Identifying Environmental Antecedents in Foodborne Illness Outbreaks in NYC Dan O’Halloran, MPH NEARS Coordinator Bureau of Environmental Surveillance & Policy New York City Department of Health & Mental Hygiene

New York City Food Environment ~ 24,000 restaurants ~ 3,000 complaints received each year ~ 25 restaurant-related outbreaks identified each year

FBI Investigations in NYC Require Collaboration Office of Environmental Investigations (OEI) Bureau of Communicable Disease (BCD) Public Health Laboratory (PHL)

Outbreak Investigation Process Complaint Verified Begin Investigation Conducts EA Additional Visits/HACCP Close Investigation NEARS and NORS submitted 311 Social Media Reported Diseases Performed by OEI. Food Worker stool testing. Once all data has been collected and there are no new illnesses. Conduct interviews w/ patrons. Food Samples may be collected and tested by PHL Review closed case, sync w/ NORS data and submit NEARS to CDC

Pathogens Identified in NORS-Reported Foodborne Illness Outbreaks in NYC Restaurants Suspected or Confirmed Agent 2013 2014 2015 Campylobacter 4 1 Clostridium perfringens Hepatitis A Listeria monocytogenes Norovirus 10 8 Salmonella 3 Scombroid Toxin Staphylococcus aureus Unknown 12 Total 30 17 24

Food Vehicles Identified in NORS-Reported Foodborne Illness Outbreaks in NYC Restaurants (2013-2015)

Environmental Antecedents Observed During Outbreak Investigations People Blocked hand wash sinks Inadequate supplies for hand wash sinks Lack of training Inadequate supervision Inadequate supply of gloves Equipment Improper design Improper construction Lack of cleanability Improper placement Improper installation Foods Improper source Improper pH Improper water activity (Aw) Improper viscosity Processes Improper handling after kill step No kill step when kill step required Improper processing in a multiple step process Cross contamination Economics Shifting food trends Narrow profit margins High operational costs such as food price Cost of equipment and facilities Cost of staffing and training

Success Stories Standardized electronic data collection allows for monitoring trends in foodborne illness over time 1-Page Data Collection Tool increased buy-in within the Health Department Environmental Assessment component adopted into OEI’s Standard Operating Procedure, ensuring 100% coverage moving forward Uncovering environmental antecedents of foodborne illness outbreaks encourages state and local jurisdictions to be proactive rather than reactive and will help PREVENT FUTURE OUTBREAKS

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