APRIL 2 , 2014

Vibrio parahaemolyticus is Coming to a Restaurant Near

You!

M H O A - D P H S P R I N G S E M I N A R

O F F I C E O F L O C A L A N D R E G I O N A L H E A LT HM A S S A C H U S E T T S D E PA R T M E N T O F P U B L I C H E A LT H

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Introduction/Vibrio parahaemolyticus (Vibrio)

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Vibrio is an emerging, naturally occurring bacterial pathogen often found in oysters harvested from warmer waters. It has caused illnesses in the Gulf Coast and West Coast of the United States for a number of years. It is not related to pollution of Massachusetts shellfish.

  When ingested, Vibrio causes watery diarrhea, often with

abdominal cramping, nausea, vomiting, fever and chills. Usually these symptoms occur within 24 hours of ingestion and last three days. Severe disease is rare and occurs more commonly in people with weakened immune systems. About ten percent of cases will develop a blood infection that may require hospitalization.

  Vibrio can also cause an infection of the skin when an open wound

is exposed to warm seawater.

Vibrio Emerging in Massachusetts

Massachusetts has had an increasing number of individuals diagnosed with Vibrio parahaemolyticus in recent years MA cases investigated by DPH and DMF each year

2011 – 13 cases 2012 – 27 cases 2013 – 58 cases

In response to 2011 illnesses, US Food and Drug Administration (FDA) directed MA to implement a Vibrio Control Plan for Eastern Cape Cod Bay (ECCB) for 2012

In 2012 harvest areas outside of ECCB were linked to illnesses, therefore FDA directed MA to expand Vibrio Control Plan statewide for 2013

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Vibrio Emerging in Massachusetts (cont.)

Of the 58 cases reported to DPH in 2013, 33 cases were traced back to one or more MA-only growing areas 19 Vibrio cases with some relationship to Duxbury 12 Vibrio cases with some relationship to Katama Bay

Consistent with guidance in the NSSP Model Ordinance closures were ordered in late August (Duxbury) and September (Katama Bay)

As a result of increased confirmed cases in 2013, FDA required additional enhancements for Vibrio Control Plans for 2014 in Massachusetts and other states

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Vibrio Emerging in Massachusetts (cont.)

New “Pandemic” Strain First cases in Pacific Northwest (WA) then the Gulf

Coast May have been introduced through ship ballast or

transplanted oysters Favors more moderate temps

Often associated with water temps < 80°F Potentially low infective dose Higher attack rate Does not test positive for known pathogenic genes Possible correlation to climate change

Warming harvest waters in MA

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Vp Growth Rates and Doubling Times

Oyster Temp(° F)

Growth Rate

(logs/hr)

Doubling Time(hours)

50 0.008 35.8

70 0.100 3.01

90 0.292 1.03

100 0.426 0.71

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Opportunities for Time/Temperature Abuse

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Transport by Harvester to

Dealer

Handling at Harvest

Handling by Dealer

Handling by Retail

Establishment

Transport by Dealer to Retailer

Receiving

Cooling to 50°F per

Plan

Storage

Receiving Storage Service

MA Vibrio Control Plan 2014

Effective dates are May 19 – October 19, 2014

Harvesters must ice oysters within two (2) hours of harvest/exposure by tide or before leaving the landing site, whichever occurs first

Original dealers must cool oysters ≤ 50° F at their facilities and prior to release for shipping

Harvesters required to maintain Vibrio Logbooks documenting all harvest activities

Dealers have additional HACCP and recordkeeping requirements

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Intertidal Subtidal

Oyster Harvest Techniques9

Intertidal Harvest

Potential for exposure to air and sunlight for up to 4 hours

a day

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“Oysterplex” Pre-collection

Oyster Culture Activities11

Wet Storage Tumbling

More Oyster Culture Activities12

Transportation of Oysters

The MA Vibrio Control Plan requires specific criteria in order for oysters to be considered adequately iced

The Plan also provides specific requirements for adequate shellfish containers

All oysters must be adequately iced within 2 hours of harvest and/or exposure by tide and prior to transport from the landing site

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Adequate Ice Dealer Facility

Oyster Handling at Wholesale14

Temperature Control Time/Temperature Abuse

Oyster Handling at Retail15

Oyster Handling at Retail

Maintain temperature control Required temperatures

Receive at ≤ 45°F Cool ≤ 41°F within four (4) hours prior to service Store and display at ≤ 41°F

Immediate placement oysters into refrigerated storage upon receipt

Encourage the use of ice where practicable e.g. oysters removed from refrigerated storage for preparation

for service

Remember: Time/temperature abuse is cumulative

• Cells are inactivated at ≈ 50°F but are not killed• They may double again with further time/temp abuse (≥ 50°F)

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Oyster Handling at Retail (cont.)

Maintain traceability Approved source

ISSL Certified Dealer Licensed in-state dealer

Shellfish tags must retained for 90 days Ensure that shellstock from one container is not commingled with

shellstock from another container Encourage recording the date when the last oyster from the

container is sold on the tag Invoices – Under the NSSP shippers are required to include

shipping records with each shipment that contain: Name, address, and certification number of the shipping dealer Name and address of the major consignee Kind and quantity of the shellfish product

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Oyster Handling at Retail (cont.)

Prevent cross-contamination Separation of shellfish from other raw foods during

storage, preparation, holding and display Especially those that contain chitin, e.g. shrimp, lobsters, etc.

Proper cleaning and sanitizing procedures where oysters are handled Especially areas where they are shucked

Proper hand washing by food handlers Prevent bare hand contact by food handlers

Change into a new pair of gloves when handling other foods

Remember: Oysters contaminated with Vp can cross-contaminate

other foods

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Illness Investigation Procedures 2014

1) Illnesses are reported to DPH Food Protection Program (FPP) and/or DPH Bureau of Infectious Disease.

2) Infectious Disease epidemiologists contact local health nurses to conduct personal interviews with those that become ill.

3) Following these interviews, FPP, assisted by local boards of health (LBOH), reviews shellfish tags and other shipping records to determine which oysters may be implicated in each illness.

4) FPP and LBOH evaluate retail shellfish handling practices, including time/temperature control of implicated oysters.

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Illness Investigation Procedures 2014 (cont.)

5) FPP then evaluates shellfish handling practices and compliance with MA Vibrio Control Plan by all dealers providing oysters to retail establishments.

6) When specific harvesters are identified, FPP and Department of Fish and Game (DMF) evaluate harvester shellfish handling practices and compliance with MA Vibrio Control Plan.

7) May result in DPH recall of implicated shellfish among wholesale dealers and closure of beds by DMF.

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Environmental Assessment - Traceability

Discussion with Person In Charge (PIC) Which dealer(s) supplied the establishment with its oysters?

Are there multiple dealers? Is more than one variety of oyster sold?

Which oysters were served on the consumption date? Determine the delivery dates

Shellfish Tags - Wholesale dealer Collect the tags that identify oysters likely served on the

consumption date Proximate to consumption date

Are they properly completed? Harvest date and area, quantity, etc.

Invoices Collect invoices that identify oysters served on the consumption

date Do they match shipping information on the tag?

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Environmental Assessment - Traceability (cont.)

Check the Menu “Happy Hours” - often use a less expensive, out-of-state oyster “Medleys” – an oyster sampler

Mix of local and out-of-state varietiesOyster Substitution

Very common occurrence, e.g. “Blue Points” Usually similar oysters when menu item is unavailable Sometimes less desirable oysters for more expensive varieties

Register Tapes Often indicate a general harvest area or “brand” of oyster

Dealer Records FPP compares tags and invoices to dealer’s required sales records

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Harvester Tag

Note: The direct sale of shellfish by a harvester to a retail establishment is prohibited under Food Protection Program regulations 105 CMR 533 and FDA’s Food Code.

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Wholesale Dealer Tag

Dealer Name

Dealer’s Address

Dealer’s Certification Number (permit #)

Original Shipper Certification Number

Harvest Date

Harvest Area

Type of Shellfish

Quantity of Shellfish

Reshipper Tag

Reshipper (RS) -means a person who purchases shellfish from dealers and sells the product without repacking or relabeling to other dealers, wholesalers, or retailers.

Note: Same info required as dealer tag with additional fields provided at bottom to indicate reshippers and dates shipped

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Actual Wholesale Dealer Tags

Unidentified Oysters Lot Identity Maintained

Traceability During an Investigation27

Environmental Assessment - Time/Temp Evaluation

Observe and record the time-temperature control in the establishment All areas where oysters are held

walk-in cooler, kitchen raw , etc. Is there potential exposure to possible heat sources?

Compressors, ovens, etc. How were oysters handled?

Were they received ≤ 45°F? Were they immediately placed in refrigerated storage? Were they cooled to ≤ 41°F prior to service? Was there adequate ice and/or refrigeration at the raw bar? Were oysters held without temperature control?

If so, how long?

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Environmental Assessment - Time/Temp Evaluation (cont.)

Review temperature records for storage area used for implicated product Review records for dates that product was held at the

establishment Temperature at receiving - receiving log Temperature of walk in cooler Thermometer calibration records

Is thermometer calibrated/working properly? Observe and record temperature and age of remaining

product Is remaining product held at ≤ 45°F? Crosscheck age of product with records

Do tags match invoices? Are quantities correct? Harvest date and area Are they “branded” oysters?

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Environmental Assessment - Time/Temp Evaluation (cont.)

Observe controls to prevent cross-contamination of product Is there potential contact with foods such as shrimp or

lobster? Vibrios are attracted to organisms that produce chitin Half-shell oysters are especially vulnerable to cross-

contamination Oysters contaminated with Vp can cross-contaminate other

foods Are handlers practicing proper hand washing procedures? Are handlers wearing gloves? Are oysters washed prior to service? Are oysters from different lots commingled?

Is any implicated product remaining? Place under embargo Possible sample collection

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Shellfish Recalls

NSSP Procedures provide additional requirements for State Shellfish Control Authority and industry in addition to FDA’s 21 CFR Part 7. Prompt reporting enables state to determine the need for:

Harvest area closures Advisories Recalls

Initiated by producing state Notification of FDA and the ISSC

Wholesale dealer responsibilities Notify receivers Instruct receivers to notify their customers

Product to remain on premises until FPP determines final disposition

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Environmental Assessment Form

Please document the findings of your investigation of implicated oysters on the Environmental Assessment form available at:

http://www.mass.gov/eohhs/docs/dph/environmental/foodsafety/foodborne-illness/risk-assessment-form.pdf

Please submit completed Environment Assessment form with all documentation collected during the investigation to the Food Protection Program.

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A Vibrio Haiku

Conduct the trace backGet shellfish tags, invoices

… call Food Protection!

- E. Hickey

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Questions?34

Eric M. Hickey

Dockside Testing / Vibrio Mgt. CoordinatorOffice of Local & Regional HealthDepartment of Public HealthBureau of Environmental Health250 Washington St., 7th FloorBoston, MA 02108Phone: 617-624-5745 Email: eric.hickey@state.ma.us

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