The javiana Sheetz Outbreak in West Virginia

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The javiana Sheetz Outbreak in West Virginia

• Danae Bixler, MD, MPH

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Objectives

• Describe the Salmonella javiana cases that
  occurred in West Virginia related to Sheetz (Step
  5)

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Methods

• Enhanced passive surveillance to encourage
  reporting of cases
• Regular feedback of information to local health
  departments and stakeholders
• Case investigation by local health departments
  using forms and protocols located at
  http//www.wvdhhr.org/idep/
• Data entered/analyzed with excel and Epi Info
  2002
• Serotyping / PFGE by OLS

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Case Definition

• Sheetz-related cases Case of culture-confirmed
  Salmonella javiana PFGE-matched to the outbreak
  strain with a history of eating at Sheetz during
  July, 2004.
• Secondary cases Culture-confirmed cases of
  Salmonella javiana epi-linked to Sheetz-related
  cases.
• Non-Sheetz-related cases Case of culture
  confirmed Salmonella javiana PFGE-matched to the
  outbreak strain without a history of eating at
  Sheetz.

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Case Counts
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Cases by County
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Age
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Symptoms (N38)

• Diarrhea 38 (100)
• Mean (median) episodes 18.8 (18)
• Fever 34 (89)
• Mean (median) 102F (102.5F)
• Cramps 31 (82)
• Nausea 31 (82)

• Headache 26 (68)
• Vomiting 20 (53)
• Mean (median) episodes 6.7 (5)
• Bloody stool 14 (37)
• Hospitalized 11 (29)

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Lessons from Barbour County

• They got the team together (nursing, sanitarian,
  clerk) (Step 1)
• had a discussion
• shared information
• made assignments
• Case-finding and communicate findings (Step 4 and
  10)
• Active surveillance
• Alert
• Direct outreach
• Press release

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Lessons from Barbour County

• Refine hypotheses (Step 8)
• Importance of
• PFGE
• Environmental specimens