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Ted Bazenas , Mike Nalipinski, Dan Wainberg, Allan Jarrell

Case Study: Decontamination of a Community Building Containing Low Concentrations of Bacillus anthracis Spores, Durham , New Hampshire. Ted Bazenas , Mike Nalipinski, Dan Wainberg, Allan Jarrell U.S. Environmental Protection Agency, Region 01 Rick Berry , Carl Woodbury, Michael Wimsatt

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Ted Bazenas , Mike Nalipinski, Dan Wainberg, Allan Jarrell

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  1. Case Study: Decontamination of a Community Building Containing Low Concentrations of Bacillus anthracis Spores, Durham , New Hampshire Ted Bazenas, Mike Nalipinski, Dan Wainberg, Allan Jarrell U.S. Environmental Protection Agency, Region 01 Rick Berry, Carl Woodbury, Michael Wimsatt New Hampshire Department of Environmental Services

  2. Brief Waysmeet House, a community building is affiliated with the campus ministry, at the Univ. of New Hampshire in Durham. It is an independent, non-profit entity that serves as a ministry, social center, food bank and student residence. One social event, the drumming circle, brings a mixed population of mostly students together to play drums. Many of the drums were crafted in Africa and some may be contaminated with Bacillus anthracis spores. Regional Response Team Meeting Region 01

  3. Waysmeet House, Durham, New Hampshire Regional Response Team Meeting Region 01

  4. Waysmeet House, Durham, New Hampshire Regional Response Team Meeting Region 01

  5. Organization of the Response • Lead Agency – New Hampshire Department of Health and Human Services (NHDHHS) • CDC and NIOSH supported the Epidemiological investigation • CDC Laboratory performed confirmatory analysis of isolate samples; performed MVLA • NH Nat’l Guard Regional Response Team Meeting Region 01

  6. U.S. EPA Role • Technical Advisor to NHDES • Regional Office Requested assistance from: • EPA National Decon Team - • Dino Mattarano • EPA Nat’l Homeland Security Research Center - • Shawn Ryan • Sample Collection Support • Initial samples collected by NH National Guard Civil Support Team • Characterization samples collected by EPA WestonSolutions • START contractor Regional Response Team Meeting Region 01

  7. Timeline • 4 December, 2009 - Drumming event at Waysmeet House, Durham, New Hampshire • Campus ministry building • Attended by 50+ people • 5 December, 2009 – one attendee develops symptoms, but does not present to healthcare Regional Response Team Meeting Region 01

  8. Timeline (continued) • 14 December, 2009 – patient presents at UNH Health Clinic • 16 December, 2009 – patient admitted to Massachusetts General Hospital • Intensive care unit, coma • Rigorous testing Regional Response Team Meeting Region 01

  9. Timeline (continued) • 24 December, 2009 – CDC notified of gastrointestinal Bacillus anthracis infection • New Hampshire DPH and DES notification • National Response Center notified • NHDES requested assistance from EPA • Patient isolates sent to CDC for confirmation • FBI determined that there was no terrorism nexus Regional Response Team Meeting Region 01

  10. Timeline (continued) • 25 December, 2009 – NHDES and EPA deployed to the Waysmeet House at 0800 to support a sample collection effort • Samples collected by NH National Guard 12th Civil Support Team (12th CST), and the NH District Hazmat Team. • 46 samples (wipe and swab) collected from drums, electrical outlets, and floors Regional Response Team Meeting Region 01

  11. Timeline (continued) • 27 December, 2009 – CST PCR results show 24 negative; 2 inconclusive • 28 December, 2009 – re-analysis (by NHDHHS lab) of inconclusive samples shows positive results for B. anthracis • NH DHHS Commissionersigned the Order of Quarantine and Closure of Building Regional Response Team Meeting Region 01

  12. Timeline (continued) • 28 December, 2009 (more) • NHDES, NHDHHS,CDC, NIOSH and EPA begin planning process for characterization and extent of contamination sample collection event • NHDES/DHHS/EPA set up a drum drop off date/location for other participants. Regional Response Team Meeting Region 01

  13. Timeline (continued) • 29 December, 2009 – CDC matches drum DNA to patient infection (MLVA-8) • Many meetings to develop sample collection strategy for characterization of the building • 06 January, 2010 – Mobilization to Durham for sample collection event; drums samples at drop off location • 07 January, 2010 – Collection of 80+ samples at Waysmeet House; wipes and HEPA vacuum samples to Lab Response Network labs for PCR and culture. Regional Response Team Meeting Region 01

  14. Basement Regional Response Team Meeting Region 01

  15. Living Area Regional Response Team Meeting Region 01

  16. Computer Sample Regional Response Team Meeting Region 01

  17. Drum Head Sample Regional Response Team Meeting Region 01

  18. Baseboard Heater Sample Regional Response Team Meeting Region 01

  19. Results - Basement Regional Response Team Meeting Region 01

  20. Results First Floor Regional Response Team Meeting Region 01

  21. Results – Second Floor Regional Response Team Meeting Region 01

  22. Summary results LRN Labs 07 January, 2010 Samples • Note: based on the sampling and processing by LRN labs, the lowest detectable level of B. anthracis spores is 20cfu/26cm2 Regional Response Team Meeting Region 01

  23. Overall Goals • Protection of Public Health • Lift the Quarantine Order • Property owner must implement the scope of work developed by the state • Property owner responsible for costs • When final report is approved by Commissioner of Health, the quarantine is lifted Regional Response Team Meeting Region 01

  24. Strategy Meeting • January 13, 2010 • NHDES, NHDHHS, NH Health Lab, CDC/NIOSH, EPA Region 01, EPA Nat’l Decon team, NHSRC (by conference/web) • Reviewed analytical results • All relatively low level results, • Included several “equivocal” results Regional Response Team Meeting Region 01

  25. Key Issues • How does the research translate to cleanup? • Levels of spores are several orders of magnitude lower than experimental levels • Study results show multi-log reduction in spore levels • Who directs the cleanup? • NHDES? CDC? NHDHHS? Ministry? EPA? • Who funds the cleanup? • NHDES? CDC? NHDHHS? Ministry? EPA? Regional Response Team Meeting Region 01

  26. Key Issues • How clean is clean? • Zero spore growth on plates following decon (Danbury, CT case) • Growth at or below detection limits? • Post-decon sample collection? • CDC Epi and LRN • agreed that equivocal results at or below detection limits pose no threat to public health and should not be a basis for an action. • Post-decon sample collection • Not recommended by EPA or CDC Regional Response Team Meeting Region 01

  27. Resolution • First 5 of 8 steps will significantly reduce spore loads (see research) • Decon will reduce spore loads below levels of health concern • NHDES will lead the decon effort • Ministry will perform cleanup via contractor; privately funded • NHDES considering post-decon sample collection Regional Response Team Meeting Region 01

  28. Work Plan • Vertical and non-carpeted floors • Spray with amended bleach • 1 part 5-6% sodium hypochlorite, 1 part white vinegar, 8 parts water (ph 6-7) • Wetted for 10 minutes minimum • Re-apply to keep wet • Scrubbed with bristle brush or sponge • Same solution amended bleach w/ TSP added • Rinse with clean water; vacuum residual water Regional Response Team Meeting Region 01

  29. Work Plan continued • Rugs and carpets (no positive results) • HEPA vacuum first • Spray with amended bleach solution • 10 minute contact time • HEPA vacuum again Regional Response Team Meeting Region 01

  30. Work Plan continued • Durable items - submerged in bleach for 10 minutes, then rinsed • Porous items - sprayed with bleach, 10 minute contact time • Large items – sprayed with bleach , 10 minute contact time • Damaged items - discarded and disposed of as solid waste as per NH regulations Regional Response Team Meeting Region 01

  31. Decontamination • Scope of Work delivered to ministry on 21 January, 2010 • Cleanup began 24 March 24, 2010 • Scheduled to be complete on 04 April, 2010 • Ministry hired contractor resources with NHDES oversight Regional Response Team Meeting Region 01

  32. Spraying wall Regional Response Team Meeting Region 01

  33. Sponging Wall Regional Response Team Meeting Region 01

  34. Sponging Ceiling Regional Response Team Meeting Region 01

  35. Floor Decon Regional Response Team Meeting Region 01

  36. Lessons Learned • Push ICS/Unified Command • Could have opened state EOC • Use all resources • EPA used ongoing research to develop site specific decon strategies Regional Response Team Meeting Region 01

  37. Lessons Learned continued • Modified decon approach can reduce spore loads to below health concern • Easily applied, • readily available technologies • Attainable equipment • Low training Regional Response Team Meeting Region 01

  38. Lessons Learned continued • CDC should also open their EOC early in the event • Coordinate the Environmental and Epi investigations • Makes CDC resoources and staff more available • Centralizes CDC response to questions and issues Regional Response Team Meeting Region 01

  39. Post Script • Patient is at home recovering • Negative air pressure for decon? • Post-decon samples were collected • Results of post-decon samples • Future of drum circles Regional Response Team Meeting Region 01

  40. Acknowledgements • EPA NHSRC • EPA NDT • NHDES and DHHS • CDC\NIOSH Regional Response Team Meeting Region 01

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