Multistate Listeria Outbreak: The New Mexico Perspective Nicole - PowerPoint PPT Presentation

Multistate Listeria Outbreak: The New Mexico Perspective Nicole West Arizona Infectious Disease Training and Exercise July 23, 2015

Listeriosis • Caused by bacterium Listeria monocytogenes • Annually causes 1,600 illnesses and 260 deaths in the U.S. • Incubation period of 3-70 days • Symptoms usually include fever, aches, and GI illness; septicemia, meningitis, and birth complications in severe cases • Pregnant women, adults > 65, and immunocompromised are at greatest risk for invasive disease

Epidemiologic Investigation • NMDOH notified of Listeria in a child on Oct. 23, an adult on Nov. 10, and a neonate on Nov. 13 • Nov. 14: Reached out to AZ and CO; CDC notified ◦ Early link: 2 young Native American boys in AZ and NM • Nov. 21: CDC begins coordination of multistate investigation ◦ 5 PFGE-matched cases in 4 states (AZ, CO, NM, WI) • Investigation combined with cluster originating in MN

Next Steps Food Histories Grocery Stores A lot of head scratching Epi Curves Epi Data

Caramel Apples • Dec. 15: CDC requests inquiry regarding caramel apple exposure ◦ Later that evening: 7/8 say “yes” • Dec. 19: CDC posts outbreak ◦ 28 ill; 15/18 say “yes” • Additional product information sought • Traceback pinpoints Bidart Brothers

Epi Curve of Outbreak Cases Oct. 15, 2014 – Feb. 02, 2015 (n=35)

Cases by state of residence As of Feb. 15, 2015 (n=35)

Whole Genome Sequencing Results w g M LS T (<All C haracters>) 100 R C cdc_id K Id State ID PFGE -AscI-patter n P FGE-Ap aI-p attern Ou tb reak IsolatDate S R U P P Sou rceState S our ceTyp e Sou rceSite 50 60 70 80 90 . . FD A00008711 F C F__824917-3A GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-12-23 MO . . F ood Granny Sm ith Apples Median [min-max] . . FD A00008715 F C F__824917-7A GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-12-23 . . MO F ood Granny Sm ith Apples . 2014L-6707 PN U SAL001180 AZ ___AZ00023560 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS . . AZ . . H um an CSF allele differences . 2014L-6790 PN U SAL001215 N V___C L2014-00024194 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-12-11 . . NV . . . H um an Blood . FD A00008671 F C F__870215-39 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-12-23 . . CA E nvironm ental Envirom ental Swab at node . FD A00008672 F C F__870215-41 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-12-23 . CA . E nvironm ental Envirom ental Swab . FD A00008673 F C F__870215-44 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-12-23 CA . . E nvironm ental Envirom ental Swab . . FD A00008712 F C F__824917-4A GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-12-23 . MO . F ood Granny Sm ith Apples 2015L-6028 . PN U SAL001289 AZ ___AZ00025892 GX6A16.0012 G X6A12.0126 1411M LGX6-1W GS 2015-01-07 AZ . . . . . H um an Blood . PN U SAL001167 M N ___C 2014019515 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-11-06 MN . . . . . H um an Hip fluid 2014L-6716 . PN U SAL001188 T X___T XACB1403719 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-11-05 . . . . TX . H um an Left Arm . FD A00008676 F C F__870215-106 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-12-23 . . CA E nvironm ental Envirom ental Swab . . C FSAN 028866 M N ___C 2015000414 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2015-01-06 MN . . . F ood . 2014L-6756 PN U SAL001225 C D C __M14-133 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS . . . . MO H um an CSF 2014L-6704 . PN U SAL001177 W I___14MP008990 GX6A16.0012 G X6A12.0126 1411M LGX6-1W GS 2014-11-09 . . . W I . . H um an CSF . 2015L-6017 PN U SAL001313 C A___M 14X06722 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-11-09 . . CA . . . H um an Blood . . FD A00008714 F C F__824917-6A GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-12-23 . . MO F ood Granny Sm ith Apples 2014L-6730 . PN U SAL001202 N M ___2014035887 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-11-17 . . . NM . H um an Blood . 2014L-6787 PN U SAL001257 C A___M 14X06515 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-11-27 . CA . . . . H um an Blood . 2014L-6684 PN U SAL001157 C D C __M14-119 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-10-26 MO . . . . H um an Blood . 2014L-6710 PN U SAL001182 C D C __M14-124 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-11-09 . . MO . . . H um an Blood 2014L-6680 . PN U SAL001146 M N ___C 2014019204 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-10-29 . . . . MN . H um an Blood . PN U SAL001168 M N ___C 2014019628 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-11-08 . MN . . . . H um an Blood 2014L-6751 . PN U SAL001220 N C ___M B120114-0028 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-11-14 . NC . . . . H um an Blood 4 [0-13] 2014L-6737 . PN U SAL001209 T X___T XACB1403739 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-11-12 . . . . . TX H um an Blood 2014L-6784 . PN U SAL001254 W I___14MP009827 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-11-26 W I . . . . . H um an Blood 2015L-6026 . PN U SAL001312 C O___H U M -2015001070 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2015-01-07 . . . . . CO H um an Blood . FD A00008670 F C F__870215-3 GX6A16.0012 G X6A12.0696 1411M LGX6-1W GS 2014-12-23 CA . . E nvironm ental Envirom ental Swab 2014L-6677 . PN U SAL001151 W I___14MP008696 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-10-29 . . W I . . . H um an Blood 2014L-6766 . PN U SAL001237 M N ___C 2014020760 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-11-22 . . . . H um an Blood 2014L-6714 . PN U SAL001186 N M ___2014035025 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-11-08 . . NM . . H um an Blood 2014L-6723 . PN U SAL001195 C D C __M14-127 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-11-06 MO . . . . . H um an Blood . FD A00008675 F C F__870215-100 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-12-23 . . CA E nvironm ental Envirom ental Swab . . C FSAN 028867 M N ___C 2015000416 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2015-01-06 . MN . . F ood . 2014L-6788 PN U SAL001258 N M ___2014038352 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-12-06 . . . . . NM H um an Blood . FD A00008674 F C F__870215-63 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-12-23 . . CA E nvironm ental Envirom ental Swab . 2014L-6736 PN U SAL001208 T X___T XACB1403743 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-11-03 TX . . . . . H um an Blood 1555 [0-1696] 2014L-6660 . PN U SAL001135 C D C __2014033414 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-10-21 . . . NM . . H um an CSF . 2014L-6732 PN U SAL001204 U T___0901244 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-11-18 . . . UT . . H um an Sputum . 14-8656 PN C __14-8656 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS . . MB . H um an . 2014L-6656 PN U SAL001131 T X___T XACB1403543 GX6A16 G X6A12.0349 1411M LGX6-1W GS 2014-10-17 TX . . . . . H um an Blood . 2014L-6724 PN U SAL001196 AZ ___AZ00023800 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-11-08 . AZ . . . . H um an Blood . 2014L-6695 PN U SAL001166 C D C __M14-123 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-11-02 . MO . . . . H um an placenta 2014L-6681 . PN U SAL001154 AZ ___AZ00023172 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-10-20 . . . . AZ . H um an Blood . 2015L-6033 PN U SAL001264 C A___M 15X00142 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2015-01-01 CA . . . . . H um an Blood 2014L-6752 . PN U SAL001221 AZ ___AZ00024032 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-11-19 . . . . AZ . H um an Blood . PN U SAL001169 W A___20278 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-11-13 . . . . . W A H um an Cerebros pinal fluid, N OS . . FD A00008716 F C F__824917-10A GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-12-23 . . MO F ood Granny Sm ith Apples 5 [0-14] . 2014L-6748 PN U SAL001218 T X___T XACB1403761 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-11-21 . . . . NM . H um an Blood . . FD A00008713 F C F__824917-5A GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-12-23 . . MO F ood Granny Sm ith Apples 2014L-6713 . PN U SAL001185 N M ___2014035347 GX6A16.0135 G X6A12.0349 1411M LGX6-1W GS 2014-11-07 . NM . . . . H um an Ascites fluid

Summary • Total: 35 cases in 12 states, 34 hospitalizations, 7 deaths; 28/31 reported eating caramel apples ◦ NM: 6 cases, 6 hospitalizations, 0 deaths* • Bidart Brothers issued voluntary recall of Granny Smith and Gala apples on Jan. 6 • Many difficulties: Long incubation period, recall, seasonal food • Utility of WGS, combined with traditional epidemiologic investigation

Acknowledgements • NMDOH Scientific Laboratory Division and Public Health Division • Indian Health Services Public Health Nursing • Arizona Department of Health Services • Centers for Disease Control and Prevention

Any questions? Nicole West Foodborne and Waterborne Disease Epidemiologist Nicole.West@state.nm.us