

Advises DMF when health risks warrant regulatory action

Permits harvesters

Permits wholesale dealers in partnership with DPH

Classification and monitoring of growing areas

Conducts inspections of landing sites for Vp Control Plan compliance

III. Roles of Shellfish Control Authority relative to Vibrio

Management7

IV. How Does Vibrio Illness Get Reported to DPH?

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Vibrio illness is a reportable disease in Massachusetts

Hospitals, doctors, and laboratories report results to DPH and to the local health department in the town where the patient lives

Patients are interviewed and their information is sent to CDC who coordinates information with affected states

Illness Investigation Procedures

1) Illnesses are reported to DPH Food Protection Program (FPP) and/or DPH Bureau of Infectious Disease Services (BIDS)

2) BIDS epidemiologists contact local health nurses to conduct personal interviews with those that become ill

3) Following these interviews, FPP, assisted by local boards of health (LBOH), reviews shellfish tags and other shipping records to determine which oysters may be implicated in each illness

4) FPP and LBOH evaluate retail shellfish handling practices, including time/temperature control of implicated oysters

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Illness Investigation Procedures (continued)

5) FPP then evaluates shellfish handling practices and compliance with MA Vibrio Control Plan by all wholesale dealers providing oysters to retail establishments

6) When specific harvesters are identified, FPP and Department of Fish and Game (DMF) evaluate harvester shellfish handling practices and compliance with MA Vibrio Control Plan

7) May result in recalls of implicated shellfish among wholesale dealers and closure of beds by DPH and DMF

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Closure of Duxbury and Katama Bays

Why was there an order to close Duxbury and Katama Bays to oyster harvesting?Massachusetts has had an unusually high number of individuals diagnosed with Vibrio parahaemolyticus since the season started 5/31/13On 8/29 DPH received confirmation of 3 cases tied directly to harvest areas in Plymouth Harbor, Duxbury and Kingston BaysOn 9/9 DPH received confirmation of 2 cases tied directly to the growing/harvest area in Katama Bay (V-20)Cases investigated by DPH and DMF each year

2011 – 13 cases 2012 – 27 cases 2013 – 58 cases

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DPH Vp Investigations Summer/Fall 2013

The cases that prompted the closures were among a number of cases that DPH investigated, including:

19 Vibrio cases with some relationship to Duxbury Bay

12 Vibrio cases with some relationship to Katama Bay

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Additional MA Confirmed Cases 2013

Illnesses associated with harvest areas in Buzzard’s Bay (BB), Cape Cod Bay (CCB) and South Cape (SC). Single illnesses – not considered outbreaks; therefore did not result

in area closures.

Of the 58 cases reported to FPP, 33 cases were traced back to one or more MA-only growing areas.

All of the MA growing areas with illnesses had consumption dates that fell between June 28th and August 27th with corresponding harvest dates between June 26th and August 25th.

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Opportunities for Time/Temperature Abuse

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Transport to Dealer

Transport

by Dealer

to Retailer

IV. Elements of2013 MA Vp Control Plan

Implemented in Spring 2013 for oysters harvested May 24 – October 20 statewide

Harvesters required to: ice oysters immediately upon landing Adequately shade during transport Record time of harvest and/or exposure by tide on

harvester tag

Dealers required to cool oysters ≤ 50° F within 10 hrs of harvest/tidal exposure

May not ship until internal temp of ≤ 50°F is verified by dealer

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Selected Areas Where Vp Control Plans Differ in Other States

New York: Includes quahogs in addition to oysters Icing required within one (1) hour of time of harvest

New Jersey: No product may be shipped the same day as harvest

Virginia: Morning harvest only

Washington: No reopening of closed areas for remainder of Vp control

period during calendar year

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DMF Vp Compliance Monitoring 2013

Landing site inspection totals: Sites in 15 towns visited;

115 individual monitoring events 52 events with market-sized oysters landed

18 compliant landings (35% compliance rate)

(See handout for DMF Vp Compliance Monitoring Form)

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Properly IcedProperly Iced Improperly IcedImproperly Iced

Adequate Icing of Oysters18

Oyster Culture Practices of Concern

Harvesting and culling oysters then re-submerging for future harvest Intertidal operations – exposure to sun/heat Subtidal operations – off-site handling/inadequate shading

Air drying racks and or bags of oysters for anti-fouling purposes may increase levels of vibrio

Culture practices on floating structures (“oysterplexes”) may also contribute to increasing vibrio levels

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V. Federal Proposals for North Atlantic 2014

Immediate icing of oysters within 1 hr of harvest (#13-204)

New procedures for closing and reopening areas with 3 tiers that include consumer warnings in advance of closures and recalls (#13-101)

Adoption of 2011 interim time/temperature changes into next version of the Model Ordinance (#11-201A, 11-201B)

Use of ice slurries for cooling shellstock (#13-208)Re-submerging of shellstock (#13-209)Bulk tagging for transport to Original Dealer (#13-211)Vp Control Plan for Quahogs (#13-221)www.issc.org

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Outreach in 2014

Industry Listening sessions in January 2014 ISSC update and discussion – February 2014 Education and training sessions for 2014 Vp Control

Plan - spring 2014

Local boards of health MA Health Officer’s Association training seminars –

April 2014 Request that local boards of health provide training to

retail food establishments

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Discussion of Issues for Consideration Vp Control Plan 2014

Definition of adequate icing

Definition of re-submergence

Air drying for removal of fouling organisms

Permissible culture practices on floating structures (“oysterplexes”) during Vp season

Discussion

For additional information, please contact the

Bureau of Environmental Health at (617) 624-5757 or e-mail vibrio.feedback@state.ma.us