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Influenza and Pneumonia and Foodborne Illness

Influenza and Pneumonia and Foodborne Illness. Megan Davies, MD State Epidemiologist Division of Public Health NCDHHS. Pneumonia: The Big Picture. Leading cause of death globally Major public health problem in the US >55,000 deaths (2006) 1.2 million hospitalizations (2006)

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Influenza and Pneumonia and Foodborne Illness

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  1. Influenza and PneumoniaandFoodborne Illness Megan Davies, MD State Epidemiologist Division of Public Health NCDHHS

  2. Pneumonia: The Big Picture • Leading cause of death globally • Major public health problem in the US • >55,000 deaths (2006) • 1.2 million hospitalizations (2006) • Many types can be prevented with vaccines • Influenza (flu) • Pneumococcal • Haemophilus influenzae type b (Hib) • Pertussis (whooping cough)

  3. Influenza: Burden of Disease • Important cause of morbidity and mortality • 36,000 deaths/year • 226,000 hospitalizations/year • Infection rates highest among children • Serious illness and death more common among • Persons aged ≥65 years • Children aged <2 years • Persons with certain underlying conditions (e.g., asthma, heart disease, diabetes)

  4. ACIP Universal Flu Vaccine Recommendation (2010): Rationale • Vaccine is safe and effective in all age groups • 2009 H1N1 affects young adults disproportionately • Complications occur even among adults who are not in high-risk groups • Eliminates confusion about who should receive flu vaccine www.cdc.gov/mmwr/pdf/rr/rr5908.pdf

  5. 2009 H1N1 Vaccine: North Carolina’s Response • Identified by CDC as one of the top three states for 2009 H1N1 vaccine administration • 637,596 doses administered during first eight weeks of response

  6. Pneumococcal Disease • Second most common cause of vaccine-preventable death in the U.S. (after influenza) • Major syndromes include • Pneumonia • Bacteremia • Meningitis

  7. Pneumococcal Pneumonia • 100,000 to 135,000 cases requiring hospitalization per year • Responsible for up to 1/3 of community-acquired pneumonias and up to 1/2 of hospital-acquired pneumonias • Common bacterial complication of influenza and measles • More fatalities in elderly www.cdc.gov/vaccines/pinkbook/pubs/pneumo11.ppt

  8. Pneumococcal Vaccines • Conjugate vaccine (PCV7/PCV13) recommended for • All children aged 2–59 months • Children aged 60–71 months with certain underlying medical condition • Polysaccharide vaccine (PPSV23) recommended for • All adults aged ≥65 years • Persons aged 2–64 years who are at increased risk for invasive disease

  9. Invasive Pneumococcal Disease Incidence by Age Group, 1998 and 2002 Effect of Pneumococcal Vaccine * Rate per 100,000 population Source: Active Bacterial Core Surveillance/EIP Network

  10. PCV7 intro-duction Effect of Vaccination: Invasive Pneumococcal Disease Among Children <5 Years of Age, 1998–2006 www.cdc.gov/vaccines/pinkbook/pubs/pneumo11.ppt

  11. Pneumococcal Polysaccharide Vaccine: Missed Opportunities • Healthy People 2010 goal: 90% coverage for persons >65 years • 2003 BRFSS: 64% of persons >65 years of age ever vaccinated • Vaccination coverage levels were lower among persons 18-64 years of age with a chronic illness www.cdc.gov/vaccines/pinkbook/pubs/pneumo11.ppt

  12. Foodborne Illness

  13. Foodborne Illness • An illness caused by infection with a virus, bacterium, or parasite transmitted on food • Examples include • Hepatitis A • Salmonella Spp • Cryptosporidium parvum

  14. Foodborne Diseases Matter • Foodborne diseases are common • estimated 76 million illnesses and 323,000 hospitalizations occur each year in the U.S. • Foodborne and diarrheal diseases can be devastating: dehydration, kidney failure, mortality among immunocompromised, and fetal death • estimated 5,000 deaths/year

  15. We Still Have a Lot to Learn • 1,300+ foodborne outbreaks are reported to the CDC every year, on average • 6% multijurisdictional • 60% of recent high-profile foodborne outbreak investigations found new pathogens or new food vehicles causing the outbreak

  16. Foodborne Disease Investigations, NC (Annual averages, 2005-2009) *Reported Hospitalization & Deaths: based on 2005-2008 data

  17. Confirmed cases reported to health department or CDC 2% of all cases 12% of all cases Burden of Foodborne Diseases From Angulo et al, United States Department of Agriculture Report to Congress Food Safety and Inspection ServiceUnited States Department of Agriculture Washington, D.C. March 1999

  18. Foodborne Disease Investigation • Sporadic cases • Sensitive professions • Foodhandler, childcare worker • Outbreaks • Classic point source • Contaminated product • PFGE clusters

  19. Pulsed Field Gel Electrophoresis (PFGE) Patterns

  20. Salmonella Typhimurium 2009 Associated with PCA Peanut Products

  21. Impact of PCA Peanut Butter Recall Economic Impact In United States Estimated $1 billion impact 20% decline in peanut butter consumption in January In North Carolina 23% decline in peanuts planted Substantial number of employees laid-off

  22. Foodborne Illness Prevention • Inspections • Farms • Production facilities • Food service establishments • Consumer education • Outbreak investigation • “Removing the pump handle” • Product recalls

  23. Prevention at the Source NCDACS Food and Drug Protection Division Protects the food supply, from farm to fork Regulatory programs include Food Feed Drugs NCDENR and Local Health Departments LHD Environmental Health staff trained and authorized to enforce state laws and rules by DENR 710 local EH staff authorized to conduct food service inspections currently in NC

  24. Food Safety on the Farm Inspection and testing of animal feeds at the manufacturing and retail levels Salmonella, aflatoxin, pesticide residue, and guaranteed analysis BSE Pesticide screening of fresh produce Pesticide and aflatoxin screening of milk NCDACS Food & Drug Protection Division

  25. 1,565 manufacturing and distributor firms subject to inspection Sandwich and prepared salad manufacturers Bottled water, juice, and beverage Seafood processors and retailers Canneries (low acid and acidified) Bakeries Dairy manufacturers and farmsteads Egg Producers and Distribution NCDACS Food & Drug Protection Division Manufacturing and Distribution

  26. 4000 retail facilities under inspection Respond to consumer complaints Over 400 in 2008 Risk-based retail surveillance program Based on recent recalls, outbreaks, import alerts, and consumer complaints NCDACS Food & Drug Protection Division Retail

  27. NCDENR Environmental Health Services Section Types of Facilities Regulated • Food Service Establishments • Restaurants • Food Stands • Mobile Food Units • Push Carts • Institutions • Hospitals • Nursing/Rest Homes • Prisons • Local confinement facilities • Residential Cares • Lodging Establishments • Hotels • B & B Inns/Homes • Child Care Centers • Schools • Tattoo Artists • Public Swimming Pools • Resident Camps

  28. NCDENR Environmental Health Services Section Food Service Establishments • Inspections of food service establishments • Mandated to take place 1-4 times per year minimum • Frequency based upon risk involved in procedures used by establishment • Follow-up inspections may be performed • Inspections in response to complaints, suspect behavior, etc. can be performed at any time

  29. NCDENR Environmental Health Services Section Top 5 CDC Risk Factors • Unapproved sources of food • Poor employee hygiene • Contaminated equipment/cross contamination • Improper hot/cold holding temperatures • Improper final cooking temperatures

  30. NCDENR Environmental Health Services Section Inspection Methods • Out-of-compliance risk factors corrected immediately or within 10 days • Chronic violations addressed through risk control plans or enforcement actions • Long-term compliance achieved through behavioral changes

  31. Prevention of Foodborne Illness at Home • Clean Wash hands and surfaces often • Separate Do not cross-contaminate

  32. Prevention of Foodborne Illness at Home • Cook Cook to proper temperature • Chill Refrigerate promptly

  33. Bon appetitandGesundheit!

  34. Many thanks to: • NCDENR • NDACS • NCDHHS • CDC

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