Strengthening State Capacity for Integrated All-
Hazards Prevention, Response and Recovery
Efforts for Incidents Involving Food and Feed
Travis Goodman
RRT Program Coordinator
FDA/ORA/Office of Partnerships

• Why RRTs?
– White House & Congressional interest in improving response and food safety
• Multi-year Cooperative Agreement Program
– Awards are up to $300,000/year (3 year awards)
– Oversight provided by FDA/ORA Office of
Partnerships
– Cross-Center RRT Advisory Committee
• Includes CDC representation
– 18 RRTs (within 14 Districts) are currently funded
2

Rapid Response Teams FY14 (2014-2015 Grant Year)
DET-DO
MIN-DO
PHI-DO
NYK-DO
Updated: October 1, 2014
NWE-DO
NER
SEA-DO
SAN-DO
LOS-DO
PAR
SWR
= Original RRT State (Joined 2008/2009)
= New RRT State (Joined 2012)
CER
KAN-DO
DAL-DO
BLT-DO
ATL-DO
NOL-DO
FLA-DO
SER
Rapid Response Teams (RRTs)
Original RRTs New RRTs
Southeast Region
NC (ATL-DO) GA (ATL-DO)
Original RRTs New RRTs
Central Region
MI (DET-DO) PA (PHI-DO)
FL (FLA-DO) MS (NOL-DO)
Northeast Region
NY (NYK-DO)
MA (NWE-DO)
RI (NWE-DO)
Pacific Region
WA (SEA-DO)
N/A
CA (LOS-DO &
SAN-DO)
MN (MIN-DO)
VA (BLT-DO)
WV (BLT-DO)
MD (BLT-DO)
Southwest Region
IA (KAN-DO)
TX (DAL-DO)
MO (KAN-DO)
Summary:
• 14 Districts have RRTs
• 1 District has 3 RRTs
• 3 Districts have 2 RRTs
• 10 Districts have 1 RRT

• Develop and maintain multi-jurisdictional RRTs that operate under ICS/NIMS and Unified Command to support integrated all-hazards prevention, response and recovery efforts for food/feed. Unify and coordinate federal/state/local food/feed emergency response efforts, including:
– Strengthening the link among epidemiology, lab and environmental health components.
– Foodborne illness/outbreak investigations, removing tainted food from commerce, root cause investigations.
– Supporting components: training, data sharing, data analysis and communications.
• Capture/develop and support adoption of best practices
(mentorship)
• Ensure alignment with national priorities (FSMA, IFSS, PFP)
4

• Ultimate Goal: Improve the effectiveness of multijurisdictional food/feed emergency responses with the ultimate objective of reducing the time from agency notification to implementation of effective control measures
• Bonus Outcome: Capture best practices and share them with others!!

• 5 ‘legs’ of the RRT
Food Program
FDA District
Laboratory
Feed Program
Epidemiology

External Communications: RRT Webpage

Internal Communications: FoodSHIELD

• Developed by Working
Groups
– Multiple States and FDA
• Reviewed by Many
Partners
– FDA Headquarters and
Field Offices
– State and local agencies
– Associations (AFDO,
NASDA, APHL, NACCHO,
ASTHO)
– Federal Partners (e.g.,
USDA, DHS)
• Biennial Revision Cycle
(working on 2015 Edition now)

1. Working With Other
Agencies
2. Federal – State
Cooperative Programs
3. Industry Relations
4. Tools for Program
Analysis & Improvement:
CIFOR
5. Food Emergency
Response Plan
6. Communication SOPs
7. ICS Concepts in RRTs
8. RRT Training
9. Tracebacks
10. Joint Inspections &
Investigations
11. Environmental
Sampling & Records
Collection
12. Food Recalls
13. After Action Reviews
14. Metrics
10

• 25/29 (86%) of CORE Investigations in 2014 involved one or more RRTs
• Example: L. mono in caramel apples (excerpt from
CORE web posting below).

• Response & Recalls WG
– FoodSHIELD best practices
– District/State Cooperative Recall Plan
– Model Food Emergency Response Framework
– RRT Capacity Development
– Improving information sharing
– Library of response resources

Martin Guardia
Emergency Response Coordinator (ERC) Baltimore District martin.guardia@fda.hhs.gov
Tel: 410-779-5134
BB: 410-736-9545

• FDA District day-to-day operations focus on inspections, FDA Center assignments, etc.
• The ERC position was created in 2010 to deal with unplanned work and to take some of the burden out of Investigations Branch
• ERCs provide additional capacity to help resolve unexpected and unplanned Agency responsibilities
• Each year foodborne illness (alone) is a significant public health problem:
• Annually:
– About 48 million (1 in 6 Americans) get sick
– 128,000 are hospitalized
– 3,000 die
14

• Coordinate District emergencies
• Serve on the Central Region (CER) Incident Management Team (IMT)
• Improve the District’s Incident Command System (ICS) knowledge
• Improve State, Tribal, Regional, and National emergency communications
• Participate/Develop/Coordinate training and table top exercises
• ERC may respond when:
– FDA is tracking a District public health issue,
– Illness/death occurs, or
– at the District Director’s discretion
15

(cont.)
• Coordinate Reportable Food Registry (RFR) responses and reporting
• Establish and document District contacts
• Provide situational reports to Office of Regulatory
Affairs (ORA) headquarters
• Develop mapping capacity at the District
• Serve as a District point of contact for emergency issues
16

Monitor for potential safety threats like:
• Weather emergencies/natural disasters: hurricanes, flood, earthquake, etc.
• Manmade disasters: train derailments, chemical spill, etc.
• Outbreaks: Ebola
• Terrorist Activities
• District ERCs success is dependent on strong work from investigators, compliance officers, supervisors, management, and state health and regulatory staff

• FDA Office of Emergency Operations (OEO)
• The Coordinated Outbreak Response and Evaluation
(CORE) Network
• CDC (through CDC-FDA liaison)
• State Agricultural Departments
• USDA Food Safety Inspections Service (FSIS)
• State Health Departments
• State Rapid Repose Teams (RRTs)
(BLT-DO is the only District (out of 21) with all three of our states with RRTs)
18

19
• Events of national importance, which by virtue of their political, economic, social, or religious significance may be targets of terrorism, or other criminal activity.
• Past NSSE events have included presidential inaugurations, major international summits, major sporting events and presidential nominating conventions.

Judy Ashcraft, R.S.
Rapid Response Team Coordinator
General Sanitation Program
West Virginia Department of Health and Human Resources

FDA’s website For Federal, State, Local, Tribal, and
Territorial Officials Rapid Response Team Webpage
States:
“The RRTs vary from each other in accordance with differences in government structures, geographies, laws, resources, etc.”

MARYLAND VIRGINIA WEST VIRGINIA
Population in 2013 Population in 2013 Population in 2013
5.94 M 8.27 M 1.85 M
Commercial Landings Commercial Landings of Seafood in 2013
Commercial Landings of Seafood in 2013 of Seafood in 2013
43,932,279 lbs. 381,723,191 lbs. 0 lbs.
Market Value of Ag
Products Sold in 2012
$2,271,397
Foodborne Illness
Outbreaks 2012,
26
Food Processors
Currently Licensed
1,044
Market Value of Ag
Products Sold 2012
$3,753,287
Foodborne Illness
Outbreaks 2012,
31
Food Processors
Currently Licensed
2,287
Market Value of Ag
Products Sold 2012
$806,775
Foodborne Illness
Outbreaks 2012,
7
Food Processors
Currently Licensed
163

• RRT RFA-FD-12-013 Revised Milestones for Year
3 (2014-2015)
– Concept Development and Documentation
• Establish a Training Plan: Proficiency development; use of a train-the-trainer approach; cross-training (cross-disciplinary and cross-agency); and tracking progress/ensuring continuing education
– Collaboration
• With support from FDA, the RRTs will contribute to the development of training courses in key areas of rapid response (e.g., for non-RRT states, for specialized investigations, to advance the RRT manual).

• To work with our District partners
– Maryland
– Virginia
– FDA
• To work with our State partners
– Local Health Departments
– WV Department of Agriculture
– WV Fusion Center
– Industry
– Private Citizens
• To encourage other states, regardless of size, geography, and economic status to develop a nationwide system of Rapid Response Teams

Pamela Miles
Program Supervisor
Food Safety & Security Program
Virginia Department of Agriculture & Consumer Services

“The Virginia RRT’s mission is to provide a rapid and unified multiagency all hazards response to food/feed emergencies in order to minimize the social, economic, and public health impact”

• Incident exceeds or expects to exceed the resources of the agency that has the authority to respond
• Developing and emerging food supply system requires new ways to deal with challenges with different sets of expertise and bringing together all needed authorities in ways that haven’t been done before.
• Formalize process that exists with current relationships for state and federal agencies
• Team can bring consistency to process

• Improve timeliness and effectiveness of responses
• Maintain an effective RRT which is integrated into the state and federal infrastructure

• In June 2010 FDA and state agency representatives met again with the rapid response coordinator to further team development
• It was decided that the best option for our state was to base the team structure on a smaller “core group” which could rapidly and progressively expand as needed

• Virginia Department of Agriculture and Consumer
Services
– Food Safety Program
– Agricultural Commodities Program
– Dairy Program
– Office of Meat and Poultry Services
• Virginia Department of Health
– Office of Epidemiology
– Office of Environmental Health
• Division of Consolidated Laboratory Services
• U.S. Food and Drug Administration
– Baltimore District Office

• The team decided to have a weekly conference call led by the
RRT coordinator to discuss ongoing and emerging threats or issues to food and feed safety
• All communications regardless of source are sent to the RRT coordinator
• An initial email about the event is sent out to the RRT core group and their designated backups
• Group members disseminate information within their respective agencies/divisions based on the details of each incide nt.

• Updates may be communicated by anyone involved in the investigation but are routed through the RRT coordinator
• Coordinator keeps a log of each agencies activities and any relevant findings
• At the completion of an event a summary email is distributed to the core group

Tomatoes
Restaurant
Laboratory
Distributor
FEDERAL PARTNERS
Repacker
VDH Environmental
Epidemiology
VDACS
Packing House/Processor
Farm
Health Care Doctor
ILL CONSUMER
Another State Yet Another
State
Just for fun, one more state

Epidemiology Laboratory Environmental Health
VDACS Rapid Response Team Federal
Emergency
Preparedness and
Response
Agencies Industry Producers Other States

• Recalls
– August 2014: Low acid canned foods found in a retail store produced without inspection
– August 2014: Low acid canned foods found at a Farmer’s
Market produced without inspection
– August 2014: Cheese collected found positive for Listeria monocytogenes . Worked with FLIRRT (Florida Rapid
Response Team) and FLA-DO (FDA Florida District Office)

• Multistate Outbreak Investigation
– Investigation associated with consumption of
Hispanic-style soft cheeses contaminated with
Listeria monocytogenes.
– Virginia sample of a cheese produced by a
DE manufacturer found to contain Listeria monocytogenes PFGE pattern matching patient isolates.
– State data used to support FDA investigation and ultimately to suspend facility registration for affected firm.

• Information is shared equally between all partners
• Common and understood flow of communications simplifies response process
• Team members are familiar with other agency’s roles and responsibilities before an event
• Proper channels for information flow are understood or easily determined
• After action reporting is simplified and all inclusive

Kyle Shannon, LEHS
Rapid Response Team Coordinator
Office of Food Protection
Maryland Department of Health and Mental Hygiene

• One of Nine “New”
RRTs formed in 2012
• Lead Agency: Maryland
Department of Health and Mental Hygiene
• Partner Agencies: FDA
BLT-DO and the
Maryland Department of
Agriculture
• Multi-Disciplinary/Multi-
Agency
Epidemiology
Outbreak
Investigation
Laboratory
Environmental
Health

• Adulterated Food and Feed
• Recall actions & trace-backs
• Foodborne illness outbreak response/monitoring
• Surveillance and Detection
• Food/Environmental Sampling
• Emergency Response
• Integration with
• Manufactured Foods Regulatory Program
Standards
• (Voluntary) Retail Foods Regulatory Program
Standards

• Authority:
– DHMH – Processors, Warehouses, Shellfish,
Dairy
– MDA – Animal Feed & Farms
– LHD – Restaurants, Retail
• Interstate Food Supply
• Out of State Distribution Centers
• National Capital Region
• Five Nuclear Power Plant Plume Zones

• 2013-2014: Listeria monocytogenes
Associated with Hispanic Style Soft
Cheese
• August 2014: Salmonella Newport
Associated with produce from the
DelMarVA Peninsula
• 2014: Detention/Recall of unapproved product associated with farm to table restaurant
• September 2014: Joint RRT/Local Health
Department Training Sessions

 Development of Inter-agency/Interdisciplinary SOPs
 Lessons Learned/Improvements made based on After-Action Reviews
 Integration of the Local Health
Departments
 Multi-Agency/Multi-State Functional
Exercise

• Outbreak investigation initiated on a cluster of 8
Listeria monocytogenes case patients with a matching PFGE pattern
– 1 case in California, patient died
– 7 cases in Maryland, 5 pregnancy associated
– 2 mother/child pairs and an infant
• Interviews conducted with 5 patients in Maryland
• 5/5 reported shopping at a Mega Mart
• 5/5 reported consumption of Hispanic style cheese products
• Mega Mart is a Hispanic style grocery store with locations in Maryland and Virginia

• Maryland Rapid Response Team (RRT) contacted Virginia
RRT on January 27, 2013
– Wanted to know about complaints or issues at Mega Mart in Manassas,
VA
– Relayed information known about investigation including Hispanic style cheese consumption
– No particular brand of cheese reported although some patients did recall getting cheese that was unlabeled or sold in bulk
• 1-28-2014: VDACS inspector sent to Mega Mart to conduct investigation
– Collect information on cheese sales
– Collect samples of “shady” or unusual cheeses
• The 4 samples collected by VDACS included the ‘smoking gun’ that PFGE-matched the MD case patients and implicated Roos Foods
– Inter-state communication was directly responsible for solving the case!

MD Retail sampling at
MegaMarts
1/27/2014 &
1/30/2014
VA unofficial sample +
2/10/2014
VA &MD issue consumer warnings
2/19/2014
VA/MD/LHD product detention
2/20/2014-
2/22/2014
Recall expanded
3/1/2014
FDA suspends
Roos Food facility registration
3/11/2014
Feb
VA Retail sampling at
MegaMart
1/28/2014
VA & MD high volume testing of official Roos
Foods cheese products
2/11/2014
FDA/DE DOH joint inspection
2/18/2014
Multiple official MD
& VA samples +,
PFGE match
2/20/2014
Mar
Recall initiated and expanded
2/23-2/25
DE DOH issues cease and desist order
2/28/2014

• RRTs: Communication already established and enhanced – routine calls, face to face meetings, exercises
– District – RRT States
• 1/24/2014: Call between DHMH, BLT-DO, Prince Georges Co. Health Dept.
– Between States
• 1/27/2014: Call between SMarRRT Coordinator and VDACS RRT Coordinator
– Calls between BLT-DO, MD, VA for updates on findings until CORE took over the event coordination
• BLT-DO, 3 RRT States, MD, VA, WV, and DC; and PHI-DO and DE working together on a Regional level to protect the consumer

Focal Point for communicating/sharing information with the states:
• Status of firm inspection
• Distribution lists of recall products
• Coordination of state access to FoodSHIELD and analytical worksheets
• CORE requests for information: sample analyses/inspectional
• Press releases
• Recall audit checks