Presentation on theme: "Salmonella Heidelberg – Outbreak to Recall Eric Coffey, Environmental Health Manager Amanda Taylor, MPH, Epidemiologist Southeast Regional Office."— Presentation transcript:
Salmonella Heidelberg – Outbreak to Recall Eric Coffey, Environmental Health Manager Amanda Taylor, MPH, Epidemiologist Southeast Regional Office
Initial Outbreak Notification On Friday, November 29th – TDH SER notified by local jail administrators that 3 ill inmates were transported to ER with high fever, diarrhea and/or vomiting Debbie Walker (SER CEDS Director) worked with Dr. Allyson Cornell (Medical Director), jail staff and hospital ICN to gather information Newly symptomatic individuals were seen by jail medical staff and quarantined to one POD TDH PIO and jail PIO notified
December 2 nd – 4 th EH was notified of the outbreak and requested to collect samples of the Thanksgiving Meal. Two food trays sampled and 10 samples were overnighted to Lab. Hospital ICN informed SER that one stool sample tested positive for Salmonella. Kitchen supervisor contacted for menu information. Questionnaire developed which included symptoms, activities, cell location and foods eaten during the previous week. Worked with jail nurse to solicit additional stool samples among ill. EPI EH LAB Food samples arrived at the lab, analysis begins.
December 5 th After the meeting, EH conducted the initial walk through assessment of the County Jail Food Facility. Case definition: an inmate or officer reporting diarrhea (≥3 loose stools in a 24 hour period) since November 27. Began interviewing ill cases (n=29) Challenges EPI EH LAB Food sample testing continued EPI/CEDS/EH/RO/MED Director met with BCSO administrators to discuss outbreak protocol, investigation direction, and expectations.
December 6 th – 11 th Environmental Health Manager was meeting with investigation team. Epi curve created Moved to case-control study Enrolled 20 controls Matched to cases by gender and POD location Interviews continued among cases and controls Database created in Epi Info 7 (EI7) Began conducting data analysis using EI7 Dashboard. EP Nurse Consultants delivered stool collection kits to jail and provided education. Took a closer look at menu items served in the week prior to illness. EPI EH LAB No findings to note from food samples on Thanksgiving tray. Additional stool samples received.
December 12 th EH returned to the Facility with EPI to collect samples of the mechanically separated chicken (MSC). Three different lots and manufacture dates were identified. Two of the lots were from around the time of the thanksgiving meals. Two samples of the were collected from the chubs. Packaged and overnighted to the lab for analysis. EPI EH LAB Stool sample results positive for Salmonella Heidelberg
December 13 th EPI EH LAB MSC samples received and testing began EH and EPI returned to the jail kitchen to conduct a food flow of MSC with the kitchen supervisor. Investigated distribution of meals (time and POD location), temp procedures/logs and potential areas for cross contamination.
December 20 th – 30 th Coordinated with USDA/FSIS to answer questions about food sample collection process Sent temp logs and inventory information to USDA/FSIS Continued data entry Continued data analysis Accompanied USDA representative during kitchen assessment and shared information EPI EH LAB Preliminary results of MSC chicken showed Salmonella Heidelberg Isolates from case-patients and MSC were subtyped using pulsed-field gel electrophoresis (PFGE) and antimicrobial susceptibility testing was performed
Descriptive Data Table 2. Symptom Profile of Cases (n=29) Symptom# (%) of Cases Diarrheaª29 (100) Abdominal cramps27 (93) Fatigue27 (93) Headache27 (93) Nausea27 (93) Muscle aches25 (86) Chills24 (83) Fever21 (72) Backache18 (62) Vomiting17 (59) Weight loss13 (45) Blood in stool8 (28) Fever > 103°F3 (10) Constipation1 (3) ª Median duration of diarrhea: 4.5 days (range: 1-8 days)
Results Summary No single food item or activity was found to have a statistically significant association with illness Due to the nature of Salmonella, mechanically separated chicken served on 11/27 in breakfast gravy and spaghetti was identified as possible exposure Stool specimens collected from 13 inmates 9 (69%) positive for Salmonella Heidelberg with indistinguishable PFGE patterns Testing of unopened MSC chub received at jail on November 22 yielded Salmonella Heidelberg indistinguishable from the outbreak strain Kitchen assessment identified the possibility of cross- contamination through improper hand washing, poor personnel hygiene, and inadequate sanitation of utensils
Recall Assessment Summary FSIS/USDA contacted for assistance with traceback investigation of MSC Epi, environmental and lab data provided Several detailed questions were asked Microbiology assessment of sample collection and lab procedures were conducted to rule out cross-contamination Representative sent to jail to inspect kitchen Manufacturer’s legal counsel notified of findings Wednesday, January 10 - MSC manufacturer initiated a voluntary recall of approximately 33,840 lbs of product
Further Action CDC notified of findings Data and media talking points discussed SharePoint site updated Human and food isolates tested for antimicrobial resistance (NARMS) Relayed information to TDH PIO and jail PIO for media inquiries
Conclusion Contaminated MSC and poor food handling practices contributed to a substantial Salmonella Heidelberg outbreak Presumptive multidrug-resistant Salmonella may have contributed to more severe illness Foodhandlers in institutional settings should receive food safety training to minimize the risk of illness associated with high-risk foods such as MSC USDA News Release: http://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and- public-health-alerts/recall-case-archive/archive/2014/recall-001- 2014-release http://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and- public-health-alerts/recall-case-archive/archive/2014/recall-001- 2014-release CDC Web Announcement: http://www.cdc.gov/salmonella/heidelberg-01-14/index.html
SERO Staff Dr. Allyson Cornell, Debbie Walker, Deb Solomon, Amanda Taylor, Eric Coffey, Marsha Rogers, Robin Moore, Melanie Grant, Christina Arriaga, Robert Goff, Beth Delaney, Glenn Czarnecki TDH Staff Dr. John Dunn, Katie Garman, Amanda Ingram, Dr. Tim Jones, Dr. Rendi Murphree, Dr. Amy Woron, Sheri Roberts, Parvin Arjmandi, Ellyn Marder, Marie Bottomley, Shelley Walker, Latoya Simmons Acknowledgments Others Dr. Stephanie Defibaugh-Chávez, FSIS/USDA Staff, CDC Staff, Sheila Spencer, Dr. Alice Green, Dana Maxwell, Latoya Simmons, Jail Administrators, Jail Medical Staff