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Waterborne Salmonella Outbreak Alamosa, March-April, 2008

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Waterborne Salmonella Outbreak Alamosa, March-April, 2008. San Luis Valley ... 1 of 4 tap water samples has elevated coliform counts ... – PowerPoint PPT presentation

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Title: Waterborne Salmonella Outbreak Alamosa, March-April, 2008


1
Waterborne Salmonella Outbreak Alamosa,
March-April, 2008
  • San Luis Valley
  • Public Health Emergency Preparedness and Response
    June 10, 2008

2
Background
Incidence of Salmonellosis San Luis Valley
Counties January 1, 1998 to December 31, 2007
ALAMOSA CONEJOS COSTILLA MINERAL RIO GRANDE SAGUACHE Total
18 12 3 1 18 2 54

3
Setting
Cold winter 2007-2008 deep frost level with
frozen underground water meters at private
residences
4
City-wide street construction 07-08
City water stored in a ground level reservoir and
two storage tanks
  • City water from multiple, deep, warm water wells
  • never chlorinated,
  • monthly testing

5
Initial Cases
  • March 8, 2008 Alamosa student, part time
    restaurant worker with bloody diarrhea
  • March 9 ER visit, stool culture
  • March 12 SLVRMC lab Salmonella
  • March 12-13 SLVRMC lab reports
  • 2 Alamosa infants also positive
  • for Salmonella
  • March 14 Alamosa physicians report 4 other cases
    of children with bloody diarrhea this week
  • March 12-16 multiple interviews of cases,
    family, coworkers and restaurant inspection
  • No links identified during initial case
    investigations

6
March 14 Outbreak Investigation Begins
7
Case Ascertainment - Providers
  • Active Surveillance
  • SLVRMC ER
  • (March 14...)
  • 6 Alamosa clinics
  • (March 15...)
  • Enhanced Passive Surveillance
  • Other SLV Clinics, ERs and Hospitals

8
Case Ascertainment Labs
Micro Lab Reports 3 SLV hospitals (local) E
lectronic reports all labs in CO (CDPHE)
Mar-Apr, 2008 212 Stool Cultures -- 117 (55.5)
for Salmonella Giardia rapid tests -- 43 (3)
Time consuming. Costly.
9
Other Surveillance
  • Daily calls to facilities
  • 2 nursing homes,
  • 1 assisted living center,
  • 1 hospital (long-term care unit),
  • 5 schools,
  • 20 child care centers

10
March 12-17 Case Investigations
  • 15 of the first 20 cases interviewed ate food
    from the high-volume restaurant where index case
    worked!
  • 4 early cases were infants on commercial baby
    food or formula only
  • By March 17, eighteen culture confirmed cases
    plus many more reports from local providers of
    children ill with bloody diarrhea and fever
  • Assistance requested from State health dept.
  • Many other local Health Departments mobilize staff

11
March 15 Case Mapping
12
March 16 Early Cases Epidemic Curve (n25)
13
Early Cases end of March 17
  • 46 cases, 18 culture confirmed
  • 37 reside in Alamosa City
  • At least 3 of the remaining 5 have recently been
    to Alamosa
  • No common sources
  • Several infants consume formula only (mixed in
    tap water)

14
Case Mapping March 17
15
Alamosa City Water Investigations and
Intervention
  • March 17 water samples collected by Ala Co. PH
  • 1 of 4 tap water samples has elevated coliform
    counts
  • March 17-18 cases re-interviewed for detailed
    water consumption exposure histories
  • 12/12 cases consumed Alamosa water including 5/5
    infants on formula
  • March 19 bottled water advisory issued by State
    Health Dept. for City of Alamosa

16
Environmental Investigations Education
  • Restaurants
  • Groceries
  • Daycares
  • Schools
  • Hospital
  • Nursing homes

Intensive messaging from public health to
community, organizations and individuals
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