Outbreak Training

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Outbreak Training
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Almonds
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Step 2 Establish Existence of an Outbreak

• On June 6th, IDEP received a call from CDC they
  had identified 3 patients in West Virginia who
  had very similar PFGE (Pulsed Field Gel
  Electrophoresis) patterns of Salmonella
  Enteritidis.
• Investigating an outbreak dealing with the
  consumption of raw almonds.

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Step 7 Tested Hypothesis

• In December 2000, Canadian health officials
  identified extremely rare phage type of S.
  Enteritidis (SE PT30).
• Implicated raw almonds purchased in bulk from a
  natural food store chain as the source of the
  outbreak.

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Step 7 Tested Hypothesis

• The almonds had been shipped from California to
  Canada and then distributed from there.
• CDC wanted to know if any of the three WV
  residents had either traveled to Canada or had
  purchased raw almonds in bulk quantity

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Step 4b Identify and count cases

• The 3 residents came from Logan, Calhoun, and
  Randolph counties.
• Using the WV Supplemental Enteric Disease Case
  Report Follow-up Form was filled by respective
  LHD
• 2 of the 3 residents had eaten raw almonds

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Step 8 Refine hypothesis and conduct additional
studies

• Laboratory analysis of raw almonds taken from
  homes of the patients, from the retail stores,
  and from the central warehouse for these stores
  confirmed that the almonds were contaminated with
  SE PT30.
• The almonds were traced to a supplier in
  California. Almonds and environmental samples
  collected from the supplier by the California
  Department of Health Services, Food and Drug
  Branch, also yielded SE PT30, as confirmed at CDC.

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Step 9 Implement Control Preventive Measures

• A recall was announced in Canada on April 13,
  2001.
• This was followed by a second Canadian recall in
  early May when additional cases were linked to
  almonds purchased through other stores.

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Step 10 Communicate findings

• Canada Communicable Disease Report
• To date, over 140 culture-confirmed cases of SE
  PT30 infection have been identified in Canada,
  with onset dates ranging from November 2000
  through May 2001.