1. 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

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

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

4. 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

5. 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

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

9. 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

10. 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

12. Thank You Environmental Health Specialists Network (EHS-NET) for supporting our work!