2006 Spinach Outbreak Environmental Investigation

1
2006 Spinach Outbreak Environmental Investigation

• Patrick Kennelly
• California Department of Public Health
• Food and Drug Branch
• Barbara Cassens
• US Food and Drug Administration
• San Francisco District

2
E. coli O157H7 and Spinach

• Timeline in the investigation
• Sept. 13, 2006
• First notifications of cluster of E. coli O157H7
  illnesses
• Sept. 14, 2006
• CDC issues health alert
• FDA issues health warning
• Sept. 15, 2006
• CalFERT team is dispatched to Processor X
• Processor X announces recall of all products
  containing spinach

3
E. coli O157H7 and Spinach

• Timeline in the investigation
• Sept. 21, 2006
• 3 California counties identified in traceback as
  source of spinach
• First positive E. coli found in bagged spinach
  from consumer with specific lot identified,
  P227AO3
• Sept. 24, 2006
• Second confirmed positive from product from UT
  with lot code P227A01
• Traceback leads to 4 ranches that supplied
  spinach to lot P227.
• Sept. 26, 2006
• Third confirmed positive from product, PA with
  lot code P227
• Oct. 12, 2006
• FDA and CDHS announce finding matching isolate to
  outbreak pattern from a ranch in environmental
  sample.

4
E. coli O157H7 and Spinach

• Timeline in the investigation
• Mar. 22, 2007
• FDA and CDHS issue joint report on environmental
  investigation

5
Dole Baby Spinach Lot P227
6
E. Coli O157H7 and Spinach

• 204 confirmed cases in 26 states
• 1 confirmed case in one Canadian province
• 104 hospitalizations (51)
• 31 Hemolytic Uremic Syndrome (15)
• 3 deaths

7
Thursday, October 5,  2006 E. Coli Kills Idaho
Toddler Spinach Plants Probed
Thursday, October 12, 2006 E. Coli Strain in
Tainted Spinach Is Linked to California Cattle
Ranch
Thursday, October 12, 2006 Source of Deadly E.
Coli Is Found
8
E. coli O157H7 and Spinach

• Environmental samples collected
• High volume of samples collected
• Consisted of
• Water
• Soil/sediment
• Cow and wild pig feces
• Field product
• Environmental samples from processor

9
E. coli O157H7 and Spinach

• Environmental testing results
• E. coli O157H7 found on all 4 ranches
• 28/45 (62) E. coli O157H7 isolates from one
  ranch matched the outbreak strain
• 4 stream water/sediment
• 1 dust/dirt from pasture
• 8 wild pig/wild pig feces
• 15 cow feces
• 13/87 (15) of wild pigs sampled on Ranch X
  positive for O157.

10
Overview of Environment
11
Leafy Green OutbreaksWhat are the contributing
factors?
12
Effect of Surface Water
River
Courtesy of R. Gelting, CDC
13
California Food Emergency Response Team
CalFERT

• A partnership between CDHS, FDA-SANDO, FDA-LOSDO
  and CFSAN.
• Conceived in 1999 and fully implemented in 2005
  to address recurring problems in environmental
  investigations of foodborne outbreaks.

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California Food Emergency Response Team
CalFERT

• Overseen by a Steering Committee
• Team Leads Assigned from each Agency
• Core Team Members Regularly Meet and Train
  Together
• Specialized Training and Skills
• Laboratory Personnel

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California Food Emergency Response Team
CalFERT

• Decision to Deploy
• Team Leads Establish ICS Structure Team
  Assignments
• Equipment, Supplies, Hotels, Meeting Place
• Assignments Prioritized Daily
• Regular Update Reports to Management

16
California Food Emergency Response Team
CalFERT

• Demobilization
• Reports
• Unified Format
• Lead Identified
• Divide Conquer the Report Components
• Joint Management Revue
• Consensus

17
California Food Emergency Response Team
CalFERT

• Key to Success
• Good Communication
• Staff Training
• FLEXIBILITY

18
California Food Emergency Response Team CalFERT

• Interdisciplinary team of experienced
  investigators and PhD level scientists.
• May not work in every state
• Sufficient number of outbreaks to maintain
  knowledge and proficiency
• Very positive working relationship between
  federal and state agencies
• Highly trained and experienced staff (not routine
  inspections)
• Written protocols
• Extensive reports

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Lessons Learned

• CalFERT partnership and collaboration
• Team approach
• Incident Command Structure
• Laboratory collaboration
• Improved Lab Methods
• http//www.dhs.ca.gov/fdlb/microbiology/RIMS.O157_
  final_5-04-07.pdf
• Utilize the latest in technology to communicate
• GPS coordinates
• Digital photos
• High speed internet access

20
Lessons Learned

• Daily Communication
• Resources
• Exercise and utilize resources
• Leafy Greens Initiative
• Standardized forms
• Farm investigation questionnaire
• FOOD!
• A fed team is productive team

21
E. coli O157H7 and Spinach - Conclusions

• Still do not know exactly how pathogens came into
  contact with spinach. Lots of speculation based
  on observations at Ranch X.
• Wild pigs
• Surface water contamination of well water
• Cattle
• Dust/Airborne
• Previously identified risk factors still relevant
• Direct fecal contamination from domestic animals
  and/or wildlife
• Water (contaminated with feces)
• Manure as fertilizer
• Workers

22
Conclusions

• An estimated 4,000 cases of E. coli O157
  infection associated with one lot of bagged
  spinach.
• Quick actions likely averted additional cases.
• Large amount of resources dedicated to
  investigation and communication during the event.
  
• No conclusive evidence of how contamination
  occurred.
• This was the 20th outbreak of O157H7 linked to
  leafy greens in the last 12 years.
• CDFA Marketing Agreement

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Findings from current and past leafy green
investigations

• Pre-harvest/harvest phases of production is the
  most likely opportunity for introduction of
  contamination
• Post harvest (cooling, processing, shipping,
  retail) practices may contribute to spreading the
  contamination over thousands of bags and/or may
  permit growth of the organism.
• Current processing practice of chlorinating/monito
  ring the chlorine levels of flume water as a CCP
  is not sufficient to control large scale
  contamination. Additional barriers and better
  monitoring procedures are needed.

24
Acknowledgements

• California Department of Public Health
• Food and Drug Branch
• Emergency Response Unit
• Food Safety Inspection Unit
• Food and Drug Laboratory Branch
• Microbial Disease Laboratory
• U.S. Food and Drug Administration
• Office of Regulatory Affairs
• San Francisco District
• Center for Food Safety and Applied Nutrition
• Centers for Disease Control
• National Center for Environmental Health
• U.S. Department of Agriculture
• Wildlife Service
• Agriculture Research Service

25
Thank You!

• pat.kennelly_at_cdph.ca.gov
• barbara.cassens_at_fda.hhs.gov