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Alamosa Salmonella Outbreak

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  1. Alamosa Salmonella Outbreak Colorado Department of Public Health and Environment Response

  2. It’s In The Water!

  3. Next Steps • Bottled water order for customers who pay water bill to the City of Alamosa (East Alamosa Water NOT affected) • Drain and patch holding tank • Decontaminate (super-chlorinate) tanks and water distribution system • Test water for chlorine levels during super-chlorination • Test water for bacteria and arsenic/heavy metal levels • Continue to monitor illness patterns • Assist businesses, food facilities, schools, daycare facilities to return to water system

  4. Timeline (cont) March 19: CDPHE issues bottled water order to City of Alamosa – residents/visitors to stop using tap water Alamosa declares city/county emergency COHELP Line activated: 1-877-452-2911 CDPHE WQCD issues request for assistance via CoWARN mutual aid network Denver Water and CDPHE Water Quality arrive March 20: 3 water distribution centers established – bulk/bottle American Red Cross volunteers staff distribution sites CDPHE, Denver Water, Alamosa develop a strategy to disinfect/flush Alamosa’s water distribution system

  5. Timeline (cont) March 21: Governor declares state public health emergency Colorado National Guard arrives Alamosa signed mutual aid agreement, establishing formal/legal relationship between city and other mutual aid partners March 22: Governor Ritter and Senator Salazar arrive for tour March 23: Jefferson County Incident Management Team (IMT) arrives Over 170 volunteers distribute over 5,000 flyers March 24 : Alamosa water samples test positive for salmonella First press conference in Alamosa Request assistance from HHS: environmental epidemiology risk communication water quality Develop color code phases for system flushing

  6. System Flushing Process • System Flushing – water disinfected with chlorine in 3-stage process • Color-coded safety notices delivered to residences at each stage STAGE 1 – Red • High concentration of chlorine - 25 ppm • Can NOT use water for anything other than flushing toilets • Possible skin, eye, or other irritation from water exposure  STAGE 2 - Yellow • Chlorine decreases to 10 ppm (slightly above swimming pool) • Water CAN be used to bathe and wash laundry • Can NOT consume water STAGE 3 - Green • Chlorine decreases to 1-2mg per liter • Normal drinking, bathing, and other water uses can be resumed

  7. Timeline (cont) March 25: Alamosa public schools close “Red” high chlorination process begins 5 FDA consumer personnel arrive March 26: Entire city in “Red” 5 water samples test positive by PCR for Salmonella – of 5 PCR-positive samples, 4 grew in culture Adams State College classes canceled CDPHE updates Alamosa City Council 5 CDC personnel arrive Mayor starts daily televised statements on channel 10 March 27: Denver Salvation Army provides vouchers for paper products NW Colorado IMT assumes authority

  8. Timeline March 28: City completes “Red” phase, goes to “Yellow” Consumer protection inspectors reach out to all regulated food service/institutional facilities -89% remain open March 30: Alamosa receives memo from CDPHE outlining how to go to “Green” status CO-HELP line open over the weekend March 31: Schools reopen All city in “Yellow” stage News conference with Colorado media Eastern Colorado IMT assumes authority CDC epidemiology staff demobilized Grocery store ensures produce not harmed by contaminated water Water shares front stage during Easter services

  9. Timeline April 3: City goes to “Boil Water” Order April 4: CDPHE meets with Alamosa City Officials in Pueblo to discuss ongoing investigation of the cause of the Salmonella water contamination April 8: CDC water samples show presence of Giardia and Cryptosporidium (samples taken before system was flushed/disinfected).   April 9: CDPHE takes water samples to confirm Giardia and Crypto have been eliminated April 10: Total Cases = 424 Hospitalizations = 22 Deaths = 1 April 11: Boil Water Order rescinded – Alamosa goes to “green” status, residents can consume water

  10. CDPHE Response CPD • Provide guidance/assistance to restaurants, food manufacturers, childcare centers, and schools • Conduct inspections of restaurants, food manufacturers, childcare centers, and schools • Track facility closures for restaurants, schools and daycare centers  Communications • Work with joint information center (JIC) partners and CDPHE divisions to draft public communications as needed  • Press releases • Flyers • Reverse 911 DCEED • Provide assistance in conducting disease surveillance, including case interviews/phone survey/etc • Track number of cases and hospitalizations EPRD • Coordinate information and response activities from CDPHE divisions • Monitor and provide staffing replacements for local/state public health staff    • Update messages on COHELP hotline and on CDPHE website  • Track COHELP reports, including homebound residents • Track KRONOS records and other CDPHE fiscal costs related to the incident • Provide ESF #8 support to Colorado Division of Emergency Management (CDEM) • Assist CDEM in getting water, personnel, equipment and other resources to Alamosa as needed • COHELP hotline • CDPHE website  

  11. CDPHE Response HFEMSD • Contact/provide assistance to hospitals, clinics, and long-term care facilities Lab • Conduct sampling for salmonella, total coliform and heavy metals PSD • Provide assistance to Alamosa WIC Director to find supplies of “ready to feed” formula Sustainability Program/Waste Facilities • Ensure recycling facilities in Alamosa are ramped up WQCD • Coordinate with city to develop and implement plan for flushing city municipal water system            • Conduct water sampling for bacteria and heavy metals before/during/after flush          • Work COWARN to provide personnel and equipment mutual aid resources to Alamosa • Provide guidance for water use during each stage during system flush     

  12. Online Situational Awareness Tool • Secure, web-based system • Critical information specific to incident • Contact information • Real time status updates and info sharing • Media reports, links to related stories

  13. Media & Public Information • Joint Information Center (JIC) established • CDPHE provided technical guidance, fact sheets, through JIC • Current information provided to media/public as it was made available • Having one point of contact for media inquires ensured accurate messages delivered • Consistent information provided by various methods (in English and Spanish): • Flyers delivered door-to-door Local/State media releases • COHELP Line • County website - • CDPHE website - • Local cable channel 10

  14. COHELP Line • Staffed with information specialists from the Rocky Mountain Poison & Drug Center (RMPDC) • Developed to provide consistent, accurate and up-to-date information to the public • Telephony, integrated voice response unit (IVR), and web-based technology • Operates daily - topics, hours, staffing adjusted to meet public need • Can take up to 1,000 calls per hour • Voice recording and option to speak to live person • Situational Awareness - data collection on dead bird/squirrel reports, zip code geocoding of public concern trends • Monthly reports on call volume and public concern trends

  15. COHELP – Alamosa Response • Total Calls = 2,544 in 14 days • Notification to Activation Time = 3 hours • Heaviest call volume hour = 90 call in one hour • Heaviest call day = 486 calls • Daily reports = call volume, top 5 FAQ’s, call trend analysis, real time reporting of emergency requests • Weekend coverage—calls transferred to registered nurses at RMPDC for medical support

  16. CoWARN Mutual Aid • Colorado’s Water/Wastewater Agency Response Network • 47 public and private water and wastewater utilities, industry support organizations and government members • Can provide immediate assistance to members in emergency • Participation is voluntary • Signed “Mutual Aid Agreements” in place allow for quick response • Colorado one of only 6 states that has web-based mutual aid system like this • Member website provides forum for establishing/maintaining emergency contacts and communicating needs/resources in real time

  17. CoWARN – Alamosa Response • Provided technical expertise, equipment and supplies to Alamosa • 23 water and wastewater utilities, industry support organizations and State of Nebraska assisted • CoWARN coordinators from CDPHE, Denver Water, and Aurora Water operated through the CDPHE DOC. • communication with City and CDPHE personnel onsite • maintained the CoWARN website • Tracked donations of supplies/assistance from private businesses in network • Crews worked 12 hour shifts, around the clock, with Alamosa and CDPHE personnel onsite

  18. CDEM Response • Colorado Division of Emergency Management • Opened State Emergency Operations Center (SEOC) • Coordinated multiple state agencies, volunteer organizations and business donations • Status reports via emails and 209 reports • Coordinated IMTs sent to manage the incident onsite • As of 4/2, 812 volunteers provided over 3,447 hours of assistance

  19. Incident Command • ICS used among all response partners

  20. External Agencies • Local Public Health Agencies • Alamosa Fire Department • Alamosa County Nursing • Alamosa County Sheriff’s Office • Alamosa County and City Management • Alamosa County Road and Bridge • Alamosa County Emergency Management • Alamosa Water Department • Alamosa Police Department • City of Durango • City of Ft. Collins • Denver Environmental Health • Denver Water • Aurora Water • Pueblo Water • Boulder Water • Colorado Rural Water Association • East Cherry Creek Village • San Luis Valley Regional EMS/RETAC • San Luis Valley Mental Health • Denver Department of Local Affairs • Costilla County • Rio Grande County • Saquache County • Jefferson County Incident Management Team • Northwest Colorado Incident Management Team • Division of Emergency Management • Department of Transportation • Department of Human Services- Mental Health • Department of Corrections • Colorado National Guard • Governor Ritter’s Office • State Senator Ken Salazar's Office • Congressman John Salazar's Office • Rocky Mountain Poison and Drug Center (COHELP) • American Red Cross • FEMA Region VIII • U.S. Dept. of Health and Human Services • Centers for Disease Control and Prevention (CDC) • U.S. Forest Service • Food and Drug Administration  • Homeland Security