Food Borne Illnesses and more …
Marlene Gaither
EH Program Manager
CCPHSD
CDC Statistics say...
200 known diseases are transmitted through foo
31 million foodborne illnesses annually
Majority are caused by viruses
3000 deaths annually
2014: 4,400 hospitalizations
Main transmission - fecal/oral route
15 FBI Progress Report
Who is responsible for reporting commu
Under , a health care provider, an administrator of a health care
Communicable Disease Code R9-6-203. Reporting Requir
. An administrator of a school, child care establishment, or shelter sha
1. The name and address of the school, child care establishment, or sh
2. The number of individuals with the disease, infestation, or symptom
3. The date and time that the disease or infestation was detected or tha
4. The number of rooms, grades, or classes affected and the name of e
ting Requirements
5. Individual information:
a. Name;
b. Date of birth or age;
c. Residential address and telephone number; and
d. Whether the individual is a staff member, a student, a child in care, or a residen
6. The number of individuals attending or residing at the school, child
7. The name, address, and telephone number of the individual making
Records to health dept/district does not violate hipp
eporting Requirements


FDA Foodborne Illness Report
Major Risk Factors (CDC)
Improper Holding Temperature
Inadequate Cooking
Contaminated Equipment
Unsafe Food Source
Poor Personal Hygiene
Foods Associated w/Foodborne Out
Food Borne Disease
There are more illnesses associ
CDC- Top 5 Pathogens
Pathogen
Estimated number of
illnesses
90% Credible Interval
%
5,461,731
3,227,078–
8,309,480
58
Salmonella,
nontyphoidal
1,027,561
644,786–
1,679,667
11
Clostridium
perfringens
965,958
192,316–
2,483,309
10
Campylobacter spp.
845,024
9
Staphylococcus aureus
241,148
337,031–
1,611,083
72,341–529,417
Norovirus
Subtotal
3
91
SALMONELLA
Salmonella spp.
Disease: Bacterial - about 2,000 known serotypes
Reservoir: Poultry, swine, cattle, rodents, turtles, lizar
Food: Raw meats, poultry, eggs, & dairy products
Infective Dose: 15 to 20 cells
Incubation period: 6 to 48 hours
Salmonella
Symptoms: Nausea, vomiting, abdominal cram
Duration : 1 to 2 days or longer
Associated foods: Raw meat, poultry, eggs, dai
Frequency: 2 to 4 million cases annually
monella Cases
2014 Georgia High School Sports banquet –
56 probable cases
Suspect food smoked chicken
2012 five schools in Illinois –
 Infected cook at commercial kitchen preparing meals for
2005 at two elementary schools –
40 probable cases – 26 confirmed
Science clubs dissecting owl pellets did not sanitize table
SHIGELLA
Shigella sp.
Agent - Gram negative bacillus that causes an infecti
Reservoir/Occurrence - Humans/Worldwide
Infective dose – As few as 10 cells
Transmission - fecal/oral route in food and water
I.p.- 1-3 days
Shigella
Symptoms - fever, nausea, vomiting, cramps and ten
Incidence - 300,000 cases annually in US
CFR’s depend on host, but is as high as 20% causes
gella Outbreak
2010 West Virginia at 3 elementary schools
105 cases not fatalities
Transmission occurred at school and at home
Escherichia coli
Escherichia coli 0157:H7
Agent - Gram negative rod shaped bacteria produce
Reservoir/Occurrence - Cattle/N.America,Europe,A
E. coli
Infective Dose ~10 to 15 cells
Transmission - Cross-contamination of infected mea
I.p. - 3-4 days
Symptoms - abdominal cramps, low grade fever, pro
E. Coli Cases
July 2015 in Wisconsin elementary school –
19 students ill
No source has been determined
Summer 2014 in Milwaukee Sizzler sickened 60
E. coli found in raw ground meat that was transf
pylobacter jejuni
Campylobacter jejuni
Disease: Campylobacterosis - curved, and motile rod
Reservoir: Cattle, chickens, birds, and flies
Infective dose: 400 to 500 cells
Incubation period: 2 to 5 days
Symptoms: Watery, stick or bloody diarrhea; fever; a
Campylobacter
I.p. - 2-5 days
Symptoms - diarrhea, abdominal pain, malaise,
CFR - 1 in 1,000 will die – 4 to 6 million cases
Hepatitis A
Hepatitis Vaccination
TWINRIX Vaccine
Ag Dose
e
(ELISA
units)2
Volum No. of
e
doses
(mL)
Schedule
≥
18
yrs
720
1.0
3
0, 1, 6 mos
≥
18
yrs
720
1.0
4
0, 7, 21–30 days
+ 12 mos3
CDC 2015
What is Norovirus?
The genus contains multiple s
Single-stranded RNA, non-env
Genus Norovirus, family Calici
(CDC, 2006; Gerba, 2001)
What do we know about Norovirus?
Causes acute gastrointestinal illness in hu
Noroviruses are highly contagious (both d
Infective dose may be as few as 10 viral p
CDC, 2006
Occurrence of Norovirus
CDC Norovirus leading cause of AGI in U.S.
21 Million per year
800 deaths
50% more illnesses when a new strains introdu
CDC, 2013
Testing for Norovirus
Reverse-transcriptase polymerase chain reactio
Sequencing to determine strain
CDC, 2006
Symptoms of Norovirus
Onset: Often begins suddenly within 1 to 2 days after
Symptoms: Abdominal cramps, nausea, vomiting (pro
Death is rare – common complication is dehydration
CDC, 2006
Is there Immunity to Norovirus?
There is evidence that suggests that immunit
Individuals are likely to be repeatedly infecte
Recent evidence also suggests that susceptib
CDC, 2006
Carriers of Norovirus
Studies with volunteers given stool filtrates hav
“The walking ill”
CDC, 2006
Treatment
To date, there are no antiviral treatments or vaccine for noro
Treatment: Replacement of fluids and electrolytes (prevent
CDC, 2006
How does Norovirus spread?
Transmission: Fecal/oral route involving food, water, person
Evidence exists for transmission to occur through aerosolizat
A person will begin shedding the virus with the start of symp
CDC, 2006
Modes of Transmission Include “Fomit
What are Fomites?
Inanimate objects involved in the spread of disease
Charles P. Gerba
Departments of Soil, Water and Environmental Science and Epidemiology and Environmental Health
Univeristy of Arizona Tucson, AZ
Toilet
Seat
Bath
Counter
Bath
Floor
Kitchen
Floor
Cutting
Board
Bath
Sink
Kitchen
Sink
Sponge
Enteric Bacteria (Coliforms) in the
Teaching: The “Germiest” Profession?
Germs per square inch by occupation
20500
18500
16500
14500
12500
10500
8500
6500
4500
2500
500
s
Te
le
vi
si
on
Co
ns
ul
ta
nt
s
Pu
bl
ic
is
ts
La
wy
er
s
to
r
Do
c
io
Ra
d
ke
rs
Ba
n
s
nt
an
t
Ac
co
u
Te
ac
h
er
s
Average All Sites
one, desk and computer mouse.
Charles P. Gerba
Department of Soil, Water and Environmental Science and
Epidemiology and Environmental Health
Univeristy of Arizona
Tucson, AZ
 The most bacteria per square
ms in all Schools – it’s not the Restroom!!
Site
Desk
Computer Mouse
Cafeteria Table
Library Table
Bathroom Sink Faucets
Water Fountain
Keyboard
Bathroom Paper Towel
Handle
Charles P. Gerba
Department of Soil, Water and Environmental Science and
Epidemiology and Environmental Health
Univeristy of Arizona
Tucson, AZ
Percent of sites positive for
Coliforms
59
57
55
53
36
33
33
29
Impact of Disinfectant Wipes on Absenteeism -S
Study
Two school semesters
3rd and 4th graders
Intervention
Children’s desk wiped with a disinfectant wipe at the end o
Results
50% reduction in absenteeism
Bright et al, 2010; J. School Nursing
How long can Norovirus survive in the
Studies indicated that Norovirus may survive:
Up to 4 weeks in “cold” surface water – can survive fre
Temps up to 1400F
Up to 10 ppm free chlorine
4 weeks or more as long as 56 days (Gerba, 2005) on s
CDC, 2006
Sanitizing Surfaces
Recent studies indicate that:
Contaminated fingers can contaminate up to 7 surfaces
Combined chlorine & detergent using 5,000 ppm chlorin
Best Method: Wash with detergent followed by chlorine
NAU Wrestling Outbreak samples
(J. Barker, I. Vipond, S. Bloomfield, 2004)
ractive Exercise
Hot Springs Elementary School K-8 with 350 s
On Monday morning a student vomits in a 5 gr
What are your first steps?
Who should be contacted?
What other information is needed?
Tuesday
The next day a student vomits in the school caf
What needs to be done?
Who should be contacted?
What other information is needed?
What are some of your resources?
Wednesday
20 students in grades 4th & 5th are ill and four more
A teacher with AGI went to a clinic and they stated
More students are falling ill at school and the high s
What control measures may be taken to control the spread
What do you think the causative agent might be?
Thursday
¼ of the students are ill
½ of the cafeteria servers are ill
It has spread to other grades
What do you do?
Who do you contact?
Who will make lunch?
Actual Case
2005 several high school wrestling teams from
July 18th: One student became ill with AGI late
July 20th: ED reported to Health District 3 stud
NAU Case
July 21st: HD visited wrestling camp and interv
Samples were collected: swabbed surfaces – do
tbreak Spreads
Wrestling students are vomiting at lunch buffet
Students from other camps are becoming ill an
115 individuals were ill (53%) from the wrestli
Outbreak peaked on July 20th
Response
An emergency operation center was set-up at N
Sample results were positive for norovirus: toil
Surfaces were disinfected using 5,000ppm chlo
Spread through fomite surfaces and airborne fr