California Department of Public California Department of Public HealthHealth

Food and Drug BranchFood and Drug Branch

San Joaquin CountySan Joaquin County

All Hazards WorkshopAll Hazards Workshop

August 2008August 2008

Food and Drug BranchFood and Drug Branch

Three sections: Food Safety, Drug Safety, and Three sections: Food Safety, Drug Safety, and Medical Device SafetyMedical Device Safety

Food Safety includesFood Safety includes– Processed food registration and inspectionProcessed food registration and inspection– Industry education and training Industry education and training – Bottled and vended water programBottled and vended water program– Seafood inspectionSeafood inspection– Emergency response and food securityEmergency response and food security– Retail food programRetail food program– Consumer complaint programConsumer complaint program

Food and Drug Lab BranchFood and Drug Lab Branch

Public health reference and research labPublic health reference and research lab Sister agency to Food and Drug BranchSister agency to Food and Drug Branch Includes Chemistry, Microbiology, and Includes Chemistry, Microbiology, and

Abused Substances Analysis SectionsAbused Substances Analysis Sections Analyzes food, drugs, cosmetics, medical Analyzes food, drugs, cosmetics, medical

devices, and environmental samplesdevices, and environmental samples Supports FDB in outbreak investigations Supports FDB in outbreak investigations

and inspection activitiesand inspection activities

Emergency ResponseEmergency Response

Emergency Response Emergency Response Unit in the Food Safety Unit in the Food Safety SectionSection– Investigates foodborne Investigates foodborne

illness outbreaksillness outbreaks– Investigates tampering Investigates tampering

incidentsincidents– Participates in Participates in

preventive outreach preventive outreach efforts including food efforts including food defensedefense

Before

After

Tampering casesTampering cases

How does this protect public health?How does this protect public health?

Outcomes from previous investigationsOutcomes from previous investigations– Almond industry has adopted a “kill step” for raw Almond industry has adopted a “kill step” for raw

almondsalmonds– Strawberry industry has modified the method of harvest Strawberry industry has modified the method of harvest

of strawberries for processingof strawberries for processing– New commodity-specific guidelines for sprouts, New commodity-specific guidelines for sprouts,

tomatoes and lettucetomatoes and lettuce– Produce industry has begun to think of harvest workers Produce industry has begun to think of harvest workers

as food handlers, enforcing hand washing procedures as food handlers, enforcing hand washing procedures and harvest equipment sanitationand harvest equipment sanitation

How are local health jurisdictions How are local health jurisdictions involved?involved?

Illnesses are reported by local public health to Illnesses are reported by local public health to state health Division of Communicable Disease state health Division of Communicable Disease Control (DCDC) and by DCDC to CDCControl (DCDC) and by DCDC to CDC

DCDC provides information to FDB about clusters DCDC provides information to FDB about clusters of illnesses where food may be the vehicleof illnesses where food may be the vehicle– If a food vehicle is implicated by epidemiological If a food vehicle is implicated by epidemiological

investigation (statistically significant association), FDB investigation (statistically significant association), FDB begins an environmental investigation begins an environmental investigation

– FDA is informed, and if interstate commerce is involved, FDA is informed, and if interstate commerce is involved, becomes the lead agencybecomes the lead agency

How are local health jurisdictions How are local health jurisdictions involved?involved?

Local health department will be asked to supply Local health department will be asked to supply information about the Point of Service (POS) for information about the Point of Service (POS) for select case-patientsselect case-patients– Those with clear recall of where/when they ate the Those with clear recall of where/when they ate the

implicated foodimplicated food If it is necessary to visit the retail POS, local If it is necessary to visit the retail POS, local

environmental health will be invited to participateenvironmental health will be invited to participate Environmental health may be asked to collect Environmental health may be asked to collect

documentation, such as invoices. The time period documentation, such as invoices. The time period for which the documentation is needed is critical.for which the documentation is needed is critical.

Foodborne outbreak investigationsFoodborne outbreak investigations

The environmental investigation may includeThe environmental investigation may include– Environmental investigation at the point of Environmental investigation at the point of

serviceservice– Traceback to manufacturer and/or farmTraceback to manufacturer and/or farm– Environmental investigation at the manufacturerEnvironmental investigation at the manufacturer– Sampling productSampling product– Environmental samplingEnvironmental sampling– Farm investigationFarm investigation– Collection and examination of recordsCollection and examination of records

How does FDB relate to other state How does FDB relate to other state agencies dealing with food?agencies dealing with food?

Dairy products are regulated by California Dairy products are regulated by California Department of Food and Agriculture (CDFA) and Department of Food and Agriculture (CDFA) and US FDAUS FDA

Many egg ranches participate in the California Egg Many egg ranches participate in the California Egg Quality Assurance Program (CEQAP), a CDFA Quality Assurance Program (CEQAP), a CDFA program intended to control SE program intended to control SE

Foodborne illness investigations involving dairy Foodborne illness investigations involving dairy and egg products are conducted jointly with CDFAand egg products are conducted jointly with CDFA

Fruit and vegetable growers must follow guidelines Fruit and vegetable growers must follow guidelines regarding pest control overseen by the county regarding pest control overseen by the county Agricultural CommissionerAgricultural Commissioner

FDB advises CDFA of illness investigations FDB advises CDFA of illness investigations involving California produceinvolving California produce

What is CalFERT?What is CalFERT?

The California Food Emergency Response Team is a The California Food Emergency Response Team is a group of state and federal Investigators and Scientists that group of state and federal Investigators and Scientists that conduct environmental investigations of foodborne illness conduct environmental investigations of foodborne illness outbreaks.outbreaks.

Food and Drug Investigators from state Food and Drug Food and Drug Investigators from state Food and Drug Branch (FDB) are peace officers and have the authority to Branch (FDB) are peace officers and have the authority to embargo food products that may be contaminated.embargo food products that may be contaminated.

Investigators/Consumer Safety Officers from FDA are Investigators/Consumer Safety Officers from FDA are associated with the Los Angeles and San Francisco District associated with the Los Angeles and San Francisco District OfficesOffices

Scientists include microbiologists associated with FDA Scientists include microbiologists associated with FDA labs, and research scientists associated with the labs, and research scientists associated with the Emergency Response Unit in FDBEmergency Response Unit in FDB

What outbreaks has the team What outbreaks has the team investigated?investigated?

State and federal investigators have worked side by side State and federal investigators have worked side by side on investigations in the past.on investigations in the past.

During the During the SalmonellaSalmonella Enteritidis outbreak associated with Enteritidis outbreak associated with almonds in 2004, investigators and laboratorians from both almonds in 2004, investigators and laboratorians from both agencies worked together as a team agencies worked together as a team

In 2005, the team was formally established and met In 2005, the team was formally established and met together outside of outbreak situations to develop protocolstogether outside of outbreak situations to develop protocols

In the fall of 2005, those protocols were put into practice for In the fall of 2005, those protocols were put into practice for the first time during the the first time during the E. coliE. coli O157:H7 outbreak O157:H7 outbreak associated with bagged lettuce and a associated with bagged lettuce and a SalmonellaSalmonella Enteritidis outbreak associated with tomatoesEnteritidis outbreak associated with tomatoes

What outbreaks has the team What outbreaks has the team investigated?investigated?

In the fall and winter of 2006-2007, the team In the fall and winter of 2006-2007, the team investigated investigated E. coliE. coli O157:H7 outbreaks associated O157:H7 outbreaks associated with spinach and shredded lettuce (Taco Bell and with spinach and shredded lettuce (Taco Bell and Taco John)Taco John)

Follow-up to the outbreaks associated with leafy Follow-up to the outbreaks associated with leafy greens has included review and input by CDHS-greens has included review and input by CDHS-FDB and US FDA of the document that became FDB and US FDA of the document that became the “Best Practices” for safe growing and handling the “Best Practices” for safe growing and handling under the Leafy Greens Marketing Agreement.under the Leafy Greens Marketing Agreement.

Most recent investigation was a romaine-Most recent investigation was a romaine-associated associated E. coliE. coli O157:H7 outbreak in the state O157:H7 outbreak in the state of Washington of Washington

Questions?Questions?

FDB Website contains food defense brochures in four languages, outbreak investigation reports, and posters on CalFERT and the Taco John investigation http://www.cdph.ca.gov/programs/Pages/FDB%20Food%20and%20Drug%20Branch.aspx

See http://www.cdph.ca.gov/programs/bes/Pages/default.aspx

for CDHS Bioterrorism Surveillance and Epidemiologic Response Plan

Contact: Mary Palumbo, (916) 650-6623 or mary.palumbo@cdph.ca.gov