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Foodborne Disease Surveillance in New Mexico

Foodborne Disease Surveillance in New Mexico. Bernadette Albanese, MD, MPH Epidemiology and Response Division New Mexico Department of Health January 13, 2005. Salmonella & Meat Jerky.

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Foodborne Disease Surveillance in New Mexico

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  1. Foodborne Disease Surveillance in New Mexico Bernadette Albanese, MD, MPH Epidemiology and Response Division New Mexico Department of Health January 13, 2005

  2. Salmonella & Meat Jerky • Since 1966, NMDOH has investigated 8 gastro-enteritis outbreaks associated with meat jerky consumption – Salmonella implicated in 6 of 8. • In September 2003, matching strains of Salmonella kiambu isolated in 6 unrelated patients • Investigation by the NMDOH revealed 26 case-patients. • 44% of cases in study identified eating jerky from same producer

  3. Risk Factors for S. kiambu Food Item Odds Ratio 95% CI

  4. Environmental Findings at Producer X • Sanitizer dispenser pump not primed • Meat left out overnight to thaw • Cold-storage did not keep meat frozen • Oven temperature unknown • Confiscated beef jerky grew Salmonella Kiambu • 8 of 8 food handler stool samples negative for Salmonella • Environmental swabs negative for Salmonella

  5. Interventions • Production facility closed/license suspended • Press release warned the public • City, statewide, and nationwide product recall • Producer required to adhere to jerky production regulations

  6. Sequence of Events -- 2003 State then National Recall USDA Beef Jerky isolate from Producer X NM human isolate posted on PulseNet No. of Patients USDA Isolate posted / / / / / / Illness Onset Week

  7. Surveillance in New Mexico • Passive – NM Notifiable Condition List • Labs, providers, hospitals contact NMDOH to report case(s) of culture positive enteric diseases • Foodborne disease outbreak investigation • Entities can also contact NMDOH to report suspected cluster of similar illness • Outbreak investigation initiated generally for similar illness in 2 or more unrelated persons • FoodNet, 2004 – Part of NM Emerging Infections Program • Active, laboratory-based statewide surveillance in NM • Quantify incidence of foodborne diseases in the US • Conduct disease-specific epidemiologic studies (e.g., associate certain food exposures with disease)

  8. States in FoodNet Program

  9. PulseNet • CDC’s network of public health labs • Perform fingerprinting on foodborne bacteria using pulsed field gel electrophoresis (PFGE) • Facilitate recognition of outbreaks (web postings) • Organisms tested include Campylobacter, E. coli 0157, Listeria, Salmonella and Shigella

  10. Reported Cases of Enteric Diseases* *Confirmed and probable cases reported to NMDOH

  11. Exceeds Expected # Cases Testing to define etiology Prevention & Control & Report OUTBREAK INVESTIGATION Test hypotheses Case Definition Person, Place, Time Find Cases (questionnaire)

  12. Many Causes of Foodborne Illnesses • Bacteria: Escherichia coli (ETEC,EPEC,EHEC,EIEC), Salmonella species, Clostridium botulinum and perfringens, Staphylococcus aureus, Campylobacter jejuni, Yersinia enterocolitica and pseudotuberculosis, Listeria monocytogenes, Vibrio cholerae 01 and non 01, Vibrio parahaemolyticus and vulnificus, Bacillus cereus, Aeromonas hydrophila, Plesiomonas shigelloides, Shigella species, streptococcus species. • Viruses: Hepatitis A,, E, Rotavirus, Norovirus, other viral agents • Parasitic protozoa and Worms: Giardia lamblia, Entamoeba histolytica, Cryptosporidium parvum, Cyclospora cayetanensis, Anisakis species, Diphyllobothrium species, Nanophyetus species, Eustrongylides species, Acanthamoeba and other amoebae, Ascaris lumbricoides and Trichuris trichiura. • Natural Toxins: Ciguatera poisoning, Shellfish poisoning, Scombroid poisoning, Tetrodotoxin, mushroom toxins, Aflatoxins, Pyrrolizidine alkaloids, Phytohaemagglutinin, Grayanotoxin.

  13. Questions for patient • Who are you (i.e, demographics)? • When did illness begin? • What are symptoms and duration? • Testing or treatment? • Food exposure history? • Know others who are ill?

  14. Clues from symptoms • Vomiting: S. aureus, B. cereus, Norovirus • Watery diarrhea: C. perfringens, B. cereus, norovirus • Subacute - Cryptosporidium, Giardia, other viruses • Bloody diarrhea: Campylobacter, Shigella, Salmonella, shiga-toxin producing E. coli • Neurological symptoms: Botulism, ciguatera toxin, scombroid, shellfish/mushroom toxins, Campylobacter

  15. Incubation Period of Selected Diseases B. Cereus C. Perfringens Listeria Salmonella shigella Yersinia Norovirus Campylobacter E. coli O157 Typhoid fever Vibrio Crytpospordium Giardia Staph aureus B. cereus Hepatitis A Entameoba 1-6 hours <1-2 days 2-10 days weeks- months

  16. Food Associations • Raw seafood: Vibrio species, hepatitis A • Raw eggs: Salmonella species • Undercooked meat or poultry: Salmonella, Campylobacter, E. coli O157, C. perfringens, Yersinia • Unpasteurized milk or juice: Salmonella, Campylobacter, Yersinia • Unpasteurized soft-cheese: Listeria, Salmonella • Home made canned goods: Botulism • Raw hot dogs, deli meat: Listeria

  17. Diagnostics Testing • Stool cultures • Stool O&P • Stool antigen testing (e.g., giardia) • Stool testing for norovirus • Food testing ( e.g, Salmonella, Campylobacter, B. cereus, C. perfringens toxin)

  18. What we THINK we are eating

  19. What we are REALLY eating

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