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Interactive Event

Interactive Event. Condensed Table Top Exercise For San Joaquin County Adapted from an exercise by CDFA, CDHS, FDA and others. Monday June 5. 9-11:00pm – San Joaquin General Hospital ER receives seven unrelated children with difficulty reading, slurred speech & choking on evening meal.

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Interactive Event

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  1. Interactive Event Condensed Table Top Exercise For San Joaquin County Adapted from an exercise by CDFA, CDHS, FDA and others

  2. Monday June 5 • 9-11:00pm – San Joaquin General Hospital ER receives seven unrelated children with difficulty reading, slurred speech & choking on evening meal. • Presumptive diagnosis is botulism • What happens next?

  3. Tuesday June 6 • 8:00 am – Most ER’s in San Joaquin and Sacramento Counties are seeing an increase in pediatric patients & some adults. Similar symptoms reported, including dizziness, fatigue, dry mouth, and double vision. • 10 am Conference Call Scheduled – Who needs to be there?

  4. Work Group Discussion # 1 • Based on information provided discuss: • What is going on? • Any suspect cause or causes? • Who are involved in response? • Record answers on flip chart

  5. Inject 1: Tuesday , June 6, 9:00am • First Cases – • Additional cases reported-

  6. First Conference Call: Tuesday, June 6, 1100 hours • Roll-call • County public health (San Joaquin and Sacramento counties), CDPH-DCDC, CDPH-FDB, CDC, FDA • Anyone Missing - If so, How do you reach out? (Are your contact lists current?)

  7. First Conference Call Tuesday, June 6, 11:00 am • Review descriptive epidemiology • Many cases are children • Some of the adult cases work in schools • No common event reported • Tentatively classified as food-borne • Local and state epidemiologists are working round the clock to conduct interviews • The media is calling county and state public health departments seeking information • Concern expressed that this was an intentional contamination event

  8. Summary of content of case investigation form for neurologic illness • Demographic information • Signs and symptoms • Past medical and social history • Hospital info • Physical exam • Lab test results • Initial treatment • Discharge information

  9. Summary of content of case investigation form for neurologic illness • Risk exposure questions • Pertain to 2-week period prior to onset • Describe your job/volunteer duties • Anyone else at your workplace have similar symptoms? • Do you know anyone else with similar symptoms • Travel? • Public functions attended? • Types of transportation used

  10. Summary of content of case investigation form for neurologic illness • Food and beverage questions • Types of food establishments where food consumed • Time and place, food consumed for each • Any free food samples? • Any supplements? • Unpasteurized products? • Mail order foods? • Water sources

  11. Tuesday June 6 at 3:00 pm • Number of ill is rising rapidly • Law enforcement has been informed of possible tampering • Largest number of ill are in 5-18 year old age group • Hypothesis-generating interviews indicate that the common exposure of most of the children was eating lunch at school • Some adults report eating lunch at school, others ate at a deli chain that serves the Sacramento area • Epidemiologists are reviewing school lunch menus for schools of affected children and developing a questionnaire

  12. Wednesday June 7 • Some patients experiencing respiratory difficulty. Additional respirators requested by hospitals. • Number of ill now exceeds 500. Additional antitoxin requested from CDC. • Worried parents are bringing children to emergency rooms that are not seriously ill. • 911 lines are overloaded • 2:30 pm - 3 deaths reported • Epi results indicate milk is possible vehicle. Conference call scheduled for 3 pm. CDFA and FBI invited to join.

  13. Work Group Discussion # 2 • Based on information provided discuss: • Next steps? • What information should be provided to the public? • What is my organization’s role? • How do I provide assistance if not directly involved? • Who is involved in response? Who needs to be involved, but isn’t?

  14. Inject 2: Conference call Wednesday June 7 at 3 pm • Epidemiology reviewed

  15. Third Conference Call Thursday June 8, 0630 • Roll-Call • New information • In San Joaquin County most victims had consumed milk at schools • Low fat milk in ½ pints were consumed at schools • Other victims had consumed either low fat or reduced fat milk • Whole milk did not appear to be implicated • Incriminated milk had one sell-by date • Incriminated milk had one plant ID# • Plant # belongs to a new plant in San Joaquin County (Note: Next 5 Slides are Reference Slides for Badger Creek Milk)

  16. Reference Slide 1: Fictional Milk Processor • Name: Badger Creek Milk Co. • Location: Lodi, CA • Company goal: Become a leader in the California organic milk market • Plant Description: Moderate sized, Grade A facility. Fluid milk bottling with an on-site evaporator

  17. Reference Slide 2: Fictional Milk Processor Badger Creek Milk Inc. • Milk Supply: Purchases milk from 25 local organic dairies, and a California based dairy cooperative • Customers Include: 1. California State University, Sacramento 2. Stockton, Tracy, Lodi, Manteca, and Elk Grove Unified School Districts 3. National made to order sandwich chain (“Deli”) • Surplus cream and condensed sold to large San Diego manufacturing plant

  18. Reference Slide 3: Badger Creek Milk Co., Plant Diagram

  19. Reference Slide 4: Low Fat Milk made for Schools and Deli • Sunday June 4, 11:00 pm: Used 17,200 gal of raw milk Silo A (uncontaminated) and 1,041 gallons of condensed to produce: • 1,255 gal of cream • 16,985 gal of low-fat milk (160,000 half pints for schools) (111,776 half pints for Deli)

  20. Reference Slide 5:Production Details • Milk received 7 days/week, used within 24 to 48 hours.   • All school districts purchase half pints of Lowfat milk • Deli purchases half pints of whole milk, reduced fat milk, and lowfat milk • Half pints are produced Sunday and Wednesday (distributed Monday and Thursday)

  21. Third Conference Call Thursday June 8 0630 • Topics during call: • Any remaining half-pints of milk must be embargoed immediately. How will this be done? • Might consumers have this product in their refrigerators? • The good news is that only one plant appears involved (at this time). Consumers who do not have this brand (and sell by date) need not be concerned. • How do you convince consumers that the problem is not more widespread? How can we be sure that no other product is contaminated? (Whole milk involved?)

  22. Inject 3: Work Group Discussion # 3

  23. Fourth Conference Call Thursday June 8, 11:30 • Roll-Call - Topics for this call • Situation update • What do you do with the remaining suspect milk (in plant, at distributors, at retail, in homes, in disposal bins at schools or elsewhere)? • Collection and disposal issues • How can you handle uncontaminated yet unwanted milk from the unaffected dairies and plants? • Are there safety precautions necessary when handling contaminated milk or containers? • What needs to decontaminated and how? • How can it be destroyed? (Note: Situation update is summarized next 2 slides)

  24. Info Presented on Call –Deaths by City up to 10:30 AM on June 8th

  25. Deaths by Age-Group and City

  26. Inject 4: Work Group Discussion (4)

  27. LABORATORY RESPONSE & RECOVERY

  28. RESPONSE TO EVENT • Who calls in the Labs & What Lab support is needed? • Capability : • Who can handle & analyze samples? • Which Food Testing Laboratories ? • Capacity: • How many Samples? • Which Product(s)?

  29. RESPONSE –con’t • Based on Current information: • Capability : • Only 5 Food testing labs available in CA can analyze milk samples. • Lab Locations: • Davis (CAHFS), Alameda (FDA), Irvine (FDA), • Fresno (County PHL) , Richmond (CDHS-FDLB)

  30. RESPONSE –con’t • Capacity: • Davis, Fresno, Richmond, Irvine can analyze 25 samples in a 24hrs period (100/day for 4 days) • Alameda Lab has same capacity as other labs, but Instrument is down & Won’t be back on-line for 5 days. (from 6/13 Capacity will be 125 samples a day)

  31. RECOVERY • What Lab support will be needed to work thru this phase? • Assume Capacity is same • Do we need more labs? • If so – How will you obtain or access additional Laboratories? • What Lab networks are out there?

  32. Inject 5 -Work Group Discussion Lab Questions “?’s”

  33. Summarize Info • Group Discussion

  34. Badger Creek Milk Inc. Event Overview • 2,500 gallons of raw milk in a dairy farm tank was contaminated with 2 grams pure botulinum toxin, type A

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