Presentation is loading. Please wait.

Presentation is loading. Please wait.

Large Outbreak Linked to a Popular Burger Lisa Berger MD Associate Medical Officer of Health, Toronto Public Health May 29, 2014

Similar presentations


Presentation on theme: "Large Outbreak Linked to a Popular Burger Lisa Berger MD Associate Medical Officer of Health, Toronto Public Health May 29, 2014"— Presentation transcript:

1 Large Outbreak Linked to a Popular Burger Lisa Berger MD Associate Medical Officer of Health, Toronto Public Health May 29, 2014 http://news.nationalpost.com/2013/08/21/at-least-12-treated-for-gastrointestinal-illness-at-cne-in-toronto/ 1

2 Outline 1.Timeline of events 2.TPH outbreak management response 3.Case investigation and epidemiology 4.Environmental investigation 5.Lessons learned – what went well 6.Lessons learned – challenges 2

3 How it all started 3 August 20, 2013 Tuesday 12 people present to the EMS booth at the CNE with severe vomiting, diarrhea and abdominal pain allegedly after eating at one premise. The premise closes voluntarily. CNE’s assistant GM contacts TPH’s Healthy Environments (HE) and Communicable Disease Control (CDC) managers

4 Timeline of events 4 Aug 21 Wed Inspection of Epic Burgers and Waffles and Le Dolci, food samples TPH invokes IMS to manage the investigation MOHLTC/PHO informed Press conference High media coverage probably prompted case reporting Aug 22 Thu 98 reports; at a glance15/17 ate the cronut (no epi avail.) Discussions about TPH response if Epic chose to reopen PHUs agree to centralize all case investigations to TPH CNE’s private lab: “endotoxin A, E” in the burger and/or bacon puree Aug 23 Fri 147 reports; 36/46 confirmed cases ate cronut, no other common items Early epidemiology analysis with Fluid Survey Early results from PHOL confirms S. aureus enterotoxin in cronut burger Press conference reporting S. aureus food poisoning from cronut burger Link to news conferences: http://www.citynews.ca/2013/08/21/34-people-fell-ill-at-cne-toronto-public-health/ http://www.citynews.ca/2013/08/23/outbreak-of-food-borne-illness-at-cne-linked-to-cronut-burger/#related-content-preview

5 The cronut burger: “‘ the star ’ of the CNE 2013 ” “Marrying a trendy snack pastry with the reliable beef patty… A food fad that began in New York City, the cronut is a donut made by shaping and deep- frying croissant pastry.” Rick McGinnis, blogTO http://news.nationalpost.com/2013/08/21/at-least-12-treated-for-gastrointestinal-illness-at-cne-in-toronto/ http://www.blogto.com/eat_drink/2013/08/how_to_have_a_heart_attack_at_the_2013_cne/ 5

6 Timeline of events Aug 24- 25 Sat/Sun Epic Burgers and Waffles remains closed Inspections across CNE food vendors New foodborne illness complaints to TPH slow down Aug 26 Mon Confirmed case definition includes Epic Burgers and Waffles 211 reports; 54 confirmed, 39 suspect cases PHOL tests: bacon puree at Epic and Le Dolci had enterotoxin+ S. aureus Le Dolci closed on Mondays Aug 27 Tue 233 reports; 83 confirmed, 29 suspect cases Epic Burgers and Waffles reopens after cleaning, staff training Le Dolci re-inspection with environmental samples Media scrum reporting bacon jam from Le Dolci as contaminated 6

7 Timeline of events 7 Aug 28 Wed Joint OMAF/TPH inspection of Superior Sausage TPH disbands IMS Aug 30PHOL results show same strain of S. aureus at Epic and Le Dolci Sep 4Le Dolci food handlers swabbed Sep 5Le Dolci reopens after cleaning, staff training

8 The rise and fall of the cronut burger “Marrying a trendy snack pastry with the reliable beef patty… A food fad that began in New York City, the cronut is a donut made by shaping and deep- frying croissant pastry.” Rick McGinnis, blogTO http://www.blogto.com/eat_drink/2013/08/how_to_have_a_heart_attack_at_the_2013_cne/ 8

9 Case definitions Initially broad, included consumption of any food from the CNE and subsequent illness (diarrhea and/or vomiting) Confirmed cases August 20 Suspect cases August 16-19 Final case definitions by level of evidence supporting inclusion in outbreak Food from Epic Burgers and Waffles Symptoms consistent with S. aureus intoxication Consumption and onset times consistent with IP Date of consumption and illness (August 20, 16-19) 9

10 Case definitions Initially broad, included consumption of any food from the CNE and subsequent illness (diarrhea and/or vomiting) Confirmed cases August 20 Suspect cases August 16-19 Final case definitions by level of evidence supporting inclusion in outbreak 10 ConfirmedProbableSuspect Food from Epic Burger and Waffles XXXX Symptoms of S. aureus intoxication XXXX Consumption and onset times consistent with IP XX Date of consumption and illness (August 20 vs 16-19) 2016-192016-19

11 Preliminary case definition Confirmed case: individuals who: Visited the CNE on Tuesday August 20, 2013 and consumed food or drink purchased at the CNE AND Subsequently became ill with diarrhea and/or vomiting, with or without abdominal pain Suspect case: individuals who: Visited the CNE between August 16-19, 2013 and consumed food or drink purchased at the CNE AND Subsequently became ill with diarrhea and/or vomiting, with or without abdominal pain 11

12 Final confirmed case definition Confirmed case: Purchased and consumed food from Epic Burger and Waffles at the CNE on August 20, 2013 AND Developed symptoms consistent with Staphylococcus aureus (S. aureus) intoxication within 10 hours of food consumption, and reported the occurrence of diarrhea and/or vomiting, with or without abdominal pain. 12

13 Final probable case definition Probable case: Either Purchased and consumed food from Epic Burger and Waffles at the CNE between Aug 16-19, 2013 AND Developed symptoms consistent with S.aureus intoxication within 10 hours of food consumption, and reported the occurrence of diarrhea and/or vomiting, with or without abdominal pain OR Purchased and consumed food from Epic Burger and Waffles at the CNE on August 20, 2013 AND Developed symptoms consistent with S.aureus intoxication more than 10 hours but less than 24 hours after consuming the food, or if the symptom onset time or time of food consumption are missing/unknown*, and reported the occurrence of diarrhea and/or vomiting, with or without abdominal pain. 13

14 Final suspect case definition Suspect case: Purchased and consumed food from Epic Burger and Waffles at the CNE between Aug 16-19, 2013 AND Developed symptoms consistent with S.aureus intoxication more than 10 hours but less than 24 hours after consuming the food, or if the symptom onset time or time of food consumption are missing/unknown*, and reported the occurrence of diarrhea and/or vomiting, with or without abdominal pain. *If cases had a symptom onset date but no time available, and the time of consumption was such that the maximum time on that day would have been within the 10 hour window, these cases are considered to be within 10 hours. E.g. if a case ate at 8:00pm and had symptoms on the same date, even if there is no time reported we will consider it within 10 hours. 14

15 Case information 257 reports investigated 144 cases, 0-82 yrs Toronto residents 56.3% Residents from 12 other health units ConfirmedProbableSuspectTotal Cases88 (61%)43 (30%)13 (9%)144 (100%) Male sex*49 (56%)21 (49%)4 (31%)74 (51%) Median age28.5 years29.0 years31.2 years29.5 years Ate cronut87 (99%)37 (86%)10 (77%)134 (93%) Mean incubation^4.0 hours5.7 hours17.6 hours4.7 hours *Where sex known ^Where incubation period could be calculated 15

16 Epidemic curve by illness onset* * Available data as of September 24, 2013; subject to change 16

17 http://news.nationalpost.com/2013/08/22/close-to-100-complaints-of-illness-at-cne-as-cronut-burger-maker-still-shut-down/ http://www.thestar.com/news/gta/2013/08/27/le_dolci_fun_foodie_studio_linked_to_cronut_burger_illnesses.html https://maps.google.ca/maps?ie=UTF- 8&q=Superior+Sausage+Co&fb=1&gl=ca&hq=superior+sausage+toronto+hours&cid=0,0,5561172707282629667&ei=0VpbUru9FMXIrQGFsIHQDw&ved=0CLIBEPwSMAs 17

18 Environmental investigation Food establishments Epic Burgers and Waffles – Aug 21 Voluntary closure Aug 21-Aug 26 Temperature abuse, inadequate cold holding Le Dolci – Aug 21 Voluntary closure Aug 26-Sept 4 Temperature abuse Environmental swabs of equipment, handles etc. (20) all negative Food handler swabs 1/5 positive for S. aureus, non-outbreak PFGE Superior Sausage – Aug 28 (OMAF/TPH) No infraction identified 18

19 Food sample testing results 19 SampleDate collected LocationBatch S. aureus Entero- toxin PFGERemarks Cronut burger - ready to eatAug 21Epic BurgersAug 20>200,000+APrepared in front of PHI Cronut burger - ready to eat (patty to the grill 10 mins) Aug 21Epic BurgersAug 207,300+APrepared in front of PHI Cronut burger - ready to eatAug 20Epic BurgersAug 20>200,000+ACollected by CNE staff Cronut burger - ready to eatAug 22Client homeAug 20Positive+ASaved by ill case Bacon pureeAug 21Epic BurgersAug 201,000+ASampled from 10 litre bucket Bacon pureeAug 21Le DolciAug 21100+A Bacon pureeAug 23Le Dolci n/a- After PHI recommendations Raw baconAug 21Superior Sau.Aug 21720-B Raw burger pattyAug 21Epic BurgersAug 20<100n/a Raw Processed cheeseAug 21Epic BurgersAug 20<100n/a Cronut (croissant donut)Aug 21Epic BurgersAug 20<100n/a Bread product only ToppingsAug 20Epic BurgersAug 20-n/a Collected by CNE staff Donut productAug 21Le DolciAug 21<100n/a Maple syrupAug 24Le Dolci -n/a Kirkland brand (Costco) Brown sugarAug 24Le Dolci -n/a

20 Lessons learned – what went well Cooperation with CNE (and vendors) CNE had private food inspection contractor TPH Healthy Environments office onsite Early invocation of IMS at TPH Best practice is real application Centralized investigation to one HU PHOL consultation and support Speedy environmental investigation Food testing was the only way to isolate pathogen Discussions about reasons to close/not close 20

21 Lessons learned – challenges Media demands Jurisdictional differences – thresholds for food testing in public health and OMAF Managing intense early ramp up phase Staffing and coordination of staffing Variable staff familiarity with IMS Consistency between case interviews 21

22 22 http://www.publichealthontario.ca/en/eRepository/Public_Health_Inspectors_Guide_2013.pdf

23 Final thoughts Relatively manageable point-source outbreak No person-to-person transmission – prompt control measures stopped further illness Rapid environmental sampling was critical Key advantage was having helpful and supportive fair organizers Early decision to use IMS was a good one For managing this outbreak For the organization – opportunity to practice, refine 23

24 Acknowledgements 24 PHOL TPH MOH TPH CDC Dr. Vanessa Allen Dr. David McKeown Dr. Barbara Yaffe Allana MurphyManisa Jiaravuthisan Erik Kristjanson TPH Healthy Environments Anne Arthur Sylvanus Thompson Debra Hayden PHO Dr. Kit Young Hoon Faron Kolbe Stephen Moore Jim Chan Effie Gournis Dr. Jin Hee Kim Tom Marjanovich Fred Taylor TPH Strategic Support MOHLTCPhil Jackson Clint Shingler Jenn Veenboer Nina Arron TPH Communications Rishma Govani Kris Scheuer

25 Initial case definitions Confirmed case: individuals who: Visited the CNE on Tuesday August 20, 2013 and consumed food or drink purchased at the CNE AND Subsequently became ill with diarrhea and/or vomiting, with or without abdominal pain Suspect case: individuals who: Visited the CNE between August 16-19, 2013 and consumed food or drink purchased at the CNE AND Subsequently became ill with diarrhea and/or vomiting, with or without abdominal pain 25


Download ppt "Large Outbreak Linked to a Popular Burger Lisa Berger MD Associate Medical Officer of Health, Toronto Public Health May 29, 2014"

Similar presentations


Ads by Google