Hilary Byrne Belfast City Council

1. Environmental Health Role in Investigation & Control of Food Poisoning & Gastrointestinal Infections Hilary Byrne Belfast City Council

2. Scope • Legal background and reporting procedures • Organisations involved • The investigation process • Risk groups • Control measures • Guidance

3. Public Health Act (Northern Ireland) 1967 • Doctors have a statutory duty to report notifiable infectious diseases • These infectious diseases include food poisoning, and other gastro infections e.g. dysentery, hepatitis A, typhoid

4. Food Poisoning: Notifications and Laboratory Reports 2005 – 2014

5. Investigation jointly by the Public Health Agency & Environmental Health

6. Notification made to the Public Health Agency Recorded on analysis database Referred to relevant Environmental Health Department EHO makes contact or visits case Complete questionnaire & food history Advise on enteric precautions, hygiene measures, exclusions Consider faecal / food sampling as necessary Feed back to PHA Discuss further action

7. Reasons for investigation • Identify the possible source of infection • To take measures to prevent further spread • To trace others who may have been infected • To offer advice on enteric precautions and food hygiene • To enable early detection of outbreaks

8. Investigation • Personal details • date and time of onset • Occupation • Food History • Details of foreign travel • Contact with animals • Details of any others ill • Specifics for different organisms

9. Control • Advise the case and contacts on food and personal hygiene • Assess the risk of further spread • Trace other contacts • Consider need for exclusion • Consider follow up to food premises

10. Risk Groups • Person of doubtful hygiene or poor facilities • Young children at preschool • Food handlers • Care staff

11. Exclusions • For certain organisms cases and contacts may need to be excluded • E coli 0157 is the organism that this occurs with most • EH source cases to be excluded • PHA carry out exclusions

12. Guidance • PHA – Investigation of Food Poisoning and Gastrointestinal Infections • Regional Guidance for Public Health Practitioners and Environmental Health Officers in NI (2012) • Other specific guidance on • E coli VTEC • Typhoid & Paratyphoid • Incident/Outbreak Plan

13. Outbreaks 2 or more unrelated case

14. E. coli O157 Outbreak - 2012 • 1st case Tuesday 9th October 2012 • Multi Agency Outbreak Control Team • 300 individuals affected • 141 clinically confirmed • 19 admitted to hospital

15. E. coli O157 Outbreak - 2012 • First 9 days worked 15 hour days • Voluntary Closure / disposal of food • Every food and garnish • Every supplier • Food, water, environmental samples • Interviewed over 300 adults / children • Wrote to 3000 businesses

16. E. coli O157 Outbreak - 2012 • Source – contaminated food stuff or infected staff member • Vehicle of spread – food (some evidence to implicate parsley) • Food Handler 1 – may have contributed to spread

17. E. coli O157 Outbreak - 2012 • Crown Court • 250 exhibits • Statements from > 100 cases • 11 offences • Fined £110,000 (largest ever in NI)

18. Thank you