Detection & Investigation of a Large Campylobacter Outbreak - PowerPoint PPT Presentation

Detection & Investigation of a Large Campylobacter Outbreak Associated with Raw Milk Cindy Burnett, MPH Utah Department of Health One Health Conference, 10/1/15

Campylobacter jejuni Reportable in Utah Gram negative bacteria Outbreaks: poultry, contaminated water, raw milk Incubation: 2-5 days Symptoms: fever, diarrhea Stringent survival/growth requirements

Campylobacter sources

Outbreak - Background In May 2014, three Campylobacter isolates with indistinguishable PFGE patterns

Investigation All 3 reported drinking raw milk

Nothing new here…. 14 outbreaks of Campylobacter due to raw milk since 2009

Raw Milk Laws in Utah Permit issued by UDAF • Milk sold directly by farm • Labeling requirements • Record keeping • Regular testing • If illness – permit may be suspended until milk tests negative for pathogen

UDAF Dairy Inspection June 16 • 10 cases identified • No violations found • Bulk tank samples negative for Campylobacter June 20 • Problem with cooling bulk tank • Bulk tank samples negative for Campylobacter

Cases Continue Number of Outbreak Cases Reported Through July 29, 2014 Investigation Began 14 12 10 8 6 4 2 0

Collaborative Inspection July 29, 2014 • UDAF, Epi and UPHL • Milk neutralized onsite • Sample positive for C. jejuni • Dairy’s license suspended Aug. 4

Success? Number of Outbreak Cases Reported Through October 1, 2014 Investigation Began 14 12 10 Raw milk 8 permit suspended Raw milk 6 permit reinstated 4 2 0

Permit Revoked Number of Outbreak Cases Reported Through July 29, 2014 Investigation Began 14 12 10 Raw milk 8 permit Raw milk Raw milk suspended permit permit 6 revoked reinstated 4 2 0

Exposures of All Cases (n = 99) Exposure No. (%) Dairy A Raw Milk 53 (54%) Mexican-style Cheese (Queso Fresco) 21 (21%) Unknown Source 25 (25%)

Exposures of All Cases (n = 99) Exposure No. (%) Dairy A Raw Milk 53 (54%) Mexican-style Cheese (Queso Fresco) 21 (21%) Unknown Source 25 (25%)

Demographics of Cases (n = 99) Characteristic No. (%) Male 58 (59%) Hispanic 31 (31%) Age (years) 0-5 11 (11%) 6-18 32 (32%) 19-64 44 (44%) ≥65 4 (4%)

Demographics of Cases (n = 99) Characteristic No. (%) Male 58 (59%) Hispanic 31 (31%) Age (years) 0-5 11 (11%) 6-18 32 (32%) 19-64 44 (44%) ≥65 4 (4%)

Demographics of Cases (n = 99) Characteristic No. (%) Male 58 (59%) Hispanic 31 (31%) Age (years) 0-5 11 (11%) 6-18 32 (32%) 19-64 44 (44%) ≥65 4 (4%) Hospitalized 10 (10%)

Demographics of Cases (n = 99) Characteristic No. (%) Male 58 (59%) Hispanic 31 (31%) Age (years) 0-5 11 (11%) 6-18 32 (32%) 19-64 44 (44%) ≥65 4 (4%) Hospitalized 10 (10%) Died 1 (1%)

Conclusions Routine testing of raw milk does not ensure safety Proper pathogen testing is essential for regulatory efforts during outbreaks Raw milk is an important source of Campylobacter infections in Utah Raw milk consumption should be discouraged

Questions? cburnett@utah.gov www.igotsick.health.utah.gov