1. When is a spread of disease considered an outbreak and what are the steps to dealing with an outbreak?
1.1. If a larger number of people appear together with the same illness that is called a cluster
1.1.1. If there is an investigation that shows that these people in a cluster have something in common to explain the cause of the illness, this is considered an outbreak
1.2. There are 7 steps to a Foodborne outbreak investigation
1.3. The first step is detecting any possible outbreaks
1.3.1. These typically start out as informal reports, which occur when members of a community call the local health department to report any suspected illness
1.3.2. This is the case with Erica's mom
1.4. This is different from formal reports, which are done by doctors and microbiologist in each state
1.4.1. This report is done after they diagnose them in patients and see them in higher rates than expected
1.5. PulseNet is a national laboratory network that connects foodborne illness cases to detect outbreaks
1.5.1. Uses DNA fingerprinting or patterns of bacteria to detect thousands of local and multistate outbreaks
1.6. The second step is to define the cases
1.6.1. Case definition is developed by a health official and spells out who is included as part of the outbreak
1.6.1.1. Includes details such as features of the illness, DNA fingerprint, pathogen or toxin, certain symptoms typical, etc
1.7. The third and fourth is to generate a hypothesis and test it
1.8. The fifth step is to try and solve the point of contamination
1.9. The sixth step is to control the outbreak
1.10. The last step is to decide that the outbreak is over
2. What can the CT local health department do about any outbreaks/ prevention?
2.1. They work with the Connecticut department of public health and the CDC to detect, investigate, control and prevent foodborne disease outbreaks
2.2. Typically the CT local health department will usually help identify and investigate the outbreaks
2.2.1. CDC will typically provide consultation and possibly hands-on assistance if the outbreak is large, unusual or severe
2.2.2. In this case, the local health department would likely do the investigation
2.3. Public officials will work as quickly as possible to collect as much information as possible
2.3.1. They collect, epidemiologic, traceback and food and environmental testing data
2.3.2. In addition, they will try and warn the public
2.4. Epidemiologic data consists of patterns of geographic distribution of illnesses, time periods of sick people and past outbreaks
2.5. Traceback data is data that finds the common point of contamination in the distribution chain
2.5.1. Typically identified by reviewing records collected from people, etc
2.6. Finally, they will test the food and environment for germs and DNA fingerprinting
3. How does E. Coli affect the GI and how is it transmitted?
3.1. E Coli or escheriachia coli is a bacteria that is the most common cause of travelers' diarrhea
3.2. This bacteria normally inhabits the intestines of humans and animals without any issue
3.2.1. However, certain strains such as E coli O157:H7 can cause food poisoning
3.2.2. This is also known as Enterotoxigenic Escherichia Coli (ETEC)
3.3. ETEC possess specialized pili that act as ligands and bind the bacterial cells to specific complex carbohydrate receptors on epithelial cell surfaces of small intestine
3.3.1. These are termed colonization-factor antigens (CFAs)
3.4. In addition, ETEC produces two toxins known as ST and LT
3.4.1. ST is heat-stable and LT is heat-labile toxin
3.4.2. Some of these toxins are cytotoxic and damages the mucosal cells whereas others are cytotonic and induce the secretion of water and electrolytes
3.4.2.1. ST converts GTP to cyclic GMP, which inhibits fluid uptake and results in net fluid secretion
3.4.2.2. LT has a similar mechanism of action to Vibrio cholerae enterotoxin
3.4.2.2.1. It converts ATP to cAMP, which leads to hypersecretion of water and electrolytes into the bowel lumen
3.5. Transmission is typically through contaminated food or water
3.5.1. Meat or poultry may come into contact with the intestines of an animal while it is processed
3.5.2. Water may contain animal or human waste
3.5.3. Handling of the food may cause issues