1. Texas Rapid Response Team for Foodborne Illness Julie Loera and Debbra Callan Texas Department of State Health Services April 5, 2012

2. Foodborne Illness in the US Each Year 48 million people (1 in 6) 128,000 Hospitalized 3000 deaths Source: Centers for Disease Control and Prevention www.cdc.gov

3. Multi-State Foodborne Illness Outbreaks -2011 Ground Beef - Salmonella TyphimuriumGround Beef Romaine Lettuce - Escherichia coli O157:H7Romaine Lettuce Kosher Broiled Chicken Livers - Salmonella HeidelbergKosher Broiled Chicken Livers Turkish Pine Nuts - Salmonella EnteritidisTurkish Pine Nuts  Jensen Farms Cantaloupes - Listeria monocytogenes Jensen Farms Cantaloupes Ground Turkey - Salmonella HeidelbergGround Turkey  Whole, Fresh Imported Papayas - Salmonella Agona Whole, Fresh Imported Papayas Alfalfa and Spicy Sprouts – Salmonella EnteritidisAlfalfa and Spicy Sprouts Turkey Burgers - Salmonella HadarTurkey Burgers Lebanon Bologna - Escherichia coli O157:H7Lebanon Bologna Del Monte Cantaloupe - Salmonella PanamaDel Monte Cantaloupe Hazelnuts - Escherichia coli O157:H7Hazelnuts Source: Centers for Disease Control and Prevention www.cdc.gov

4. Notable Past Outbreaks 2010 –Shell Eggs - Salmonella EnteritidisShell Eggs 1939 cases in ~11 states  2009 –Peanut Butter - Salmonella TyphimuriumPeanut Butter 714 cases in 46 states  2008 –Raw Produce - Salmonella SaintpaulRaw Produce 1442 cases in 43 states Source: Centers for Disease Control and Prevention www.cdc.gov

5. Takes a Multi-level Team Effort Federal, State, Local Epidemiologists Laboratorians Environmental Specialists Subject Matter Experts Regulatory Officials

6. PFGE – Food CSI Pulse Field Gel Electrophoresis Links human cases Links human cases to food Links food to a facility (plant or farm) http://www.cdc.gov/pulsenet/

7. PFGE Results Source: Texas Department of State Health Services Laboratory Services

8. Importance of Solving the Outbreak Message to consumers Stop the source Prevent recurrence

9. National Rapid Response Team Concept Surveillance, investigation, and response, to alleged food-related incidents and emergencies Collection, analysis, and dissemination of information that may prevent recurrence Response to all food hazard incidents in the farm to table continuum using ICS Operate in conjunction with other food and feed agencies, other state RRTs, FDA district offices, and state emergency response operations centers.

10. Rapid Response Teams Currently 9 active teams nationwide 6 states piloted in 2008 3 additional states added in 2009 9 states coordinate Yearly meetings Work groups to produce standard documents Request for proposal open for additional teams

15. Texas Rapid Response Team (TRRT) Texas Department of State Health Services Infectious Diseases Branch Laboratory Services Regulatory Division Office Of the Texas State Chemist US Food and Drug Administration Dallas District Office Southwest Import District Southwest Regional Office Food Emergency Response Network (FERN)

16. Scope of Team Operations The purpose of the TRRT is to provide preparedness, prevention, and timely response to food and/or feed related disasters that may affect the citizens of Texas. The TRRT may respond to large scale investigations involving food and/or feed and large scale recalls of food and/or feed. It is not intended to include a natural disaster (hurricane, forest fire, etc.). However, there may be outcomes of a natural disaster that require the activation of all or portions of the TRRT under the State of Texas Emergency Operations Command.

17. Highlights of the TRRT ICS Structure –Combined Federal/State Team Response Operating Guidelines Communication Platform – Traction ® Software –Allows remote uploading –Sharing of extensive traceback records –Ability to pull in other RRT States

18. Incident Commander Operations Chief Animal Feed Branch Human Food Branch Planning Chief Situation Unit (SMEs) Documentation Unit Resource Unit Logistics Chief Service Support Unit IT Unit (As needed) Finance Chief Public Information Officer Safety Officer Liaison Officer Texas Rapid Response Team Agency Representatives State Agency Directors FDA District Director FDA Director/Investigations FDA Director/Compliance FDA Director FERN TDA Emergency Response Coordinator

19. Texas RRT Response Operating Guide Table of Contents

21. Our Long Hard Road – Step 1

24. Our Long Hard Road – Step 2 Source: Centers for Disease Control and Prevention www.cdc.gov

28. We’ve Made It Halfway– Step 3

31. TRRT – Step 4 ROG - APPENDIX B – Activation/Deactivation SOP – approved March 2012 –Describes potential triggers for team activation –Delineates the process for team activation –Delineates the process for team deactivation All Team training and meeting in Austin November 2011 Working on Sampling, Training, and Traction ® SOPs

32. Next Steps Food Emergency Response Plan – Annex O- Appendix to the State Emergency Response Plan – in draft TRRT Table Top – April 28 th, 2012– Austin Functional Exercise – Fall 2012 Continue Work on TRRT Standard Operating Procedures Potential National Exercise with all Rapid Response Teams

33. Questions?? Contact Information Julie Loera 512-834-6770 ext 2342 julie.loera@dshs.state.tx.us Debbra Callan 512-834-6770 ext 2484 debbra.callan@dshs.state.tx.us