Objectives

1. When Private Events Go Public: Gastrointestinal Outbreak Anthony Eshofonie; Katherine Blanco; Huai Lin; Randy Valcin; LaTasha Martin Texas Department of State Health Services, Region 6/5 South Objectives Timeline for Food Delivery, Storage, Preparation and Service Results continued • To highlight when a temporary retail food establishment permit is required for an event • To highlight the crossover of a private organizational event to a public event requiring professional and legal oversight • To highlight difficulties in foodborne outbreak investigations when there are uncoordinated multiple sources of food • To highlight potential sources of infection from raw food delivery, storage, preparation and eating in a non-regulated environment Figure 1: Frequency table of known food Items eaten by cases Day 1: Delivery Day 1: Cooler Raw meat stored in “walk- in- cooler” and mobile truck cooler outside Background A Houston area church organization notified the Texas Department of State Health Services of gastrointestinal illness among attendees at its annual bazaar. Within 19 days of the event, 15 attendees reported illness to the organizers. The event was catered by a volunteer group, had food stands on-site and had members contribute dessert directly. This event was open to the public with over 800 food tickets sold. Despite the scale of the event and the sale of food to the public there was no licensed food manager to oversee food service activities. Texas State law requires the church to have at the minimum a temporary retail food establishment permit with a licensed food manager. This was not known to the organizers before the event .The multiplicity of food sources and lack of licensed food manager oversight compounded outbreak investigation and reveals the potential danger of private events becoming new sources of foodborne illness outbreaks and a weak link in the food safety network Figure 2: Outbreak epidemic curve Event Day: Cases started appearing in the evening Day 3: Cooler Day 2: Cooked Outbreak Investigation Highlights and Challenges Notification A representative of the church organization notified the Texas Department of State Health Services that 15 individuals had called to report illness following attendance at its annual bazaar • Delay in reporting: Initial notification was 18 days after the event and onset of illness • No permit was sought and provided: No food guidelines provided • No central food coordinator to talk to about food provision: The volunteer group (cooks) were not available for interview • Too many sources of food to do a proper food frequency analysis • No record of the ambient temperature of the delivery truck • Cooking the meat 2 days prior to the event, cooling (and refrigerating) and reheating posed additional challenges • Organization voluntarily paid for medical expenses of cases Day 4: Reheated Methodology Day 2. Cooked meat left to cool in a room • Interview of known event attendees and event organizers • Site visit to event venue, food storage, preparation and serving areas Results • Total attendees could not be determined as it was open to the public but over 800 food tickets were sold • Forty-one (41) interviews were completed. Interviewees were spread over 6 counties • Thirty eight (38) interviewees met the outbreak case definition • Main symptoms were diarrhea (97%), abdominal cramps (61%) , vomiting (39%), and fever (39%) • The incubation period was 5-24 hours. The duration of illness was from 1–17 days. • Eleven (11) interviewees saw a health care provider and three of them were hospitalized • Ten stool samples were collected and all tested positive for SalmonellaNewport with matching PFGE patterns Conclusion Other Sources of food Organizations planning events requiring food preparations and consumption need to be aware of when at the minimum a temporary retail food establishment permit is needed. This would ensure not only a legal cover for the organization, but that proper food safety guidelines are provided. This omission could be a potential source of foodborne disease as in this outbreak. Day 4. Meat served Day 4. Deserts from Parishioners Day 4. On-Site food Vendors