Shiga Toxin Producing E. coli Office of Communicable Disease Epi - - PowerPoint PPT Presentation

Shiga Toxin Producing E. coli

Office of Communicable Disease Epi

Objectives

 Shiga toxin E. coli  Notifications Process  Task Force Initiation/IMT initiation  Operations  Deactivation

Shiga toxin E. Coli

 Epidemiology

 E. Coli O26; symptoms include diarrhea (bloody), nausea,

vomiting, headache. Sever Symptoms HUS can occur but is rare.

 Incubation Period: Avg 3‐4 days (up to 10 days)  Transmission: fecal‐oral  Symptoms generally last 5‐7 days  Estimated US cases annually: 265,000 (under‐diagnosed)  Carrier: Several weeks or chronic shedders (several months)

after symptoms resolve

Case Definition

 Case Definitions

• Case Definition Change 11/16/15 ‐ Any Washington resident

with symptoms consistent with STEC, with an onset on or after Oct 7th and:

 ‐Confirmed (24):

• Culture positive E. coli O26 with PFGE XbaI pattern EVCX01.1180

 ‐Probable/Presumptive (3):

• Culture positive E. coli O26 pending PFGE

 ‐Suspect:

• Dined at Chipotle 1‐10 days prior to symptom onset
• Estimated and reported illness onset dates range from October 19 to

October 31, 2015

Data

• Total as of 11/15/15: 27 cases
• Ages range from 5 years to 60 years (median 21 years)
• 18 (67%) female
• 9 (33%) hospitalized
• No deaths reported / No HUS
• No food items implicated
• 26/27 (96%) ate at Chipotle
• Meal dates range from

October 14 – October 24, 2015

County Total Clark 13 Cowlitz 2 Island 2 King 4 Skagit 6 Total 27

Onset Date (N = 27)

1 2 3 4 5 6 7 8 9 10 10/7/2015 10/8/2015 10/9/2015 10/10/2015 10/11/2015 10/12/2015 10/13/2015 10/14/2015 10/15/2015 10/16/2015 10/17/2015 10/18/2015 10/19/2015 10/20/2015 10/21/2015 10/22/2015 10/23/2015 10/24/2015 10/25/2015 10/26/2015 10/27/2015 10/28/2015 10/29/2015 10/30/2015 10/31/2015 11/1/2015 11/2/2015 11/3/2015 11/4/2015 Case count Date of illness onset Clark Cowlitz King Island Skagit Whatcom

Epi Task Force/IMT Activation

 Activation Determination

 Concept of Operations in Task Force Plan

 Level 1‐4; This was level 3

 More than one local health departments impacted and the

response needs exceed the capacity of the LHJ

 Regional Response approach needed with 5+ LHJs and one other

state involved

 Resource needs to handle response load exceeded DOH

Foodborne/Enteric Team

Timeline of Events

 10/28‐ First E. coli cases occurred in Clark County  10/29‐ Additional cases occurring in King County  10/30‐ Additional cases identified in 3 other WA counties

and Oregon

 10/30‐ Epidemiology Task Force Activated (23 ‘cases’

under investigation at this time)

 11/2‐ DOH PHL IMT activated (Case counts continued to

evolve)

 11/10‐ IMT deactivation

Response Org Chart (ICS)

IC PSC PHL EPH Epi OPS PIO Liaison SitL Deputy IC

Epi Task Force Org Chart

OPSC

Data and Surv Group

Task Force Lead

Data Compiler Statistical Analyst Control Investigation Case Investigation Epi Investigation Group

DOH PHL Response

 Epidemiology Task Force (Epi)

 Hypothesis Generating Questionnaire  Case/Control Study

 Public Health Lab (PHL)

 Shiga toxin testing  Serotyping  PFGE

 Environmental Public Health (EPH)

 Sample collection coordination  Re‐opening recommendations  Trace‐back

 Communications (PIO)

 Media Availability/Press Conferences  Daily updates

IMT Deactivation

 Deactivation Determination

 Daily Partner Meetings  Daily ICS Meetings  Daily Assessment of needs and resources  De‐escalation of response activities

 No new cases

 Case/control studies completed  Epi Analysis complete

 No new testing needed  Re‐opening of implicated chain

 Return to normal ‘daily’ response activities

THANK YOU

 Contact:

 Cynthia Harry, Epi Emergency Preparedness and

Surveillance Section Supervisor

 Phone: (206)418‐5553  Email: cynthia.harry@doh.wa.gov