YOUR ASSOCIATION
Open Access
PRESIDENT’S MESSAGE
Nobody Wants to Eat Your Poop
Scott E. Holmes, MS, REHS
W hen my family is together, we en- joy playing board games such as Azul, CATAN, and Ticket to Ride. Before the COVID-19 pandemic, we used to play Pandemic, but I can’t seem to get up the nerve to play that game anymore. When our kids were young, we often played the murder mystery game Clue. In Clue, you take turns gathering clues until you think you know WHO did it (6 potential culprits), WHAT they used (6 weapons), and WHERE it happened (9 rooms). When you think you’ve solved the mystery, you declare your findings: “I think it was Miss Scar- let, with the wrench, in the study.” Investigating an illness outbreak is similar to the game of Clue, but much more com- plicated. In the “Illness Outbreak Game” for environmental public health, you gather clues until you identify: • WHO was affected (from 2 to 1,000s of people) • WHAT caused the outbreak (100s of pos- sible microbes or toxins) • WHEN was the incubation period (from minutes to weeks) • WHERE did the outbreak happen • HOW did the illness spread • WHY did the illness outbreak happen (i.e., identifying the root cause) As the outbreak unfolds, you develop hypotheses (i.e., educated guesses) based on partial data while remaining open to other ideas as you gather new data. The goal is to stop the spread of illness and solve the mystery, thereby protecting the public’s health. Right? Yes, but for environmental public health, I’d add another very important “other reason,” which I share at the end of the column.
» Two food preparation staff became ill with similar symptoms approximately 24–48 hr after the reception. » Food was served buffet style. Buffet line utensils were not changed. No hand san- itizer was provided for guests. • Clue #4: Further findings from data analysis and epidemiology interviews showed that: » A likely food source was not identified. » The attack rate was highest in the wed- ding party and close family members. Frustrated that they could not identify the cause, our epidemiology team did not give up. They doubled down and searched for more clues to solve this outbreak mystery. Guests and staff were interviewed again, which led to new clues and new data. • Clue #5: The wedding party and guests who went through the buffet line early were more likely to become sick. • Clue #6: A child of a wedding party mem- ber had a “blowout” diarrhea accident dur- ing rehearsal. The child’s father changed the diaper and cleaned up the clothes. Sev- eral wedding party members helped care for the child afterward. • Clue #7: Staff saw a wedding party mem- ber washing a child’s soiled clothing in the hand sink in restroom A. • Clue #8: Individuals who used restroom A were more likely to get sick. • Clue #9: Norovirus was identified in stool samples. Conclusion The child’s diarrheal accident was likely the root cause. Norovirus probably spread in sev- eral ways: 1) changing the diaper and handling
Investigating an illness outbreak is similar to the game of Clue, but much more complicated.
Mystery at the Country Club The food safety program supervisor took a call from the groom’s mother. “I want to report a foodborne illness outbreak at the Country Club.” She insisted that she, her husband, the bride and groom, and other wedding party members became sick after eating food served at the reception. She said the magic words, “I have never been so sick in my life,” which usually means norovirus. So began the investigation of the Mystery at the Country Club. • Clue #1: Members of a wedding party became ill after the reception. • Clue #2: Main symptoms were vomiting and diarrhea. The incubation period was 24–48 hr (the norovirus alert went off). Hypothesis: Focus on food handlers and food preparation. • Clue #3: The environmental health assess- ment found that: » Food preparation and storage did not identify risk factors for foodborne illness. » No bare-hand contact was practiced. » Food preparation staff had not been ill or missed work in the past week.
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Volume 89 • Number 4
https://doi.org/10.70387/001c.173644
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