Texas Rapid Response Team (TRRT) & Outbreak Response

Tishara Coleman Texas Department of State Health Services

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What is a RRT?

• Rapid Response Team (RRT) • The Food Protection RRTs conduct integrated,

multiagency responses to all-hazards food and feed emergencies in various states across the Nation.

• Multi-year cooperative • FDA • State food regulatory partners.

RRT cooperoti•e Agreement stoles Voluntory RRT States

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What is a RRT? • There are currently 24 RRTs nationwide.

RRT History • The RRT program was created to address

the need for improved, integrated rapid response to food and feed emergencies.

• Multi-Agency Collaboration • Between disciplines • Between RRTs • Incident Command System (ICS) principles

TEXAS Health and Human I Texas Depa~ment of State Services Health Serv1CeS

U.S. FOOD & DRU ADMINISTRATION

Texas Rapid Response Team Multiple agencies make up the TRRT and work together to provide preparedness, prevention, and timely response to food and/or feed related disasters that may affect the citizens of Texas.

TRRT Organizational Structure The TRRT follows Incident Command System principles

• What is an Incident Command System (ICS)? • ICS is a standardized on-scene incident management

concept designed to allow responders to adopt an integrated organizational structure equal to the complexity and demands of any single incident or multiple incidents without being hindered by jurisdictional boundaries. -OSHA

Animal FOOD A NO FEED

B RANC,H

Feed Branch

Htanan FOOD B RANCH

Gro up I Group Lead

Group II GroLJp Lea d

Unified Comma nd DSHS/FDA

Public Information

Officer Safety Officer

Planning Chief

Situation Unit Res ource s

Unit

Agency Represenfati11es

Stale Age ncy Dire ctors FDA District Dire ctor FDA Dire ctor FE RN

Logistics Chief

Oocurnentatio n Unit

Demobilization Unit

COMMAND STAFF

GENERAL STAFF

TRRT Organizational Structure

Harvey Texas Rapid Response Team 10/ 02/ 2017

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PmUn;t(Fopdd t..wis Ressl•r

Bra nch Chief (M&D) Hanis Holli ngs1"1orth

Jntjdent Commanders Jane Broussard ( FDA)

Lindsay Bertl ing ( Depu ty FDA) Ben Jones (OTSC)

J ulie Loera ( OS HS)

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Public Information Officer Tim Hemnan (OTSC)

Operations DSHS

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Field Team (Foods SE)

FitJd Tgm {l.fb) Sara Williams

Carl ton Peterson Erin Walker John Hsieh

InnaJar.tmillo Linda Menafee

Emma Gorishek Cindy McCormick

Megan Rooney Wei li

Justin Hydock Cheryl Maxwell

Julie Mitchell

Field Team (Foods NE)

fl.t!&.Inm Zach Vice

Shireen Jahedkar Kelsey l ewis Russell Scott

Branch Chief (foods W) l oeWilhams

fje;ld Team (Foods Wl

Harvey 2017

yclospora 2019 Updated 8/26/2019

I O~erations Sect ion

Lori Woznicki

!Incident Commanders Kevin Veal (Lead} Jane Broussard

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Planning Section Tishara Coleman

Davonna Koebr i1 ck

Lewis Ressler

I E~idemiolog~ Branch Field Team Documentation Unit

Jlonathon IKollsin Ninfa Carreon (not mobilized) Adrienne Fung Juan Munguia

Samuel Cuevas

Wa rren Chambers

Cyclospora 2019

TRRT Operations • There are four phases of the RRT food and/or feed

emergency cycle. All four of these phases must be completed in sequence. This cycle is continuous.

Deactivation Surveillance Phase Phase

Activation Alert Phase Phase

Activate vs. Response • May activate for large scale investigations involving

food and/or feed and large scale recalls of food and/or feed.

• May respond to events with increased potential public risk.

Activation • Why activate?

• to prevent both ongoing transmission of diseaseand similar outbreaks in the future

Activation

Activation

DSHS

FDA LHDs

TDA

OTSC

Activation

Activation

Activation Triggers • What triggers an activation?

• High probability that an adverse foodand/or feed related incident exists.

• Positive pathogen results • What is the number of cases? • How quickly is the event escalating? • Is the event localized, statewide or

national?

What happens during an activation? • What does the TRRT do?

• Emergency evaluation of food firms andestablishments • Disaster

• Traceback/Product tracing • Foodborne illness outbreak

Emergency evaluation • Natural or man-made emergency events • Ensure that food put in commerce is safe for

consumption

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Emergency evaluation • Identify affected areas • Survey food firms and establishments • Conduct onsite visit if needed

Traceback • Product Tracing

Verifying the records of a food/feed item from its source to final distribution.

• Traceback An investigation that starts with the consumer or the point-of-service and traces the distribution of the product back to the source.

Traceback • Foodborne illness outbreak

• Confirmed cases • Suspect food item

Traceback

Traceback

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TRRT Past Activations and Responses

• 2011 - Salmonella Agona* • 2013 – Cyclospora • 2014 – Cyclospora • 2015 – May Weather Incident • 2015 – Cyclospora • 2016 – Cyclospora* • 2017 – Cyclospora • 2017 - Hurricane Harvey • 2018 – Cyclospora* • 2019 - Cyclospora

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Case Count of Cyclosporiasis in Texas, 2012 •

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Cyclospori11sis inTeias. 2014•

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case Count of CyclosponasIs in Texas, 2013 •

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case Count of Cyclosporiasis in Texas, 2015 •

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Cyclospora Past Activations and Responses

2012 - 44/9 cases 2013 - 351/270 cases

2014 - 200/130 cases 2015 - 316/184 cases

Home > Import Program > Import A lerts > Imports Alerts by Number

Import Alert 24-23

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Changes are noted and bracketed by three asterisks ('**).

The Centers for Disease Control and Prevention (CDC) and state public health officials have identified annually recurring outbreaks (in 2012, 2013, and 2014) of cyclosporiasis in the United States wh ich have been associated with fresh cilantro from the state of Puebla, Mexico. There is currently (in July 2015) another ongoing outbreak of cyclosporiasis in the United States in wh ich both the Texas Department of State Health Services and the Wisconsin Department of Health Services and the Wisconsin Department of Agricu lture, Trade and Consumer Protection have identified cilan tro from the Mexican state of Puebla as a suspect veh icle with respect to separate illness clusters.

Cyc lospora cayetanensis is a human-specific protozoan parasite that causes a prolonged and severe diarrheal illness known as cyclosporiasis. In order to become infectious, the organism requires a period outside of its host. Illnesses are known to be seasonal and Ille parasite is not known to be endemic to the United states. Cyclosporiasis occurs in many countries. but it seems to be most common in tropical and subtropical regions. People become infected with C. cayetanens is by ingesting sporu lated oocysts. wh ich are Ille infective form of the parasite. This most commonly occurs when food or water contaminated with feces is consumed. An infected person sheds unsporulated (immature. non-infective) C. cayetanenis oocysts in the feces.

Cyclospora FDA Import Alert

Based on epidemiological evidence collected by affected domestic states, the CDC and traceback evaluations conducted by FDA, cilantro from the state of Puebla, Mexico was implicated as the vehicle for some of the U.S. cyclosporiasis infections in 2013 and 2014. In addition, after cyclosporiasis illnesses from the 2013 outbreak were linked to cilantro from Puebla…

Cyclospora Post Import Alert

2016 • DSHS received 120 reports of

cyclosporiasis• 48 domestically acquired cases

2017 • DSHS received 281 reports of

cyclosporiasis• 174 domestically acquired cases

2018 • DSHS received 349 reports of cyclosporiasis• 225 cases domestically acquired cases

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Activation In Depth Cyclospora 2019

Outbreak-Related Cyclosporiasis Cases in Texas, 2019*

Case Count bv Cluster

- Juice establishment - 13 cases

- Me xican restaurant- 29 cases

- Mexican restaurant- 5 cases

~ Seafood restaurant- 27 cases

- Mexican restaurant- S cases

- Mexican meat market- 9 cases

~ Mexican rest aurant- 3 cases

• As of 9/ 25/ 2019

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TEXAS Health and Human Services

Source: Texas Department of State Health Services, Infectious Disease Control Unit.

Prepared: September, 2019 ( n = 91 )

Texas Department of State Health Services

Activation In Depth Cyclospora 2019

pora 2019 Dallas M etroplex

9/ 4/ 2019 Pathogen: Cyclospora

Veh icle: Cilant ro Exposure Date: 6/ 26

Texas Rapid Response Team

POSA: Irvi ng, TX 1+------1 Dist A:Dallas, TX

Dist B: Mc Allen, TX

Dist C: McAl len, TX

Dist H: Tlaxcala, Dist G: Hida lgo, TX i.---------t Mexico

-------·---·---------·---------·---·----, . . j Dist F: Puebla, , Mexico

Dist D: Puebla, ~c.:.:._ __________________ 7 Mexico

', j Dist E: Jalisco, , Mexico - - - - - - - - - - - - - - - - - - - -

Activation In Depth Cyclospora 2019

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Cyclospora in Texas Outbreak Related Cases of Cyclosporiasis in

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What’s Next?

• FDA Food Testing• CDC Sequencing Project

In the meantime…

Surveillance Deactivation Phase Phase

Activation Alert Phase Phase

In the meantime… • TRRT is still active while not activated

• Surveillance phase• Monitor current outbreaks

• Networking/collaboration• Conferences• Calls

2018 RRT Face-2-Face Meeting

In the meantime… • TRRT is still active while not activated

• Training • Traceback course • Online training • Webinars

• Exercises • ICS • Tabletops

• Outreach • Relationship building

• LHDs • Industry

Traceback Investigations course

TEXAS RAPID RESPONSE TEAM

R'Sl fuil•f•IIUi•l•f4thi.f•lfoiMI

Response Operating Guide (ROG)

The TRRT Response Operating Guidelines (ROG) outlines policies for TRRT preparedness, activation, operation, and deactivation.

• Definitions • TRRT members • Policies and

responsibilities • Standard Operating

Procedures (SOPs) • Reviewed and revised

as needed

Sponsor

Food SHIELD Is sponsored by the N3tlonal C11nter for Food

Protection ~nd Defense.

NCFPO 1s a U S Department of Homeland Secunty

Science & Technology Center or Excellence based at lhe Umvers1ty of Minnesota

FoodSHIELD FoodSHIELD is the communication platform for the TRRT.

• Provides public and private food and agriculture sectors an on-line platform to coordinate their efforts in a secure and efficient way.

• Serves as the primary communication and coordination toolduring all phases of a the TRRT emergency cycle.

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«: Latest Activity

RRT Loca l and Regional Partners

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1:57 PM

10:42AM

1/18/17

nshara Coleman replaced Version 1 .0 of Updated ROG 05242016.docx

a Read Current Version J:. Dow nload Current Version

7/22/16

Catherine Thibodaux posted a document At Toi bets From Gordon Food Service

0518201 6_07152016.pdf

a Read J:. Dow nload Current Version 1 .0

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FoodSHIELD TRRT Local and Regional Partners

TRRT Contact Information

Tishara Coleman Texas Rapid Response Team Coordinator tishara.coleman@dshs.texas.gov