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Number of Salmonella per gram. Effect of Temperature in Salmonella Growth. 50 o F (10 o C). 95 o F (35 o C). 44 o F (6.7 o C). 42 o F (5.5 o C). 3. 4. 5. 1. 2. Days. Incubation Periods. Cooked ham, meat, eggs, sauces and gravies. 2-4 hours. Staphylococcus aureus.

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effect of temperature in salmonella growth

Number of Salmonella per gram

Effect of Temperature in Salmonella Growth

50oF (10o C)

95oF (35o C)

44oF (6.7o C)

42oF (5.5o C)

3

4

5

1

2

Days

incubation periods
Incubation Periods

Cooked ham, meat,

eggs, sauces and gravies

2-4 hours

Staphylococcus aureus

Clostridium perfringens

12 hours

Cooked meats, gravy

12-36 hours

Salmonella*

Meat, poultry, eggs

Clostridium botulinum

Canned foods, smoked fish

12-36 hours

Vibrio parahemolyticus*

Raw fish, shellfish

12 hours

Contaminated by carrier, not foodborne

24-48 hours

Shigella*

* Fever

national data on etiology of foodborne illness
National Data on Etiology of Foodborne Illness

Agent

Bacteria (40 agents)

68.7%

Salmonella

25.0%

Staph. aureus

12.7%

Clostridium perfringens

10.0%

Clostridium botulinum

9.5%

Viral (11 agents)

9.4%

Parasites (31 agents)

0.5%

Fungal (16 agents)

1.8%

Plants (36 agents)

-

Fish (28 agents)

12.3%

Chemicals (28 agents)

7.3%

investigating an epidemic oswego ny

On April 19, 1940, the local health officer in the village of Lycoming, Oswego County, New York, reported the occurrence of an outbreak of acute gastrointestinal illness to the District Health Officer in Syracuse.  Dr. A. M. Rubin, epidemiologist-in-training, was assigned to conduct an investigation.

Investigating an Epidemic: Oswego, NY

When Dr. Rubin arrived in the field, he learned from the health officer that all persons known to be ill had attended a church supper the previous evening, April 18.  Family members who had not attended the church supper had not become ill.  Accordingly, the investigation was focused on the circumstances related to the supper.

slide5

Interviews regarding the presence of symptoms, including the day and hour of onset, and the food consumed at the church supper, were completed on 75 of the 80 persons known to have been present.  A total of 46 persons who had experienced gastrointestinal illness were identified.

Q: Is this an Epidemic?

Endemic for the region?

Due to seasonal variation?

Due to random variation?

slide6

Select the correct case definition

  • and find the error in the others:
  • All participants in the Oswego church supper held in the basement of the church in Lycoming, Oswego County, New York, on April 18, 1940, between 6:00 PM and 11:00 PM; whether they attended church or not; whether they participated in food preparation, transport, or distribution or not; whether they ate or not.
  • Persons who developed acute gastrointestinal symptoms within 72 hours of eating supper on April 18, 1940, and who were among attendees of the Lycoming, Oswego Church supper.
  • Church members who developed acute gastrointestinal symptoms within 72 hours of the church supper held in Lycoming, Oswego on April 18, 1940.
slide7

Select the correct case definition

  • and find the error in the others:
  • All participants in the Oswego church supper held in the basement of the church in Lycoming, Oswego County, New York, on April 18, 1940, between 6:00 PM and 11:00 PM; whether they attended church or not; whether they participated in food preparation, transport, or distribution or not; whether they ate or not.
  • Persons who developed acute gastrointestinal symptoms within 72 hours of eating supper on April 18, 1940, and who were among attendees of the Lycoming, Oswego Church supper.
  • Church members who developed acute gastrointestinal symptoms within 72 hours of the church supper held in Lycoming, Oswego on April 18, 1940.
slide8

Select the correct case definition

  • and find the error in the others:
  • All participants in the Oswego church supper held in the basement of the church in Lycoming, Oswego County, New York, on April 18, 1940, between 6:00 PM and 11:00 PM; whether they attended church or not; whether they participated in food preparation, transport, or distribution or not; whether they ate or not. Missing definition of sickness
  • Persons who developed acute gastrointestinal symptoms within 72 hours of eating supper on April 18, 1940, and who were among attendees of the Lycoming, Oswego Church supper. CORRECT
  • Church members who developed acute gastrointestinal symptoms within 72 hours of the church supper held in Lycoming, Oswego on April 18, 1940. Did not specify that they went to the dinner
incidence of cases of diarrhea among people attending lycoming oswego church supper june 1940
Incidence of Cases of Diarrhea Among People Attending Lycoming,Oswego Church Supper, June 1940
slide10

The supper was held in the basement of the village church.  Foods were contributed by numerous members of the congregation.  The supper began at 6:00 PM and continued until 11:00 PM.  Food was spread out upon a table and consumed over a period of several hours.

slide12

Which menu item(s) is the potential culprit?

To find out, calculate attack rates.

The foods that have the greatest difference in attack rates may be the foods that were responsible for the illness.

attack rates by items served church supper oswego new york april 1940
Attack Rates by Items Served: Church Supper, Oswego, New York; April 1940

Number of persons who

ate specified item

Number of persons who did not eat specified item

Attack rate (%)

Attack rate %

Ill

Well

Ill

Well

Total

Total

Baked ham

29

17

46

17

12

29

Spinach

26

17

43

20

12

32

Mashed potato

23

14

37

23

14

37

Cabbage salad

18

10

28

28

19

47

Jello

16

7

23

30

22

52

Rolls

21

16

37

25

13

38

Brown bread

18

9

27

28

20

48

Milk

2

2

4

44

27

71

Coffee

19

12

31

27

17

44

Water

13

11

24

33

18

51

Cakes

27

13

40

19

16

35

Ice cream (van)

43

11

54

3

18

21

Ice cream (choc)

25

22

47

20

7

27

Fruit salad

4

2

6

42

27

69

attack rates by items served church supper oswego new york april 194014
Attack Rates by Items Served: Church Supper, Oswego, New York; April 1940

Number of persons who ate

specified item

Number of persons who did not eat specified item

Total

Attack rate (%)

Ill

Well

Ill

Well

Total

Attack rate %

Baked ham

29

17

46

63

17

12

29

59

62

Spinach

26

17

43

60

20

12

32

Mashed potato

23

14

37

62

23

14

37

62

Cabbage salad

18

10

28

64

28

19

47

60

Jello

16

7

23

70

30

22

52

58

Rolls

21

16

37

57

25

13

38

66

Brown bread

18

9

27

67

28

20

48

58

Milk

2

2

4

50

44

27

71

62

Coffee

19

12

31

61

27

17

44

61

Water

13

11

24

54

33

18

51

65

Cakes

27

13

40

67

19

16

35

54

Ice cream (van)

43

11

54

80

3

18

21

14

Ice cream (choc)

25

22

47

53

20

7

27

74

Fruit salad

4

2

6

67

42

27

69

61

attack rates by items served church supper oswego new york april 194015

Number of persons who ate

specified item

Attack Rates by Items Served: Church Supper, Oswego, New York; April 1940

Number of persons who did not eat specified item

Total

Ill

Well

Ill

Well

Attack rate (%)

Total

Attack rate %

Baked ham

29

17

46

63

17

12

29

59

Spinach

26

17

43

60

20

12

32

62

Mashed potato

23

14

37

62

23

14

37

62

Cabbage salad

18

10

28

64

28

19

47

60

7

Jello

16

23

70

30

22

52

58

Rolls

21

16

37

57

25

13

38

66

67

Brown bread

18

9

28

20

48

58

27

4

50

Milk

2

2

44

27

71

62

19

Coffee

12

31

61

27

17

44

61

24

Water

13

11

54

33

18

51

65

Cakes

27

13

40

67

19

16

35

54

Ice cream (van)

3

43

11

54

18

21

14

80

25

22

47

53

20

7

27

74

Ice cream (choc)

Fruit salad

4

2

6

67

42

27

69

61

attack rate by consumption of vanilla ice cream oswego new york april 1940
Attack Rate by Consumption of Vanilla Ice Cream, Oswego, New York; April 1940

Ill

Well

Total

Attack Rate (%)

Ate vanilla ice cream?

Yes

43

11

54

79.6

No

3

18

21

14.3

Total

46

29

75

61.3

  • The relative risk is calculated as 79.6/14.3 or 5.6
  • The relative risk indicates that persons who ate vanilla ice cream were 5.6 times more likely to become ill than those who did not eat vanilla ice cream
conclusion
Conclusion
  • An attack of gastroenteritis occurred following a church supper at Lycoming
  • The cause of the outbreak was most likely contaminated vanilla ice cream
surveillance
Surveillance

Ongoing systematic collection, collation, analysis and interpretation of data; and the dissemination of information to those who need to know in order that action may be taken.

World Health Organization

purposes of public health surveillance
Purposes of Public Health Surveillance
  • Estimate magnitude of the problem
  • Determine geographic distribution of illnesses
  • Portraying the natural history of disease
  • Detect epidemic / Define a problem
  • Generate hypotheses and stimulate research
  • Evaluate control measures
  • Monitor changes in infectious agents
  • Detect changes in health practice
  • Facilitate planning

CDC

passive surveillance
Passive Surveillance
  • Physicians, laboratories, and hospitals are given forms to complete and submit with the expectation that they will report all of the cases of reportable disease that come to their attention
  • Advantages: Inexpensive
  • Disadvantages: Data are provided by busy health professionals. Thus, the data are more likely to be incomplete and underestimate the presence of disease in the population
active surveillance
Active Surveillance
  • Involves regular periodic collection of case reports by telephone or personal visits to the reporting individuals to obtain the data
  • Advantages: More accurate because it is conducted by individuals specifically employed to carry out the responsibility
  • Disadvantages: Expensive
sentinel surveillance
Sentinel Surveillance
  • Monitoring of key health events, through sentinel sites, events, providers, vectors/animals
  • Case report indicates a failure of the health care system or indicates that special problems are emerging
  • Advantages: Very inexpensive
  • Disadvantages: Applicable only for a select group of diseases
some surveillance programs
Some Surveillance Programs
  • National Notifiable Diseases Surveillance System

http://www.cdc.gov/epo/dphsi/nndsshis.htm

  • Morbidity and Mortality Weekly Report (MMWR)

http://www.cdc.gov

  • Cancer Surveillance, Epidemiology and End Result (SEER)

http://www.seer.cancer.gov/

slide24
“Good surveillance does not necessarily ensure the making of right decisions, but it reduces the chances of wrong ones.”

Alexander D. Langmuir

NEJM 1963;268:182-191