Foodborne Disease Outbreak Detection: Disease Detectives Wanted - - PowerPoint PPT Presentation

Foodborne Disease Outbreak Detection: Disease Detectives Wanted

Kara Cooper, Ph.D.

My Career Path

• Laboratory experience though high school and

college

• B.S. in Microbiology from Kansas State University
• Ph.D. in Medical Microbiology and Immunology
• Worked for Centers for Disease Control and

Prevention for 6.5 years

– Foodborne Disease Surveillance

• Currently work for MRIGlobal in Kansas City

– Manage Bacteriology and Molecular Biology Group – BSL-2 and BSL-3 laboratories

Microbiology

• Microbiology is the study of

microrganisms, which can’t be seen with the naked eye

– Bacteria - ~1-10 µm – Viruses - ~20-400 nm – Fungi – Prions

• Scale

– Centi – 0.01 – Milli – 0.001 – Micro – 0.000001 – Nano – 0.000000001

It’s a Dirty World

• Microorganisms are all

around

• Symbiotic Relationship at

times

• Non-pathogenic vs.

Pathogenic (organism that cause disease)

Biosafety Levels

• Microorganisms are categorized in Risk Groups (RG)

based on their relative risk.

– Pathogenicity of the organism – Mode of transmission and host range – Availability of effective preventive measures or treatment (e.g., vaccines or antibiotics) – Infectious dose – Other factors

• BSL Levels

– BSL-1 – Are not associated with disease in healthy adult humans or animals (Ex. non-infectious bacteria and laboratory adapted strains) – BSL-2 – Are associated with disease which is rarely serious and for which preventative or therapeutics is

• ften available (Ex. Salmonella, Staphyloccus)

– BSL-3 – Are associated with serious or lethal human disease for which preventative or therapeutics may be available (Ex. Bacillus anthracis, Rift Valley Fever Virus) – BSL-4 – Are associated with lethal human disease for which preventative or therapeutics are not readily available (Ex. Ebola)

Foodborne Illness

• Consumption of

contaminated food

• Each year:

– 76 million cases of foodborne illness – 325,000 hospitalizations – $7 billion is the annual cost of treating the top 4 foodborne pathogens

Foodborne Illness

Food Poisoning Foodborne Disease Harmful chemicals or bacterial toxins Illness caused directly by infection with organism Don’t need to ingest organism to become ill Bacteria must be eaten to cause disease Generally short incubation period before symptom onset (4-12 hrs) Longer incubation period (days to weeks) Nausea, vomiting, diarrhea Nausea, vomiting, diarrhea, fever

Campylobacter Salmonella

• E. Coli O157:H7

Listeria

Routes of Contamination

Food can be contaminated at any point along the food production process. This is described as from “Farm to fork”.

Globalization

• New global economy has

created a food revolution

– 1950’s: stocked an average

• f 300 items

– 1990’s: stocked 25,000- 50,000 different items – Rapid transit of perishable foods – Increased demand for fresh produce year round – Industrialization

Surveillance Systems

• Surveillance is an epidemiological practice by which

the spread of disease is monitored in order to establish patterns of progression. The main role of disease surveillance is to predict, observe, and minimize the harm caused by outbreak,, as well as increase our knowledge as to what factors might contribute to such circumstances.

• Agencies involved in National Surveillance

– Centers for Disease Control and Prevention (CDC) – Food and Drug Administration (FDA) – U. S. Department of Agriculture (USDA) Local and Public health departments

A large outbreak in one place may be

• bvious

A dispersed outbreak in many places may be difficult to detect, unless

• Test the bacteria from all the cases, and
• Find they are infected with the same bacterial strain

Disease Reporting Pyramid

What is PulseNet USA?

• Established in 1996, The National Molecular Subtyping

Network for Foodborne Disease Surveillance

• A national network of >85 state and local public

health/food regulatory agency laboratories (USDA, FDA) coordinated by CDC and APHL

• Perform standardized DNA “fingerprinting” of

foodborne disease-causing bacteria – Pulsed-field gel electrophoresis (PFGE)

• Dynamic databases of DNA “fingerprints” at CDC
• Early identification of common source outbreaks

Deoxyribonucleic acid (DNA)

• Building blocks of living things
• Unique for all individuals –

Makes us what we are

• Used to distinguish between

relatives of bacteria

• Useful in Outbreak

identification – Molecular Epidemiology

The Three Basic Elements of PulseNet

3.Data exchange

1.Data acquisition 2.Data analysis

PulseNet Laboratory Network

Local Databases

PulseNet National Databases (CDC) Participating Labs PFGE Patterns

Philadelphia

West Mountain South Central North Central Midwest Mid-Atlantic Southeast Northeast

The National Molecular Subtyping Network for Foodborne Disease Surveillance

COLORADO OREGON CALIFORNIA NEVADA IDAHO UTAH ARIZONA MONTANA WYOMING WASHINGTON NEW MEXICO NORTH DAKOTA SOUTH DAKOTA NEBRASKA KANSAS OKLAHOMA MINNESOTA IOWA MISSOURI ARKANSAS ILLINOIS WISCONSIN MICHIGAN ALASKA TEXAS HAWAII LOUISIANA KENTUCKY OHIO VIRGINIA TENNESSEE NEW YORK MAINE NEW HAMPSHIRE ALABAMA MASSACHUSETTS RHODE ISLAND CONNECTICUT NEW JERSEY DELAWARE MARYLAND GEORGIA SOUTH CAROLINA Los Angeles County San Diego County Santa Clara County Houston New York City Tarrant County Tampa USDA-AMS USDA- ARS/FSIS Orange County Washington D.C. FDA-CFSAN FDA-ORA FDA-ORA FDA-ORA FDA-ORA FDA-ORA FDA-CVM FDA-ORA Milwaukee Florida Ag Lab

Area Laboratories PulseNet Central County/City Laboratories USDA Laboratories FDA Laboratories

FDA-ORA Las Vegas PUERTO RICO VERMONT

PulseNet Activity, 1996-2010

PulseNet in the Numbers

What is a Cluster Search?

Cluster of indistinguishable patterns by primary enzyme

• Patterns submitted

electronically

• 60- or 120-day cluster

search performed

• Visually compare

indistinguishable patterns with 1st enzyme, then 2nd

• Patterns and clusters

are named by CDC

Recent Foodborne Outbreaks With PulseNet Involvement

• Salmonella Enteritidis - eggs
• E. coli O145 – lettuce
• Salmonella Montevideo – salami/pepper
• E. coli O157 – cookie dough
• Listeria monocytogenes – sprouts
• Salmonella Typhimurium – African dwarf frogs;

peanut butter products

• Salmonella Saintpaul – Raw Produce

Just to name a few.......

10 20 30 40 50 60 70 1 8 15 22 29 36 43 50 57 64 71 Day of Outbreak Number of Cases

• utbreak detected 1993

726 ill, 4 deaths

1993 Western States E. coli O157 Outbreak 39 d

10 20 30 40 50 60 70 1 8 15 22 29 36 43 50 57 64 71 Day of Outbreak Number of Cases

• utbreak detected 2002

44 ill, no deaths

18 d 2002 Colorado E. coli O157 Outbreak

PFGE Patterns Spinach- associated E. coli O157:H7 Outbreak

This TIFF was uploaded to PulseNet on 9/8/2006 Outbreak patterns are in lanes 3, 4, 6-9 (XbaI)

Outbreak Pattern: Comparison shows 100% similarity among PFGE patterns from various states

Isolate Submissions with Spinach Outbreak Pattern to PulseNet, by month, since 2002 Increase due to

• utbreak

Preliminary data

States reporting cases in 0609mlEXH-2

(as of October 6, 2006)

COLORADO OREGON CALIFORNIA NEVADA IDAHO UTAH ARIZONA MONTANA WYOMING WASHINGTON NEW MEXICO NORTH DAKOTA SOUTH DAKOTA NEBRASKA KANSAS OKLAHOMA MINNESOTA IOWA MISSOURI ARKANSAS ILLINOIS WISCONSIN MICHIGAN ALASKA TEXAS HAWAII LOUISIANA KENTUCKY OHIO VIRGINIA TENNESSEE NEW YORK MAINE NEW HAMPSHIRE ALABAMA MASSACHUSETTS RHODE ISLAND CONNECTICUT NEW JERSEY DELAWARE MARYLAND GEORGIA SOUTH CAROLINA New York City VERMONT PUERTO RICO

Preliminary data

States reporting cases

PulseNet International A Family of Networks

• 6 Networks, 67 total participating

countries

Disease Detectives

• Careers in public health

– Epidemiologist – Laboratorian – Public Health Law – Public Health Communication – Physician

• Disease Detectives Camp

– a week-long day camp for rising high school juniors and seniors that exposes students to epidemiology, the field of public health and the diverse career opportunities within the field of public health

• Dates: June 18-21, and July 16-20, 2012
• Times: 8:45-4:00pm
• Location: CDC, 1600 Clifton Road, Atlanta, GA

– http://www.cdc.gov/museum/camp/detective/ – http://www.youtube.com/user/CDCStreamingHealth#p/u/21/7hO5WZ 0oshw

Questions????