Alamosa Salmonella Outbreak

1
Alamosa Salmonella Outbreak

• Colorado Department of Public Health and
  Environment Response

2
Its In The Water!
3
Next Steps

• Bottled water order for customers who pay water
  bill to the City of Alamosa (East Alamosa Water
  NOT affected)
• Drain and patch holding tank
• Decontaminate (super-chlorinate) tanks and water
  distribution system
• Test water for chlorine levels during
  super-chlorination
• Test water for bacteria and arsenic/heavy metal
  levels
• Continue to monitor illness patterns
• Assist businesses, food facilities, schools,
  daycare facilities to return to water system

4
Timeline (cont)

• March 19 CDPHE issues bottled water order to
  City of Alamosa residents/visitors to stop
  using tap water Alamosa declares city/county
  emergency
• COHELP Line activated 1-877-452-2911
• CDPHE WQCD issues request for assistance via
  CoWARN mutual aid network
• Denver Water and CDPHE Water Quality arrive
• March 20 3 water distribution centers
  established bulk/bottle American Red Cross
  volunteers staff distribution sites
• CDPHE, Denver Water, Alamosa develop a
  strategy to disinfect/flush Alamosas water
  distribution system

5
Timeline (cont)

• March 21 Governor declares state public health
  emergency
• Colorado National Guard arrives
• Alamosa signed mutual aid agreement,
  establishing formal/legal relationship between
  city and other mutual aid partners
• March 22 Governor Ritter and Senator Salazar
  arrive for tour
• March 23 Jefferson County Incident Management
  Team (IMT) arrives
• Over 170 volunteers distribute over 5,000
  flyers
• March 24 Alamosa water samples test positive
  for salmonella
• First press conference in Alamosa
• Request assistance from HHS
• environmental
• epidemiology
• risk communication
• water quality
• Develop color code phases for system flushing

6
System Flushing Process

• System Flushing water disinfected with chlorine
  in 3-stage process
• Color-coded safety notices delivered to
  residences at each stage
• STAGE 1 Red
• High concentration of chlorine - 25 ppm
• Can NOT use water for anything other than
  flushing toilets
• Possible skin, eye, or other irritation from
  water exposure 
• STAGE 2 - Yellow
• Chlorine decreases to 10 ppm (slightly above
  swimming pool)
• Water CAN be used to bathe and wash laundry
• Can NOT consume water
• STAGE 3 - Green
• Chlorine decreases to 1-2mg per liter
• Normal drinking, bathing, and other water uses
  can be resumed

7
(No Transcript)
8
Timeline (cont)

• March 25 Alamosa public schools close
• Red high chlorination process begins
  5 FDA consumer personnel arrive
• March 26 Entire city in Red
• 5 water samples test positive by PCR
  for Salmonella of 5 PCR-positive
  samples, 4 grew in culture
• Adams State College classes canceled
• CDPHE updates Alamosa City Council
• 5 CDC personnel arrive
• Mayor starts daily televised statements
  on channel 10
• March 27 Denver Salvation Army provides
  vouchers for paper products
• NW Colorado IMT assumes authority

9
Timeline

• March 28 City completes Red phase, goes to
  Yellow
• Consumer protection inspectors reach out
  to all regulated food service/institutional
  facilities -89 remain open
• March 30 Alamosa receives memo from CDPHE
  outlining how to go to Green status
• CO-HELP line open over the weekend
• March 31 Schools reopen
• All city in Yellow stage
• News conference with Colorado media
• Eastern Colorado IMT assumes authority
• CDC epidemiology staff demobilized

Grocery store ensures produce not harmed by
contaminated water
Water shares front stage during Easter services
10
Timeline

• April 3 City goes to Boil Water Order
• April 4 CDPHE meets with Alamosa City Officials
  in Pueblo to discuss ongoing investigation of
  the cause of the Salmonella water contamination
• April 8 CDC water samples show presence of
  Giardia and Cryptosporidium (samples taken
  before system was flushed/disinfected).  
• April 9 CDPHE takes water samples to confirm
  Giardia and Crypto have been eliminated
• April 10 Total Cases 424
• Hospitalizations 22
• Deaths 1
•  
• April 11 Boil Water Order rescinded Alamosa
  goes to green status, residents can consume
  water

11
CDPHE Response

• CPD
• Provide guidance/assistance to restaurants, food
  manufacturers, childcare centers, and schools
• Conduct inspections of restaurants, food
  manufacturers, childcare centers, and schools
• Track facility closures for restaurants, schools
  and daycare centers 
• Communications
• Work with joint information center (JIC) partners
  and CDPHE divisions to draft public
  communications as needed 
• Press releases
• Flyers
• Reverse 911
• DCEED
• Provide assistance in conducting disease
  surveillance, including case interviews/phone
  survey/etc
• Track number of cases and hospitalizations
• EPRD
• Coordinate information and response activities
  from CDPHE divisions
• Monitor and provide staffing replacements for
  local/state public health staff   
• Update messages on COHELP hotline and on CDPHE
  website 
• Track COHELP reports, including homebound
  residents

• COHELP hotline
• CDPHE website  

12
CDPHE Response

• HFEMSD
• Contact/provide assistance to hospitals, clinics,
  and long-term care facilities
• Lab
• Conduct sampling for salmonella, total coliform
  and heavy metals
• PSD
• Provide assistance to Alamosa WIC Director to
  find supplies of ready to feed formula
• Sustainability Program/Waste Facilities
• Ensure recycling facilities in Alamosa are ramped
  up
• WQCD
• Coordinate with city to develop and implement
  plan for flushing city municipal water system
            
• Conduct water sampling for bacteria and heavy
  metals before/during/after flush         
• Work COWARN to provide personnel and equipment
  mutual aid resources to Alamosa
• Provide guidance for water use during each stage
  during system flush     
•        

13
Online Situational Awareness Tool

• Secure, web-based system
• Critical information specific to incident
• Contact information
• Real time status updates and info sharing
• Media reports, links to related stories

14
Media Public Information

• Joint Information Center (JIC) established
• CDPHE provided technical guidance, fact sheets,
  through JIC
• Current information provided to media/public as
  it was made available
• Having one point of contact for media inquires
  ensured accurate messages delivered
• Consistent information provided by various
  methods (in English and Spanish)
• Flyers delivered door-to-door Local/State media
  releases
• COHELP Line
• County website - www.CityofAlamosa.org
• CDPHE website - www.cdphe.state.co.us/epr/Alamosa.
  html
• Local cable channel 10

15
COHELP Line

• Staffed with information specialists from the
  Rocky Mountain Poison Drug Center (RMPDC)
• Developed to provide consistent, accurate and
  up-to-date information to the public
• Telephony, integrated voice response unit (IVR),
  and web-based technology
• Operates daily - topics, hours, staffing adjusted
  to meet public need
• Can take up to 1,000 calls per hour
• Voice recording and option to speak to live
  person
• Situational Awareness - data collection on dead
  bird/squirrel reports, zip code geocoding of
  public concern trends
• Monthly reports on call volume and public concern
  trends

16
COHELP Alamosa Response

• Total Calls 2,544 in 14 days
• Notification to Activation Time 3 hours
• Heaviest call volume hour 90 call in one hour
• Heaviest call day 486 calls
• Daily reports call volume, top 5 FAQs, call
  trend analysis, real time reporting of emergency
  requests
• Weekend coveragecalls transferred to registered
  nurses at RMPDC for medical support

17
CoWARN Mutual Aid

• Colorados Water/Wastewater Agency Response
  Network
• 47 public and private water and wastewater
  utilities, industry support organizations and
  government members
• Can provide immediate assistance to members in
  emergency
• Participation is voluntary
• Signed Mutual Aid Agreements in place allow for
  quick response
• Colorado one of only 6 states that has web-based
  mutual aid system like this
• Member website provides forum for
  establishing/maintaining emergency contacts and
  communicating needs/resources in real time

18
CoWARN Alamosa Response

• Provided technical expertise, equipment and
  supplies to Alamosa
• 23 water and wastewater utilities, industry
  support organizations and State of Nebraska
  assisted
• CoWARN coordinators from CDPHE, Denver Water, and
  Aurora Water operated through the CDPHE DOC.
• communication with City and CDPHE personnel
  onsite
• maintained the CoWARN website
• Tracked donations of supplies/assistance from
  private businesses in network
• Crews worked 12 hour shifts, around the clock,
  with Alamosa and CDPHE personnel onsite

19
CDEM Response

• Colorado Division of Emergency Management
• Opened State Emergency Operations Center (SEOC)
• Coordinated multiple state agencies, volunteer
  organizations and business donations
• Status reports via emails and 209 reports
• Coordinated IMTs sent to manage the incident
  onsite
• As of 4/2, 812 volunteers provided over 3,447
  hours of assistance

20
Incident Command

• ICS used among all response partners

21
External Agencies

• Local Public Health Agencies
• Alamosa Fire Department
• Alamosa County Nursing
• Alamosa County Sheriffs Office
• Alamosa County and City Management
• Alamosa County Road and Bridge
• Alamosa County Emergency Management
• Alamosa Water Department
• Alamosa Police Department
• City of Durango
• City of Ft. Collins
• Denver Environmental Health
• Denver Water
• Aurora Water
• Pueblo Water
• Boulder Water
• Colorado Rural Water Association
• East Cherry Creek Village
• San Luis Valley Regional EMS/RETAC

• Jefferson County Incident Management Team
• Northwest Colorado Incident Management Team
• Division of Emergency Management
• Department of Transportation
• Department of Human Services- Mental Health
• Department of Corrections
• Colorado National Guard
• Governor Ritters Office
• State Senator Ken Salazar's Office
• Congressman John Salazar's Office
• Rocky Mountain Poison and Drug Center
  (COHELP)
• American Red Cross
• FEMA Region VIII
• U.S. Dept. of Health and Human Services
• Centers for Disease Control and Prevention
  (CDC)
• U.S. Forest Service
• Food and Drug Administration 
• Homeland Security