California Department of Public Health Food and Drug Branch

1. California Department of Public HealthFood and Drug Branch San Joaquin County All Hazards Workshop August 2008

2. Food and Drug Branch • Three sections: Food Safety, Drug Safety, and Medical Device Safety • Food Safety includes • Processed food registration and inspection • Industry education and training • Bottled and vended water program • Seafood inspection • Emergency response and food security • Retail food program • Consumer complaint program

3. Food and Drug Lab Branch • Public health reference and research lab • Sister agency to Food and Drug Branch • Includes Chemistry, Microbiology, and Abused Substances Analysis Sections • Analyzes food, drugs, cosmetics, medical devices, and environmental samples • Supports FDB in outbreak investigations and inspection activities

4. Emergency Response • Emergency Response Unit in the Food Safety Section • Investigates foodborne illness outbreaks • Investigates tampering incidents • Participates in preventive outreach efforts including food defense Before After

5. Tampering cases

6. How does this protect public health? • Outcomes from previous investigations • Almond industry has adopted a “kill step” for raw almonds • Strawberry industry has modified the method of harvest of strawberries for processing • New commodity-specific guidelines for sprouts, tomatoes and lettuce • Produce industry has begun to think of harvest workers as food handlers, enforcing hand washing procedures and harvest equipment sanitation

7. How are local health jurisdictions involved? • Illnesses are reported by local public health to state health Division of Communicable Disease Control (DCDC) and by DCDC to CDC • DCDC provides information to FDB about clusters of illnesses where food may be the vehicle • If a food vehicle is implicated by epidemiological investigation (statistically significant association), FDB begins an environmental investigation • FDA is informed, and if interstate commerce is involved, becomes the lead agency

8. How are local health jurisdictions involved? • Local health department will be asked to supply information about the Point of Service (POS) for select case-patients • Those with clear recall of where/when they ate the implicated food • If it is necessary to visit the retail POS, local environmental health will be invited to participate • Environmental health may be asked to collect documentation, such as invoices. The time period for which the documentation is needed is critical.

9. Foodborne outbreak investigations The environmental investigation may include • Environmental investigation at the point of service • Traceback to manufacturer and/or farm • Environmental investigation at the manufacturer • Sampling product • Environmental sampling • Farm investigation • Collection and examination of records

10. How does FDB relate to other state agencies dealing with food? • Dairy products are regulated by California Department of Food and Agriculture (CDFA) and US FDA • Many egg ranches participate in the California Egg Quality Assurance Program (CEQAP), a CDFA program intended to control SE • Foodborne illness investigations involving dairy and egg products are conducted jointly with CDFA • Fruit and vegetable growers must follow guidelines regarding pest control overseen by the county Agricultural Commissioner • FDB advises CDFA of illness investigations involving California produce

11. What is CalFERT? • The California Food Emergency Response Team is a group of state and federal Investigators and Scientists that conduct environmental investigations of foodborne illness outbreaks. • Food and Drug Investigators from state Food and Drug Branch (FDB) are peace officers and have the authority to embargo food products that may be contaminated. • Investigators/Consumer Safety Officers from FDA are associated with the Los Angeles and San Francisco District Offices • Scientists include microbiologists associated with FDA labs, and research scientists associated with the Emergency Response Unit in FDB

12. What outbreaks has the team investigated? • State and federal investigators have worked side by side on investigations in the past. • During the Salmonella Enteritidis outbreak associated with almonds in 2004, investigators and laboratorians from both agencies worked together as a team • In 2005, the team was formally established and met together outside of outbreak situations to develop protocols • In the fall of 2005, those protocols were put into practice for the first time during the E. coli O157:H7 outbreak associated with bagged lettuce and a Salmonella Enteritidis outbreak associated with tomatoes

13. What outbreaks has the team investigated? • In the fall and winter of 2006-2007, the team investigated E. coli O157:H7 outbreaks associated with spinach and shredded lettuce (Taco Bell and Taco John) • Follow-up to the outbreaks associated with leafy greens has included review and input by CDHS-FDB and US FDA of the document that became the “Best Practices” for safe growing and handling under the Leafy Greens Marketing Agreement. • Most recent investigation was a romaine-associated E. coli O157:H7 outbreak in the state of Washington

14. Questions? FDB Website contains food defense brochures in four languages, outbreak investigation reports, and posters on CalFERT and the Taco John investigation http://www.cdph.ca.gov/programs/Pages/FDB%20Food%20and%20Drug%20Branch.aspx See http://www.cdph.ca.gov/programs/bes/Pages/default.aspx for CDHS Bioterrorism Surveillance and Epidemiologic Response Plan Contact: Mary Palumbo, (916) 650-6623 or mary.palumbo@cdph.ca.gov