Safer Slurping or Lessons Learned from Shellfish associated Vibrio parahaemolyticus Outbreak 2006

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Safer Slurping or Lessons Learned from
Shellfish associated Vibrio parahaemolyticus
Outbreak 2006

• Mary Ferluga , R.S., CPITO
• Washington State Department of Health
• Food Safety Program
• Farm to Table
• Moscow, Idaho
• May 28, 2008

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Vibrio species

• Bacteria
• Pathogenic species of Vibrio
• V. cholerae
• V. vulnificus
• V. parahaemolyticus

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Vibrio cholerae

• Choleragenic Vibrio
• Cause of cholera epidemics
• Prevalent in developing countries
• 131,943 cases worldwide in 2005
• Non-choleragenic Vibrio
• Causes smaller outbreaks or sporadic cases

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Vibrio vulnificus

• Found primarily along Gulf Coast
• 90 of cases hospitalized
• 40 of cases fatal

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Vibrio parahaemolyticus

• First identified in 1950 in Japan
• First isolated in the U.S. in 1968
• First WA outbreak in 1997

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Vibrio parahaemolyticus

• Occurs naturally in warm marine and estuarine
  water
• More Vp in the water in warmer months

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Vibrio parahaemolyticus infection

• Transmission
• Consuming raw or undercooked molluscan shellfish
  
• Cross contamination with raw seafood

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Vibrio parahaemolyticus infection

• Incubation 4 to 30 hours (average 12-24)
• Symptoms D (watery), AbC, N, V, HA, F, Chills
• Duration 1-7 days, median 2.5 days
• About 30 cases a year reported in WA

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Vibrio parahaemolyticus infection

• Prevention
• Cook to 145F
• Avoid cross contamination
• Use only approved sources for shellfish

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Vp Outbreak May - August 06

• 2nd largest outbreak of Vp in U.S.
• 113 ill 75 lab-confirmed cases of Vp

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Washington Vp Cases (1997-2006)
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Vibriosis related to WA oysters May-August, 2006

• Washington residents 113 65
• Washington visitors 10 6
• Other states 36 23
• (CA, OR, NY)
• Canada 10 6
• ____ ____
• Total known cases 169 100

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Onset of vibriosis by week summer 2006
Week of July 2 - 8
July 4
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Vp Outbreak May - August 06

• 2 Recalls
• July 13-17
• July 27-August 2
• 114,690 dozen oysters sold during these two
  periods
• 23 States and 8 foreign countries affected

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Vp Outbreak May - August 06

• 20 Growing areas in 4 counties were closed
• 147 Different harvesters affected

Oyster growing area closures expanded due to
vibriosis outbreak OLYMPIA ? The Department of
Health is closing more oyster growing areas due
to a bacteria that is making people sick. The
state now has 86 reported cases of vibriosis
related to eating raw oysters. Most of the
illnesses recently reported occurred before the
Department of Healths latest commercial closures
on July 24.
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Vibriosis Source of oysters
Washington, 2006
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Contributing Factors

• Unseasonably warm temperatures

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Illnesses 2006 vs. 2007
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Contributing Factors

• Low tides were in afternoon
• Oysters easier to harvest at low tide
• Harvesting practices did not account for unusual
  conditions

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Contributing Factors

• Huge volume of oysters

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Only eat oysters if the month includes the
letter R
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Contributing Factors
Triploid
Diploid
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Emergency Shellfish Rules

• DOH Shellfish Program requested SBOH for
  emergency rule change
• Was effective June through September 2007
• 24 harvest sites were tested bi-weekly
• Testing changed to weekly if action level
  triggered

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Retail Controls

• Restaurants, markets, and grocery stores need a
  system to prevent illness from shellfish

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Approved Source at Retail

• Use tag information
• Verified with Interstate Certified Shellfish
  Shippers List
• https//info1.cfsan.fda.gov/shellfish/sh/shellfis.
  cfm
• If no tag for shellstock, shipment must be
  rejected by retailer
• If no tags present during inspection hold order

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Interstate Certified Shellfish Shippers List
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• Name of shellstock shipper (ss) or shucker packer
  (sp)
• AKA a Dealer
• SS or SP Certification Number
• Harvest date

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• 4. Shipping Date
• 5. Harvest Location
• 6. Type and Quantity of Shellfish
• 7. May be used by re-shipper
• - Re-shippers often make new tag

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Shellfish Tags

• Kept for 90 days
• Correlated to date of sale or service

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Shellfish Tags

• Customer does not need tags
• Once bag sold,
• retail store keeps tags

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Receiving Temperatures

• Shellstock
• Must have internal temp of 50F

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Receiving Temperatures

• Shucked
• Must have internal temp of 45F

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Receiving Temperature

• Corrective action
• Reject shipment

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New Zealand Mussel

• Commonly called Green Lipped Mussel or Greenshell
  Mussel

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Shucked Shellfish

• Shucked shellfish have at least one shell removed
• On half-shell is shucked
• Often served raw

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Shucked Shellfish

• Use labels instead of tags
• Label must have shucker-packers or re-packers
• Name
• Address
• Certification Number

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Re-Packer of Shucked

• DOH License is Shucker-Packer
• Can shuck, pack, and/or re-pack
• Bags have individual tags
• Shellfish harvested in WA must have tagged bag (
  that is the primary container)

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Shucked Shellfish

• If removed from original container into a display
  container for dispensing to customer
• Labels must be retained
• Label information correlated to dates of sale or
  service

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Changes to the Rules

• Time from harvest to temperature control being
  shortened
• Improved sampling protocol and sampling quality
  control/quality assurance

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Changes to the Rules

• The time to temperature control will be cut in
  half if
• Any sample from a growing area if action level is
  exceeded
• Any Vp illness is associated with a growing area
• Growing areas will continue to be closed if
  associated with an outbreak

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WAC 246-282-006 Vibrio Control Plan

• Harvest record requirements
• Dealer and harvester license holders shall
  maintain harvest records showing
• time of harvest
• time of temperature control

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WAC 246-282-006 Vibrio Control Plan

• Two types of harvest control requirements
• Intertidal (exposed) harvest - Time begins after
  the first oysters to be harvested are exposed to
  the air by the receding tide
• Submerged harvest - Time begins after the first
  oysters harvested are exposed to the air and have
  been placed onto a conveyance, such as a barge or
  boat

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WAC 246-282-006 Vibrio Control Plan

• Vibrio illness response requirements
• When two Vp-associated illnesses are linked to a
  growing area, the time to temperature control is
  reduced by 1 hour
• The growing area remains under the reduced time
  regimen the remainder of the season
• If two or more Vp-associated illnesses occur
  within 30 days under the one-hour reduction
  regimen, the growing area shall be closed

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WAC 246-282-006 Vibrio Control Plan

• If the additional illnesses are attributed to the
  same dealer, DOH shall investigate to determine
  if the dealer or the growing area is at fault
• In lieu of closure if the dealer can show that
  an additional 1-hour reduction can be
  successfully implemented, DOH may approve harvest
  for the remaining months

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WAC 246-282-006 Vibrio Control Plan

• Training requirements
• All licensed dealers and harvesters must complete
  DOH-approved training on the control plan
  requirements prior to harvesting or shipping
  oysters between June and September
• Licensed dealers and harvesters who complete the
  training must train employees who harvest oysters

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WAC 246-282-006 Vibrio Control Plan

• Harvest plan and Hazard Analysis CriticalControl
  Points (HACCP) plan requirements
• All licensed harvesters shall develop a harvest
  plan and checklist that follows the harvest
  protocols they use to place oysters under
  temperature control
• Licensed dealers must amend their HACCP plans to
  show the harvest protocols they will use to bring
  the oyster under temperature control

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What Happens Next

• WA rule change has been evaluated
• Updated rules are to be changed permanently as
  needed
• DOH Shellfish Program is proposing these changes
  to harvest standards nationwide

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Lessons Learned
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Lessons Learned

• Raw clams are a delicacy
• Consumer advisories remind people of risks
  associated with raw foods of animal origin

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Lessons Learned

• When there is a state or nation-wide outbreak,
  every case needs to be investigated
• Field investigations need to be thorough

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Lessons Learned

• When interviewing patients, ask
• Where did you get the oysters?
• Recreational, market, restaurant
• What variety of oyster did you eat?
• Penn Cove Select, size, Kumamoto

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Lessons Learned

• If the oysters were from a restaurant ask
• What menu did you order off?
• Lunch, dinner, lounge
• What menu item did you order?
• Shooter, on the half shell, grilled, appetizer

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Lessons Learned

• If the oysters were recreationally harvested
• Where did you harvest the oysters?
• Private, public, illegally
• Where and when did you eat them?
• How did you prepare them?
• BBQ, slurp, recipe

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Lessons Learned

• Oysters need to be served according to label
  directions
• Harvesters are allowed to harvest oysters from
  closed growing areas if
• They shuck them
• Complete a MOA with DOH Shellfish Program
• Label oysters For Cooking Only

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Lessons Learned

• Shellfish tags must be
• Retained
• Accurate

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Lessons Learned

• Shellfish tags must be legible

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Lessons Learned

• Shellfish tags
• How to correlate tags to date of sale
• Write on tag
• Keep a log
• Use a spreadsheet
• Photocopy the tag to keep with displayed
  shellfish

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Lessons Learned

• Vibrio parahaemolyticus is destroyed when oysters
  are fully cooked!

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QUESTIONS ?
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