OB# Name: FOODBORNE Outbreak Summary Initial impetus citizen complaint ICP/clinician surveillance blip seen by OHD CDC for investigation nursing home staff surveillance blip seen by LHD other state HD school report 1st notification to LHD Syndrome BASICS gastroenteritis 1st notification to OHD pertussis OHD lead respiratory investigation start date hepatitis Setting(s) of exposure varicella unknown grocery store other County of exposure(s) restaurant/deli hospital meeting/convention workplace cafeteria City* * where applicable DCC nursing home/LTC/ALC school prison, jail Location/facility name* religious facility private home camp picnic Contact info for group, office/worksite fair/festival/mobile facility, etc. Brief overview Earliest exposure latest exposure Were specimens of any kind tested anywhere? Y N ETIOLOGY Y N Was the etiologic agent lab-confirmed? If no, presumptively identified? Y N Confirmed (or presumptive) bug/disease PFGE pattern/other Bug first identified at which lab? private OSPHL other PHL CDC Other… Sources of positive specimens cases food environment food handler From how many persons were specimens tested? Count people, not specimens. From how many persons were stool specimens tested? Count people, not specimens. How many non-fecal specimens were tested at the PHL? Overall, how many cases were lab-confirmed? How many food samples were tested? water? other environmental samples? How many of the following kinds of specimens were tested? Use estimates if necessary. bacterial cx O & P Norwalk estimates at private labs at the PHL What was the median lag time from onset of D or V to enter exact time if known within 3 days within 2 weeks collection of specimens tested at the PHL? could not be determined within 1 week more than 2 weeks If no etiology was established through basic tests, none toxin screens other PCR other culture referral to CDC what other lab work was done? form revised 22 Jan 2004 page 1 CASES Was a formal case definition used? Y N If yes, specify: Lab-confirmed or... Earliest known onset date latest Check if onsets unknown Confirmed case count including secondary cases Presumptive case count including secondary cases Suspect case count Extrapolated total ill Do these tallies include any non-Oregon residents? How many symptom profiles were systematically collected from confirmed and presumptive cases? Of those, how many had... AGE SEX min median max hours/days cramps infants female incubation H D vomiting 1–4 male duration H D fever 5–19 unknown any diarrhea 20–49 total SEVERITY 3+ diarrhea in 24 h 50+ saw clinician bloody stools unknown hospitalized overnight total died FOOD Based on epi, lab, and other evidence, was a specific vehicle convincingly Y N implicated? Food prep method(s) M1 Foods eaten raw or lightly cooked (e.g., hard shell clams, sunny side up eggs) If yes, specify item(s) M2 Solid masses of potentially hazardous foods (e.g., casseroles, lasagna, stuffing) M3 Multiple foods (e.g., smorgasbord, buffet) main ingredients M4 Cook/serve foods (e.g., steak, fish fillet) M5 Natural toxicant (e.g., poisonous mushrooms, paralytic shellfish poisoning) bad ingredients M6 Roasted meat/poultry (e.g., roast beef, roast turkey) M7 Salads prepared with one or more cooked ingredients (e.g., macaroni, potato, tuna) nature of evidence M8 Liquid or semi-solid mixtures of potentially hazardous foods (e.g., gravy, chili, sauce) 1 Statistically implicated from analytic study M9 Chemical contamination (e.g., heavy metal, pesticide) 2 Lab evidence (e.g., food culture) M10 Baked goods (e.g., pies, eclairs) 3 Compelling supportive evidence M11 Commercially processed foods (e.g., canned fruits and vegetables, ice cream) 4 Other data (e.g., same phage type on farm) M12 Sandwiches (e.g., hot dog, hamburger, Monte Cristo) 5 Seems likely based on general knowledge M13 Beverages (e.g., carbonated and non-carbonated, milk) M14 Salads with raw ingredients (e.g., green salad, fruit salad) M15 Other, does not fit into above categories (please describe in Comments) Was a specific food handler Y N M16 Unknown, vehicle was not identified implicated as the probable source of contamination? Where was the implicated food prepared? unknown camp workplace cafeteria fair/festival/mobile location If yes, was that conclusion based on.... restaurant/deli caterer nursing home/LTC/ALC contaminated food (imported) lab evidence DCC office/worksite prison, jail contaminated food (domestic) epi evidence school grocery store private home commercial product, no local prep reasonable guess religious facility hospital picnic other ___________ FOOD FACTORS How did the implicated food originally come to be contaminated? ??? unknown C1x Toxic substance part of tissue (e.g., ciguatera) C2 Poisonous substance intentionally added C3 Poisonous or physical substance accidentally/incidentally added (e.g., sanitizer or cleaning compound) C4 Addition of excessive quantities of ingredients that are toxic under these situations C5 Toxic container or pipelines (e.g., galvanized containers with acid food) C6 Raw product/ingredient contaminated by pathogens from animal or environment (e.g., SE in egg) C7 Ingestion of contaminated raw products (e.g., raw shellfish, produce, eggs) C8 Obtaining foods from polluted sources (e.g., shellfish) C9 Cross-contamination from raw ingredient of animal origin (e.g., raw poultry on the cutting board) C10 Bare-handed contact by handler/worker/preparer (e.g., with ready-to-eat food) C11 Glove-handed contact by handler/worker/preparer (e.g., with ready-to-eat food) C12 Handling by an infected person or carrier of pathogen (e.g., Staphylococcus, Salmonella, Norwalk agent) C13 Inadequate cleaning of processing/preparation equipment/utensils – leads to contamination of vehicle C14 Storage in contaminated environment – leads to contamination of vehicle (e.g., store room, refrigerator) C15 Other source of contamination (please describe in Comments) If bacterial, what factors were identified that contributed to the proliferation/amplification of the bug? ??? unknown P1x Allowing foods to remain at room or warm outdoor temperature for several hours (e.g., hot/hold violations) P2 Slow cooling (e.g., deep containers or large roasts) P3 Inadequate cold-holding temperatures (e.g., refrigerator inadequate/not working, iced holding inadequate) P4 Preparing foods a half day or more before serving (e.g., banquet preparation a day in advance) P5 Prolonged cold storage for several weeks (e.g., permits slow growth of psychrophilic pathogens) P6 Insufficient time and/or temperature during hot holding (e.g., malfunctioning equipment) P7 Insufficient acidification (e.g., home canned foods) P8 Insufficiently low water activity (e.g., smoked/salted fish) P9 Inadequate thawing of frozen products (e.g., room thawing) P10 Anaerobic packaging/Modified atmosphere (e.g., vacuum packed fish, salad in gas flushed bag) P11 Inadequate fermentation (e.g., processed meat, cheese) P12 Other situations that promote or allow microbial growth or toxic production (please describe in Comments) What factors contributed to survival of the bugs? ??? unknown S1 Insufficient time and/or temperature during cooking/heat processing (e.g., faulty pasteurization) S2 Insufficient time and/or temperature during reheating (e.g., sauces, roasts) S3 Inadequate acidification (e.g., mayonnaise, tomatoes canned) S4 Insufficient thawing, followed by insufficient cooking (e.g., frozen turkey) S5 Other process failures that permit the agent to survive (please describe in Comments) S6 No kill step in processing (e.g., alfalfa sprouts) METHODS OHD lead Which agencies were substantively involved? other OHD 1 LHD Who designed the investigation? 2+ LHDs LHD sanitarians State HD (Oregon) LHD lead(s) LHD CD nurses ODA OHD staff other state HDs others with advanced epi skills others CDC FDA Other outbreak-related activities What methods were used to investigate this USDA outbreak? (Check all that apply.) product recall active case finding press release case interviews How many well persons (controls) media coverage chart/record review were systematically interviewed? out-of-office travel by LHD case-control study out-of-office travel by OHD cohort study overnight travel by OHD How were well cohort members food prep review controls selected? meal companions food cultures phone # match product traceback friends factory investigation source investigation environmental cultures QA What additional records are available? (File hard copies in folder.) questionnaire written report computer files epi curve Please check your work before submitting the report! Q01Do the various case tallies (see CASES) add up consistently? Q02For reportable diseases (e.g., O157), do tallies match those in the main surveillance database (CASES)? Q03Was the summary and any final report sent to LHD staff? Q04Have hard copies of any questionnaires, reports, etc., been filed in the outbreak folder? Q05Has material been copied to the appropriate folder on STASH? Q06Are all sections of this report complete? Attach or e-mail any stand-alone reports. Add comments as indicated on this form. NARRATIVE Initial impetus citizen complaint ICP/clinician surveillance blip seen by OHD CDC for investigation nursing home staff surveillance blip seen by LHD other state HD school report 1st notification to LHD Syndrome BASICS gastroenteritis 1st notification to OHD pertussis OHD lead respiratory investigation start date hepatitis Setting(s) of exposure varicella unknown grocery store other County of exposure(s) restaurant/deli