Summer of Salmonella sorrow in South East Queensland. P Seal, S Peroni,

Transcription

1 Summer of Salmonella sorrow in South East Queensland P Seal, S Peroni,

2 Outline Salmonella genotyping Food borne illness trends Detecting outbreaks Outbreaks: what does public health do? Outbreaks, outbreaks, outbreaks

3 Salmonella Typhimurium (STm) Most common Salmonella in Australia Traditionally been phage typed (PT) Genotyped by MLVA (Multiple Locus Variable number tandem repeats Analysis) Particularly useful for this serotype but also in others eg. Saint Paul A string of 5 numbers e.g or

4 Salmonella Typhimurium (STm) trends in Qld by MLVA type

5 Detecting outbreak Notifications from GPs (clinically notifiable) Food borne illness in a food handler Food (or water) borne illness in two or more associated cases Members of the public Laboratory notifications But time required (MLVA runs and analysis)

6 Outbreaks

7 What happens in food borne outbreaks? TEAM WORK!...outbreak control team 1. Epidemiology 2. Environmental health 3. Laboratory Human Environmental 4. Other agencies eg. Councils, Safe Food Production Qld (SFPQ)

8 We started off looking forward to Christmas, but.. 10 cases of GI illness associated with eating at a popular cafe between December 8/10 ate deep fried ice-cream (DFI); 2/10 duck (but also DFI) EH inspection poor food handling practices opportunities for cross contamination (confirmed with environmental swabs showing B cereus & Coag + Staph) Lab: frozen stored raw DFI & duck test positive for STm but all ingredients of DFI (eggs, coconut, breadcrumbs) test negative raw & cooked duck from supplier test negative Public Health interventions private food safety consultant engaged to improve cleanliness and food handling practices Trace back of suppliers conducted

9 And meanwhile on the Gold Coast Two separate small outbreaks identified in mid-dec with the same MLVA ( ) Both prestigious locations Epi did not identify any particular food items Buffet meals often mean poor recall of foods EH visits confirmed very high food hygiene practices Traceback conducted

10 Well we managed a couple of Champagnes over the festive Season, until.. 4 th January,141 people (multiple parties) with GI illness at a Chinese Restaurant ate between 2-5 January 2015 (103 confirmed STm strain; 201 patrons int.) Strongest association with DFI Other foods also statistically significantly associated with illness (cross contamination) EH inspection poor food handling practices, opportunities for cross contamination (environmental swabs confirmed B. cereus & Coag + Staph) Lab: STm (MLVA ) strain widely found environmental swabs (cutting boards, sink, freezer door, tea towels) samples (including raw egg cracked in container; stored DFI balls and each individual ingredients, cut raw zucchini, battered chicken) from kitchen Public Health interventions Restaurant licence suspended for 7 days, cancelled and never reopened Extensive trace back of suppliers conducted

11 And whilst in the middle of the other outbreaks. Wham bang!! 16/22 diners on 10 Jan at another Asian Restaurant with GI illness 16/17 who ate DFI ill On EH inspection very poor food handling practices multiple opportunities for cross contamination (confirmed with environmental swabs showing B cereus & Coag + Staph) Lab: STm MLVA (variant of ) strain found in stored frozen DFI, used ingredients and cloths/towels Public Health interventions unlicensed; required building repairs, commercial cleaners employed, staff training in food handling and cleaning/sanitization before given licence for 3 months; then reviewed Trace back of suppliers conducted

12 And just a day or so later.. Multiple reports of people ill after eating Kimbap sushi from various retail outlets in Brisbane 84 ill people interviewed: all ate variety pack so unable to determine exact food vehicle 42 faeces samples positive Sushi producer unable to be contacted No EH inspection possible operator did a runner Public Health interventions Advised retailers to advise MSPHU if any contact with supplier in future No trace back of suppliers of ingredients possible

13 And again on the Gold Coast Reports of food borne illness (FBI) in people attending franchise of sushi stores on the Gold Coast Extensive sampling of sushi products: NO Salmonella Rigorous interviewing revealed that complainants had also consumed chocolate mousse EH inspection of the manufacturer identified raw egg in the mousse Lab detected same STm (MLVA ) in chocolate mousse, cream cheese, baked cheesecake and Death by Chocolate cake Same manufacturer supplied the GC prestigious locations Trace back of eggs same egg farm

14 Investigators getting very tired In mid-feb, 6 Vietnamese children with GI illness who ate sushi sold at tuckshop for weekend education classes On EH inspection Food preparation under a suburban house Poor food handling practices Likely temperature abuse No product left for testing Public Health interventions Unlicensed, ceased preparing food Trace back of suppliers conducted: cracked eggs from the same egg producer found being sold at retail outlet CONSUMER LEVEL RECALL

15 MSPHU again.. (did we actually have any staff available???) Mid Feb 2015 FBI complaints associated with Café A (7 cases) Epi implicated Eggs Benedict EH inspection: bernaise sauce served with Eggs Benedict had no kill step Lab: food samples all negative, faecals positive for STm Traceback of suppliers conducted

16 But at least we re getting used to it Late Feb 2015 Engagement party at Restaurant B with 17/71 people ill Epi implicated the slow roasted duck EH investigations: Chef putting tea towels over raw duck then used for other purposes in kitchen Re-using cardboard boxes that raw duck had been delivered in for storing cooked duck Lab Many environmental swabs from prep area +ve for B. cereus (evidence of cross contamination) Faecals and Tea towel with STm (variant of ) Trace back of duck conducted: not found at supplier

17 And another biggie.. Early March, MSPHU was notified of multiple people attending a national conference becoming ill after eating at a prestigious venue 258 cases of 1418 who attended 2 day event in late Feb; 140 cases of 723 interviewed Epi implicated the rum & raisin bread cake and custard EH: multiple kitchens--difficult investigation Lab 58 cases lab confirmed (54 x STm , 2 x STm ,1 x Stm ) No left over food for sampling Lack of stock rotation of eggs made trace back very difficult

18 And more news While investigating last outbreak, another earlier event held at the same venue reported FBI At least 31 cases (of 1100 attendees) from Qld, interstate and overseas 9 lab confirmed Epi implicated parfait and grilled salmon EH: similar findings UNTIL An item of equipment was swabbed and found positive for the same STm

19 Trace back Extensive food supply trace back did not identify any issues other than: Common egg producers Mid Jan 2015 Drag swabs, boot covers and spent chicken feed from one farm tested positive for STm MLVA and another farm STm MLVA Egg Recalls Salmonella made an issue of Statewide significance because of emergence of this STm strain

20 Current Outbreak Trends

21 Inspection Photos

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37 Moral of the tale Widespread outbreaks of this MLVA ceased following egg recall Sale of eggs with Salmonella on the shell is not illegal Sale of cracked and/or dirty eggs is illegal SO eggs are not a sterile product and require exemplary food handling practices Training, training, training particularly with high risk foods Regulation

38 Acknowledgements & Questions Brisbane City Council Logan City Council Metro South Public Health Unit staff Gold Coast Public Health Unit staff Queensland Health (QH) Forensic & Scientific Services staff QH Communicable Diseases Unit QH Health Protection Unit Special Acknowledgements: V Slinko, A Neill, G Pollard, J Barten, A Khan, K Jarvinen (Metro South Public Health Unit), R Bell, R Stafford (OzFoodNet Queensland), J Bates, L Hiley, G Micalizzi, T Graham (QH Forensic & Scientific Services)