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 7 th 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 County Total • 9 (33%) hospitalized Clark 13 • No deaths reported / No HUS Cowlitz 2 • No food items implicated Island 2 • 26/27 (96%) ate at Chipotle King 4 • Meal dates range from Skagit 6 October 14 – October 24, 2015 Total 27

Onset Date (N = 27) Case count 10 0 1 2 3 4 5 6 7 8 9 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 Date of illness onset 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 Whatcom Skagit Island King Cowlitz Clark

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) Deputy IC IC OPS PSC Liaison PIO Epi SitL EPH PHL

Epi Task Force Org Chart OPSC Task Force Lead Data and Surv Group Epi Investigation Group Data Compiler Case Investigation Statistical Analyst Control Investigation

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