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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

Interactive Event

Condensed Table Top Exercise

For San Joaquin County

Adapted from an exercise by CDFA, CDHS, FDA and others

monday june 5
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?
tuesday june 6
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?
work group discussion 1
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
inject 1 tuesday june 6 9 00am
Inject 1: Tuesday , June 6, 9:00am
  • First Cases –
  • Additional cases reported-
first conference call tuesday june 6 1100 hours
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?)
first conference call tuesday june 6 11 00 am
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
summary of content of case investigation form for neurologic illness
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
summary of content of case investigation form for neurologic illness9
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
summary of content of case investigation form for neurologic illness10
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
tuesday june 6 at 3 00 pm
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
wednesday june 7
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.
work group discussion 2
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?
third conference call thursday june 8 0630
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)

reference slide 1 fictional milk processor
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
reference slide 2 fictional milk processor badger creek milk inc
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

reference slide 4 low fat milk made for schools and deli
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)

reference slide 5 production details
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)
third conference call thursday june 8 063021
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?)
fourth conference call thursday june 8 11 30
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)




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)?
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)
response con t30
  • 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)
  • 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?
summarize info
Summarize Info
  • Group Discussion
badger creek milk inc event overview
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