Massachusetts 2015 Vibrio parahaemolyticus Presentation Johanna Vostok, MPH Massachusetts Department of Public Health Scott Troppy, MPH, PMP Massachusetts Department of Public Health
Overview • Vibrio parahaemolyticus (Vp) and oysters • National and statewide trends • Summary of 2013 Vibrio season • Review changes made to Vibrio events in MAVEN, implemented May 2014 • Summary of 2014 Vibrio season • What to expect this year
VIBRIO PARAHAEMOLYTICUS & OYSTERS
What is is Vp? Vibrio parahaemolyticus , or Vp, is a bacterium that naturally lives off the coast of the United States and Canada and causes gastrointestinal illness in humans when consumed • Is part of the same family of bacteria that cause cholera
Where does Vp come from? • Vp naturally lives in brackish water along the coast of Massachusetts • Brackish water is water that has more salinity than fresh water, but not as much as seawater • May result from seawater mixing with freshwater, as in estuaries • It is not an indication of pollution • Thrives in low ‐ salt, high temperature environments • Present in higher concentrations during the summer
What type of illness does Vp cause? Watery diarrhea, often with abdominal cramping, nausea, vomiting, Clinical and fever. Less commonly, wound or soft tissue infections. features Occasionally blood stream infections. Incubation Less than 24 hours period Most persons recover after 3 days and suffer no long ‐ term Duration consequences. Everyone is at risk of infection. Individuals with underlying medical Risk groups conditions, such as alcoholism and liver disease, may be at increased risk of infection and serious complications.
How is Vp diagnosed and treated? Diagnosis • Vibrio organisms can be isolated from stool, wound or blood cultures Treatment • In most cases, no treatment necessary • No evidence indicating antibiotic treatment decreases the severity or length of illness • Re ‐ hydration recommended from fluids lost due to diarrhea
How does illness with Vp occur? • People become infected by eating raw or undercooked shellfish, especially oysters • Less commonly, Vp can cause an infection in the skin when an open wound is exposed to warm seawater • Documented in shellfish on Cape Cod as early as 1972* * Earle and Crisley Appl. Environ. Microbiol., 1975
Why oysters? Oysters are filter feeders • Feed on particles (algae) in surrounding seawater by filtering water through gills • Each oyster filters up to 5 liters of water per hour • Oysters can accumulate Vp as they filter water – may result in concentrations 100 times greater than those found in surrounding seawater Potential for time ‐ temperature abuse after harvest • Promote growth of bacteria Consumed raw • No opportunity for Vp to be killed
NATIONAL & STATEWIDE TRENDS
Relative rates of culture ‐ confirmed infections compared with 2006–2008 rates, by year — FoodNet, United States, 2006–2013 MMWR April 18, 2014
Confirmed Vibrio cases in Massachusetts by species, May 1 – October 31 100 80 90 70 80 60 Number of cases 70 Percent VP 50 60 50 40 40 30 63 30 20 20 39 32 10 22 10 20 20 8 0 0 2008 2009 2010 2011 2012 2013 2014 Year Vibrio parahaemolyticus Vibrio fluvialis Vibrio alginolyticus Other Vibrio species Percent Vibrio parahaemolyticus (VP) Data as of April 21, 2015
2013 VIBRIO SEASON
Vibrio parahaemolyticus cases in Massachusetts, 2013: week reported to MDPH vs. week of seafood consumption 14 Recall Closure 12 Number of cases 10 8 6 4 2 0 Week Reported to MDPH Consumption of oysters Consumption of other seafood 5 VP cases with oyster exposure and no consumption date; 18 with no or unknown seafood consumption.
2013 Challenges • Burdensome to identify new cases in MAVEN • Two surveillance systems used for case investigation: MAVEN & COVIS • Cumbersome to share information between programs • Difficult to aggregate data, delaying public health action
CHANGES MADE TO VIBRIO EVENTS IN MAVEN
Cholera and Other Vibrio Illness Surveillance (COVIS)
Vibrio treated as an immediate disease from May 1 st – October 31 st
Notes from the Epi ‐ of ‐ the ‐ day (EOD) regarding next steps for investigation Vp or Vibrio species in stool Not Vp or Vibrio species in non ‐ stool specimen Old case
Vibrio Events in MAVEN
Clinical Question Package
Clinical Question Package
Risk/Exposure/Control & Prevention QPKG
Risk/Exposure/Control & Prevention QPKG
New Traceback Question Package for the MDPH Food Protection Program
2014 VIBRIO SEASON
Vibrio parahaemolyticus cases in Massachusetts, 2014: week reported to MDPH vs. week of seafood consumption 14 Closure 12 Number of cases 10 8 6 4 2 0 Week Reported to MDPH Consumption of oysters Consumption of other seafood 3 VP cases with oyster exposure and no consumption date; 8 with no or unknown seafood consumption.
Timeliness of Investigation n Median Min Max Consumption ↓ 19 1 0 4 Symptom onset ↓ 26 4.5 0 9 Lab specimen collected ↓ 28 5.5 0 19 Vibrio parahaemolyticus identified ↓ 28 1 0 18 Report to MDPH ↓ 28 4 0 29 Completion of CRF
WHAT TO EXPECT THIS YEAR
The 2015 Vp Season • No additional changes have been made to MAVEN • Same protocol as last year: • Vibrio events will be treated as immediate events from May 1st – October 31st • MDPH epidemiologists will work with LBOHs to obtain case interview within 24 hours of report of a case
Tips for Case Interview • WE NEED DETAILS! • Case having difficulty recalling date, time, or location of purchase: • Did case pay using credit or debit card? Ask to look up bill/statement. • Did case save paper receipt? • Google ‐‐ for restaurant name, items served on menu. • Restaurant consumption of oysters: • Were oysters consumed during happy hour, as an appetizer, or as a meal? • Was a specific type of oyster ordered? • Are oyster types listed on restaurant/retail receipt?
Additional Resources • Vibrio parahaemolyticus Fact Sheet http://www.mass.gov/eohhs/docs/dph/cdc/factsheets/vibrio.pdf
Additional Resources • Vibriosis Chapter in Guide to Surveillance http://www.mass.gov/eohhs/docs/dph/disease ‐ reporting/guide/vibriosis ‐ june ‐ 2014.pdf
Thank you MAVEN Questions: isishelp@state.ma.us 617 ‐ 983 ‐ 6801 Case Follow ‐ up Questions: 617 ‐ 983 ‐ 6800
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