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

1. 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

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

3. 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

4. Vibrio vulnificus • Found primarily along Gulf Coast • 90% of cases hospitalized • 40% of cases fatal

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

6. Vibrio parahaemolyticus • Occurs naturally in warm marine and estuarine water • More Vp in the water in warmer months

7. Vibrio parahaemolyticus infection • Transmission • Consuming raw or undercooked molluscan shellfish • Cross contamination with raw seafood

8. 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

9. Vibrio parahaemolyticus infection • Prevention • Cook to 145°F • Avoid cross contamination • Use only approved sources for shellfish

10. Vp Outbreak May - August ‘06 • 2nd largest outbreak of Vp in U.S. • 113 ill 75 lab-confirmed cases of Vp

11. Washington Vp Cases (1997-2006)

12. 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%

13. Onset of vibriosis by week – summer 2006 Week of July 2 - 8 July 4

14. 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

15. 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 Health’s latest commercial closures on July 24.

17. Vibriosis: Source of oysters – Washington, 2006

18. Contributing Factors • Unseasonably warm temperatures

19. 2006 • Record hot, sunny weather • Record lack of rain • Low afternoon tides • Record number of illnesses • 2007 • Temperatures return to normal • Less direct sun, more rain • Less harvest for raw consumption • Immediate harvest controls when pathogenic Vibrio is detected • Harvest site surveillance by DOH # of cases # of cases Illnesses: 2006 vs. 2007*

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

21. Contributing Factors • Huge volume of oysters

22. “Only eat oysters if the month includes the letter R”

23. Contributing Factors Triploid Diploid

24. 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

25. Retail Controls • Restaurants, markets, and grocery stores need a system to prevent illness from shellfish

26. 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

27. Interstate Certified Shellfish Shippers List

28. Name of shellstock shipper (ss) or shucker packer (sp) • AKA a Dealer • SS or SP Certification Number • Harvest date

29. 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

30. Shellfish Tags • Kept for 90 days • Correlated to date of sale or service

34. Shellfish Tags • Customer does not need tags • Once bag sold, retail store keeps tags

35. Receiving Temperatures • Shellstock • Must have internal temp of 50°F

36. Receiving Temperatures • Shucked • Must have internal temp of 45°F

37. Receiving Temperature • Corrective action • Reject shipment

38. New Zealand Mussel • Commonly called Green Lipped Mussel or Greenshell Mussel

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

40. Shucked Shellfish • Use labels instead of tags • Label must have shucker-packer’s or re-packer’s • Name • Address • Certification Number

41. 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)

42. 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

43. Changes to the Rules • Time from harvest to temperature control being shortened • Improved sampling protocol and sampling quality control/quality assurance

44. 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

45. 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

46. 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

47. 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

48. 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

49. 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

50. 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