Synchronization of foodborne disease seasonality Elena N. Naumova, - PowerPoint PPT Presentation

Synchronization of foodborne disease seasonality Elena N. Naumova, Ryan Simpson Aishwarya Venkat, Bingjie Zhou Gerald J. and Dorothy R. Friedman School May 27 th , 2019 of Nutrition Science and Policy University of Vermont, Burlington, VT Boston, MA USA Symposium on Networks in Food Systems & Nutrition

Food Systems are complex and dynamic with potential for contamination at almost every node or link Source: https://foodtechconnect.com/2010/0 7/29/exploring-relationships-in-the- food-system-map /

Food supply chains are stretching nationwide Source: https://www.gopopro.com/starters/2015/4/14/mcdonalds Source: http://fortune.com/2017/06/16/amazon-whole-foods-stores-locations/ Source:https://www.nass.usda.gov/Publications/AgCensus/2007/Online_Highligh ts/Ag_Atlas_Maps/Economics/Farm_Related_Income_and_Direct_Sales/07- M038.php Source: https://www.businessinsider.com/biggest-food-chains-in-america-maps-2016-11

Food Recalls = Supply Chain Inefficiencies Health alert issues for salads, You May Be at Higher Risk of The Tremendous Cost of Potential Hepatitis A Exposure wraps from Kroger, Trader’s Eating Contaminated Food from McDonalds Restaurant Foodborne Illnesses, and What Joe’s, Walgreens due to parasite During the Government Worker - Again to Do About It concerns Shutdown TIME (Jan. 10, 2019) QSR Magazine (Dec. 17, 2018) Food Poison Journal (Mar. 28, 2019) CNN (Aug. 01, 2018) FDA restarts food inspections, Chipotle to retrain all workers on The Staggering Costs of Foodborne Chicken Is the Number One Cause food safety after Ohio episode mainly with furloughed workers Illness Incidents CS News (Aug. of Foodborne Illness Outbreaks. CIDRAP (Jan. 15, 2019) USA Today (Aug. 16, 2018) 14 2018) Here’s How to Stay Safe Health (Feb. 11, 2019) The key role farm workers play in Will the foodservice industry ever Study: Foodborne Illness Outbreak knock down it’s brick wall of Could Cost a Restaurant Millions produce safety These Are the Foods That Cause Food Safety News (Oct. 21, 2018) Claims Journal (Apr. 26, 2018) denial? the Most Illnesses, the CDC Says Food Safety News (Oct. 04, 2018) Self (Jul. 30, 2018) USDA: US Foodborne Illnesses Cost Farmers’ market vendors need Economics of Food Safety More Than $15.6 Billion training to improve food-safety Should You Throw Out Your Convenience Store Decisions practices Annually Avocados? What to Know About Food Safety News (Oct. 08, 2014) (May. 11, 2018) Science Daily (Nov. 03, 2018) the Recall Healthline (Mar. 26, 2019) Source: https://consultqd.clevelandclinic.org/collaboration-with-cdc-uncovers-genetic-risk-for-foodborne-disease/

Hospitalizations due to Salmonellosis, USA Salmonella Infection 72% variability is explained by in the USA elderly seasonal and trend components Summer time: 1998 1999 2000 2001 2002 Many infectious diseases exhibit a 70 s strong seasonal e s 60 a pattern distinct for a c f specific pathogen in a o 50 r given population and e b 40 m locality. u n 30 What is driving 20 disease seasonality? 10 0 50 100 150 200 250 time in weeks Chui K, Webb P, Russell RM, Naumova EN. Geographic variations and temporal trends of Salmonella -associated hospitalization in the US elderly, 1991-2004: A time series analysis of the impact of HACCP regulation. BMC Public Health . 2009. 9(1):447

Simple Seasonal Pattern JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 45 40 35 30 25 20 15 1 16 31 46 61 76 91 106 121 136 151 166 181 196 211 226 241 256 271 286 301 316 331 346 361 TIME IN DAYS Time of Disease Incidence Maximum

Seasonal pattern with two peaks JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 115 Lag 105 95 Amplitude of 1 st Seasonal Peak 85 Amplitude of 2 nd Seasonal 75 Peak 65 55 1 16 31 46 61 76 91 106 121 136 151 166 181 196 211 226 241 256 271 286 301 316 331 346 361 TIME IN DAYS Time of the 1 st Seasonal Peak Time of the 2 nd Seasonal Peak

Standardizing Seasonality Features Seasonality can be defined by: Peak Timing 1. Timing of maximum incidence ( Peak Timing) 2. Magnitude of peak Incidence incidence (Amplitude) Amplitude 3. Duration of peak incidence (Duration) 4. Rate of incidence change from nadir to peak (Acceleration) 5. Rate of incidence change from peak to nadir Source: Naumova, E. N. (2006). Mystery of seasonality: getting the rhythm of nature. Journal of public health policy , 27 (1), 2-12. (Deceleration) Consistent and systematic characterization of a temporal disease pattern

δ -Method has been applied to trend- adjusted Negative Binomial regression models to estimate peak timing, amplitude, and their measures of uncertainty. Time (months) Alarcon, T. F., Cruz, M. S., & Naumova, E. N. (2018). The shift in seasonality of legionellosis in the USA. Epidemiology and infection , 146 (14), 1824-1833.

Synchronization of Peak Timing • Phase synchronization is observed when peak timing estimates overlap SYNCHRONOUS (given their narrow 95% CI) • The width of CIs inform stability of 1 : recurring or operating at the same time or periods peak timing estimates • Phase-amplitude synchronization is 2 : having the same period, phase, observed when peak timing correlates amplitude or any combination with amplitude of seasonality metrics Amplitude Calibration STABLE • Anchoring magnitude of seasonal 1 : firmly established; fixed, incidence by their nadir values in de- steadfast trended time series • Enables comparison of inter-annual 2 : not changing or fluctuating; unvarying amplitude estimates and variability of these estimates Naumova, Elena N., et al. "Seasonality in six enterically transmitted diseases and ambient temperature." Epidemiology & Infection 135.2 (2007): 281-292.

Questions: ❑ How stable is peak timing for specific infections? ❑ How well are peak timing and amplitude synchronized for specific infections? ❑ How well are peak timing and amplitude synchronized across locations?

Yersinia enterocolitica FoodNet Fast Surveillance Data: Vibrio Jan 1996 – Dec 2017 Shigella Salmonella Listeria Escherichia Campylobacter Cryptosporidium Cyclospora Source: https://www.cdc.gov/foodnet/sites.html https://www.cdc.gov/foodnet/PDFs/2007_annual_report_508.pdf

Annualized phase- amplitude synchronization Synchronization Year of Study between peak timing ➢ The upper panel displays a and amplitude over time forest plot of annual peak timing estimates. ➢ The low panel displays a forest plot of annual amplitude estimates. ➢ Dashed red lines indicate the average peak timing and amplitude estimates for the full time series. ➢ The two original panels Amplitude contributes to a scatterplot across the shared peak timing and amplitude axes (with 95% CI) to assess possible synchronization and trends over time for peak timing and amplitude shift. Year of Study Peak Timing (Month)

Salmonella Cross-state analysis can Peak Timing inform national surveillance across 10 states ➢ Cross-state synchronization could enable triangulation of disease incidence across states in the absence of sufficient surveillance information ➢ A more refined temporal and spatial data resolution offers a better ability to distinguish changes from noise or artifacts of surveillance system ➢ State participation is patchy (Pop in M) Salmonella peak 97 98 99 00 01 02 03 2004 – 2017* ➢ y CA 1.92 1.94 1.96 3.18 3.22 3.21 3.21 3.21 – 3.69 timing estimates show CO 2.10 2.46 2.51 2.53 – 3.15 summer peak across CT 1.62 3.27 3.28 3.40 3.41 3.43 3.46 3.49 – 3.59 GA 3.66 3.78 7.78 8.52 8.62 8.77 9.07 9.15 – 10.43 states, yet earlier peak MD 2.44 2.45 2.52 4.24 5.43 5.50 5.55 – 6.05 in states with shorter ➢ MN 4.69 4.73 4.78 4.93 4.98 5.02 5.05 5.09 – 5.58 NM 1.90 – 2.09 growing season NY 1.11 2.08 2.12 2.12 3.34 3.98 4.15 – 4.34 OR 3.24 3.28 3.32 3.43 3.47 3.51 3.55 3.57 – 4.14 TN 2.88 2.91 2.95 5.84 5.91 – 6.72

Phase – phase and phase – Peak Timing and amplitude Amplitude synchronization Synchronization for Location Salmonellosis in 10 U.S. ➢ States Synchronization & stability serve as tools for assessing drifts in peak timing and amplitude estimates. ➢ A deeper understanding of drivers for phase-amplitude synchronization may yield new insights into interactions within Amplitude food systems. ➢ Comparisons across geographic locations for the same disease provides insight on possibility for multi-state outbreaks Peak Timing Location

Synchronization of peak Peak Timing for 9 foodborne infections in US timing across pathogens ① Except Yersinia all notifiable infections peaked during the 3- month “summer months” period Bacterial Infections (June to September). ② Except Cyclospora seven infections peaked between mid- July to mid-August: STEC, Salmonella, & Vibrio have synchronized peak near end of July (7.6-7.9 month) Cryptosporidium, Shigella, & Protozoa Listeria have synchronized peak in August (8.0-9.0 month)