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Investigation of a Large Foodborne Illness Outbreak in Toronto, Canada

Investigation of a Large Foodborne Illness Outbreak in Toronto, Canada. Sylvanus Thompson PhD, CPHI(C) Associate Director Toronto Public Health. City of Toronto. Largest City in Canada Most multi-cultural city 2.7 million people 17000 Food Establishments

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Investigation of a Large Foodborne Illness Outbreak in Toronto, Canada

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  1. Investigation of a Large Foodborne Illness Outbreak in Toronto, Canada Sylvanus Thompson PhD, CPHI(C) Associate Director Toronto Public Health

  2. City of Toronto • Largest City in Canada • Most multi-cultural city • 2.7 million people • 17000 Food Establishments • 437,00 cases of foodborne illnesses annually • $476 – 587 million • Numerous special events • Canadian National Exhibition (CNE)

  3. Canadian National Exhibition • Canada's largest community event • Founded in 1879 - a showcase of the nation • 7th largest fair in North America • Close to 1.5 million visitors over its 18 day duration • Starts mid August • Ends on Labour Day

  4. Food Building

  5. FBI Outbreak at the CNE • Call from CNE Manager at 10:30 pm-August 20 • Several persons reported being ill shortly after consuming food at a specific outlet • TPH 24/7 On Call system • Dial 311 • CNE advised to ensure premise is kept closed • Secure any left over food product • Control of Communicable Disease Manager informed

  6. FBI Outbreak Investigation • Outbreak included in news • PHI and CDC staff onsite by 8:30 am • Modified HACCP Audit and inspection • Food and environmental samples collected for lab analysis • RTE burgers, bacon jam • Production site of major ingredient inspected and sample taken • Bacon jam sample

  7. Epi Investigation • CDC staff interviewed 257 persons • Standard Outbreak investigation questionnaire • Fluid survey data entry tool • iPHIS • At risk population exposure August 16 –20 • Kits provided for specimen collection • Victims reported • Treated onsite by EMS personnel • Taken to Hospital • Family physician • Food handling staff interviewed

  8. Incubation Period • Short Incubation Period • Mean 4.7 hours • Median 4.0 hours • Range 0.5 – 22.0 hours

  9. Symptoms • Watery diarrhea (83%) • Vomiting (81%) • Nausea (76%) • Abdominal pain (74%) • Loss of appetite (62%) • Headache (43%) • Chills (42%) • Bloody diarrhea (6%)

  10. Inter- Agency Collaboration • Liaise with other affected health units based on where cases reside • Notify to Ministry of Health and Long Term Care • Responsibility for healthcare system • Chairs Outbreak Investigation Coordinating Committee • Inform Public Health Ontario • Public Health Laboratory • Technical support

  11. Outbreak Management • News Release • Implicated premises closed voluntarily • Section 13 Order contemplated • No health hazard identified • Epievidence • No new cases • Follow-up visit to establishment where bacon jam produced • Teaching school • Bakery • Modified HACCP Audit and additional sampling

  12. Laboratory Results • Seven Food samples positive for Staph aureus • 4 RTE burgers with bacon jam • 2 bacon jam • smoked bacon • All samples, except the bacon, had same PFGE pattern and entero-toxin present • All other samples negative

  13. Food sample testing results

  14. Bacon Jam • Bacon jam determined as cause of illness • Media release • Food establishment at the CNE permitted to re-open under specified conditions • no bacon jam from that producer • re-training of all food handlers • thorough cleaning and sanitization • Re-opened on August 27

  15. Epic re-opened (pic)

  16. Bacon Jam Producer • Establishment voluntarily closed • Section 13 issued • Environmental sampling before and after cleaning • Training of food handlers • All samples negative for Staph aureus • More detailed interview of food handlers • Nasal swabs • Permitted to re-open under conditions • modify bacon jam production process • 1 of 4 food handler positive for Staph • unrelated PFGE pattern

  17. Communication • Media releases on timely basis • Actions being taken by TPH • Investigation into source • Lab results • 5 media advisories • 4 press conferences • 190 media calls

  18. http://news.nationalpost.com/2013/08/22/close-to-100-complaints-of-illness-at-cne-as-cronut-burger-maker-still-shut-down/http://news.nationalpost.com/2013/08/22/close-to-100-complaints-of-illness-at-cne-as-cronut-burger-maker-still-shut-down/ http://www.thestar.com/news/gta/2013/08/27/le_dolci_fun_foodie_studio_linked_to_cronut_burger_illnesses.html https://maps.google.ca/maps?ie=UTF-8&q=Superior+Sausage+Co&fb=1&gl=ca&hq=superior+sausage+toronto+hours&cid=0,0,5561172707282629667&ei=0VpbUru9FMXIrQGFsIHQDw&ved=0CLIBEPwSMAs

  19. Lessons Learned • Prompt TPH response • Importance of keeping the public informed and re-assured • Detailed sampling and analysis • Multi – agency coordination and response Resulted in quick identification of the implicated food and end outbreak!

  20. Quick identification of the implicated food and end outbreak!

  21. Sylvanus Thompsonsthomps@toronto.ca416 338 3661

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