Selected Zoonotic Diseases  Conference Call October 7, 2009
Casey Barton Behravesh, DVM, DrPH, DACVPM, Veterinary Epidemiologist, Outbreak Net, Division of Foodborne, Bacterial and M...
Human Salmonellosis Linked to Contact with Live Poultry From Mail-Order Hatcheries Casey Barton Behravesh, DVM, DrPH, DACV...
The Mail-Order Hatchery Industry in US <ul><li>Estimated <100 hatcheries supply baby birds </li></ul><ul><li>Any one hatch...
Shipping Live Poultry <ul><li>Hatcheries ship birds </li></ul><ul><ul><li>To customers </li></ul></ul><ul><ul><li>To agric...
Drop Shipping <ul><li>Common practice in hatchery industry </li></ul><ul><li>Hatchery 1 can not complete customer order be...
Contact with Live Poultry as Source of Human  Salmonella  Infections <ul><li>> 25 outbreaks since 1950s </li></ul><ul><ul>...
Recent Outbreaks <ul><li>Salmonella  Montevideo, Outbreak Strain A </li></ul><ul><ul><li>Hatchery A </li></ul></ul><ul><li...
Salmonella  Montevideo Outbreak Strain A, 2005-2009 <ul><li>Outbreaks annually since 2005 </li></ul><ul><li>Human  Salmone...
Isolates of  Salmonella  Montevideo in PulseNet-USA by Year, 1999-2009 Outbreak Strain A Other strains
Salmonella  Montevideo Outbreak Pattern B, 2007-2009 <ul><li>Outbreaks annually since 2007 </li></ul><ul><li>Human  Salmon...
Salmonella  Montevideo Outbreak Pattern B, 2009 <ul><li>One family reunion, two weddings catered by unlicensed caterer in ...
Isolates of  S . Montevideo in PulseNet, Pattern 21 Outbreak Strain and Non-Outbreak Strains, 1999-2009 (N=6,412) Number o...
Salmonella  Johannesburg, 2009 <ul><li>7 case-patients from 4 states  </li></ul><ul><ul><li>Median age: 1 year (range <1 t...
Salmonella Thompson, 2009 <ul><li>25 case-patients from 7 states </li></ul><ul><ul><li>Median age: 19 years (range: <1 to ...
Multistate Outbreak of  Salmonella  Typhimurium Infections Linked to Live Poultry from a Mail-Order Hatchery, 2009
Outbreak Detection, Pennsylvania <ul><li>May, 2009   </li></ul><ul><ul><li>PulseNet identified an isolate of  Salmonella  ...
Isolates of  Salmonella  Typhimurium with the Outbreak Strain in PulseNet by Upload Date (N=139),  February – September, 2...
CA 1 CT 5 WI 3 KY 3 MD 5 MA 16 MI 6 NH 2 NJ 7 NY 34 NC 2 OH 2 PA 30 RI 2 UT 8 VA 7 AL 1 AK DE 2 Isolates of  Salmonella  T...
Salmonella  Typhimurium 0905PAJPX-1 Patient Characteristics (n=139) <ul><li>Female – 49%  </li></ul><ul><li>Median age –  ...
Initial Investigation <ul><li>State and local health department conducted initial patient interviews </li></ul><ul><ul><li...
Case Definition <ul><li>Illness after February 23, 2009 </li></ul><ul><li>Yielding  Salmonella  Typhimurium from a clinica...
Case-Control Study Methods <ul><li>Developed questionnaire tool modeled after past live poultry contact survey </li></ul><...
Questionnaire <ul><li>Clinical information </li></ul><ul><ul><li>Illness, past medical history </li></ul></ul><ul><li>Cont...
Exposure % Cases (n=37)  % Controls (n=33) mOR CI Live poultry contact 50 9 13 2-552.5 Chick contact 43 3 13 2-552.5 Duckl...
Descriptive Statistics – Case patients <ul><li>Types of contact with live poultry* (n=18) </li></ul><ul><ul><li>Touched li...
Additional Laboratory Findings <ul><li>Multiple-Locus Variable-Number Tandem Repeat Analysis (MLVA) performed on PA & NY i...
Feed Store Survey <ul><li>Evaluate poultry management practices at agricultural feed stores in PA </li></ul><ul><ul><li>Nu...
Feed Store Survey Results <ul><li>102 agricultural feed stores contacted by either in-store visit or by phone </li></ul><u...
Feed Store Customers <ul><li>Feed Store X </li></ul><ul><ul><li>Display of live poultry in store </li></ul></ul><ul><li>Ot...
Feed Store Survey Comparison  2006 & 2009 New Mexico 2006 Pennsylvania 2009 Awareness that poultry can cause  Salmonella  ...
Hatchery Traceback <ul><li>Feed Store X utilizes Hatchery C </li></ul><ul><ul><li>Delivery with US Postal Service </li></u...
Public Education  <ul><li>All persons should wash their hands with soap and warm water for at least 20 seconds after touch...
Recommendations for Feed Stores  <ul><li>Provide educational material for customers </li></ul><ul><li>Warning signs and ha...
Poultry Specific Questionnaire
Summary <ul><li>Multiple live poultry-associated outbreaks identified in recent years </li></ul><ul><li>Multiple outbreak ...
Contact Information <ul><li>Casey Barton Behravesh DVM, DrPH, DACVPM  </li></ul><ul><li>LCDR, U.S. Public Health Service  ...
Selected Zoonotic Diseases  Conference Call October 7, 2009
Upcoming SlideShare
Loading in …5
×

October 2009 Conference Call Slides For Upload

732 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
732
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
37
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Human Salmonellosis Linked to Contact with Live Poultry From Mail-Order Hatcheries Casey Barton Behravesh, DVM, DrPH, DACVPM, Veterinary Epidemiologist, Outbreak Net, Division of Foodborne, Bacterial and Mycotic Diseases (DFBMD), CDC, 404-639-0367, [email_address] .; Anagha Loharikar, MD, EIS Officer, Enteric Diseases Epidemiology Branch, DFBMD, 404-639-3510, [email_address]
  • Next, I will give a brief overview of the hatchery industry in the United States. It is estimated that there are fewer than 100 of these hatcheries that supply baby birds to customers in the U.S. And there are only 20 of these hatcheries that produce live birds. However, since few published data exist describing such bird distribution patterns, the actual number of these hatcheries is unknown. Any one of these hatcheries may supply birds to customers in several states including other hatcheries. There is no public health oversight in this industry concerning requirements for warning labels to consumers who are able to purchase birds, or for housing conditions of birds in stores. Typically, day-old baby poultry that are hatched in hatcheries are sent to agricultural feed stores or residences in cardboard boxes, such as the one pictured in the top corner, via the United States Postal Service.
  • Now we would like to discuss this most recent multistate outbreak of Salmonella Typhimurium infections associated with live poultry from a mail-order hatchery this summer.
  • In May 2009, PulseNet identified an isolate of Salmonella Typhimurium with an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern termed the “outbreak strain”. Meanwhile, states with cases had already begun initial evaluation of cases using general state forms. Then CDC contacted states with this outbreak strain to begin multi-state discussions.
  • This is the epi-curve of this outbreak strain. From February to September of 2009, we have seen 139 cases thus far, with peaks at the end of May &amp; early-mid July.
  • This map shows the distribution of cases among states of this outbreak strain. States with the highest number of cases were Pennsylvania and New York, followed by Massachusetts.
  • 49% of cases with this outbreak strain were female, with a median age of 12 years. This outbreak affected mostly younger children, and 36% of cases were between the ages of 0 and 5.
  • State and local health departments had conducted initial case interviews, which showed a preliminary link with exposure to live baby poultry. Many cases reported purchasing poultry or having contact with poultry at feed stores.
  • Our case definition for the case-control study was Illness after February 23, 2009, Yielding Salmonella Typhimurium from a clinical specimen with PFGE Xba I pattern JPXX01.0302 and Living in either Pennsylvania and New York.
  • We developed a questionnaire tool which was modeled after past live poultry contact surveys and enrolled case-patients from PA and NY. We enrolled control patients with the goal of one control for each case-patient. We selected controls that were geographically-matched, using reverse phone look-up, and age-matched with the following age categories.
  • In our questionnaire, we asked about Clinical information, Contact with animals, Attending event or visiting location with animals, Contact with or Purchase of live poultry Poultry care at home and a Supplemental questionnaire for National Poultry Improvement Plan which discussed sex and breed of birds purchased.
  • This slide shows the preliminary results from our study; we enrolled 37 cases and 33 controls thus far. Matched odds ratios and confidence intervals are shown for these significant variables. Cases were 13 times more likely to have had live poultry contact and contact with baby chicks when compared with controls. Interestingly, cases were also 6 times more likely to have visited a feed store and 5 times more likely to have visited feed store X.
  • Of the 18 cases that had poultry contact, 89% stated they touched live poultry, 62% held poultry and 22% kissed baby birds. Of the 10 case patients that reported purchasing live poultry at a feed store, 60% received NO information from the place of purchase. Of the 17 case-patients that reported having contact with poultry in their home or someone else’s home, 35% of the birds were kept in the home and 29% were kept in the basement.
  • As we were conducting the case-control study, we requested Multiple-Locus Variable-Number Tandem Repeat Analysis (MLVA) Patterns on isolates from PA and NY, which is a newer advanced and more specific technique for evaluating isolates. We have received 49 results thus far, of which 73% have a matched MLVA pattern in NY and PA, which suggests a point source for infection.
  • The second study was a feed store survey to evaluate poultry management practices at agricultural feed stores in PA. We asked about Number and types of birds sold, Hatcheries used; method of delivery from hatchery, Method of packaging for sale, Medication and antibiotic use, how birds are displayed in stores, hand-washing stations and signs. We also asked about what kind of Customer education was provided with regard to handling poultry and health risks, and store Knowledge of Salmonella and its association with live poultry.
  • 102 feed stores were contacted and 50 identified as havign sold poultry. Feed stores reported selling a wide range of number of birds from about 60 to even over 20,000 at larger stores. The peak season of sales is between March through May and around Easter, although it was later this year because the winter was longer. Stores mainly sell baby chicks and ducklings, and reported no artificial coloring of birds. re contacted, of which 50 stores identified as having sold poultry and were surveyed.
  • Feed Store X displayed their birds in metal galvanized livestock bins like these shown, while many other stores had chick days for order only purchases from long-time customers and did not display birds in the store.
  • When we look at the feed store survey done in New Mexico in 2006 compared with Pennsylvania in 2009 we can see that although many stores are aware that poultry can cause Salmonella, only some state that they warn customers.
  • Many of the case-patients reported contacting or purchasing poultry from Feed Store X which buys their birds from hatchery C and has them delivered by US Postal Service. This hatchery was also implicated in the Salmonella Johannasburg outbreak earlier this year. Other feed stores surveyed reported utilizing other hatcheries, many of which were local and delivery was by private truck.
  • Some recommendations for feed stores can include having Standardized educational material for customers and Warning signs and hand-washing stations by displayed poultry. Also, stores can have specific Chick days for order only purchase or Keep poultry in back of store as well as display poultry in covered or glass tanks out of reach of children.
  • This shows the case questionnaire and the supplemental NPIP questionnaire that were used.
  • In Summary…
  • Thank you! This is our contact information at the CDC; we look forward to hearing from you.
  • October 2009 Conference Call Slides For Upload

    1. 1. Selected Zoonotic Diseases Conference Call October 7, 2009
    2. 2. Casey Barton Behravesh, DVM, DrPH, DACVPM, Veterinary Epidemiologist, Outbreak Net, Division of Foodborne, Bacterial and Mycotic Diseases, CDC; 404-639-0367; cbartonbehravesh@cdc.gov Selected Zoonotic Diseases Conference Call October 7, 2009 Human Salmonellosis Linked to Contact with Live Poultry From Mail-Order Hatcheries
    3. 3. Human Salmonellosis Linked to Contact with Live Poultry From Mail-Order Hatcheries Casey Barton Behravesh, DVM, DrPH, DACVPM Anagha Loharikar, MD Division of Foodborne, Bacterial and Mycotic Diseases National Center for Zoonotic, Vector-Borne and Enteric Diseases Centers for Disease Control and Prevention October 7, 2009 For internal use only, please do not distribute
    4. 4. The Mail-Order Hatchery Industry in US <ul><li>Estimated <100 hatcheries supply baby birds </li></ul><ul><li>Any one hatchery may supply birds to customers in several states </li></ul><ul><li>Little regulatory oversight of industry </li></ul>
    5. 5. Shipping Live Poultry <ul><li>Hatcheries ship birds </li></ul><ul><ul><li>To customers </li></ul></ul><ul><ul><li>To agricultural feed stores </li></ul></ul><ul><ul><li>100 - 125 chicks or 60 ducklings per box </li></ul></ul>
    6. 6. Drop Shipping <ul><li>Common practice in hatchery industry </li></ul><ul><li>Hatchery 1 can not complete customer order because no birds are available </li></ul><ul><li>Hatchery 1 contacts Hatchery 2 for availability </li></ul><ul><li>Hatchery 2 ships order to customer under Hatchery 1 name </li></ul>
    7. 7. Contact with Live Poultry as Source of Human Salmonella Infections <ul><li>> 25 outbreaks since 1950s </li></ul><ul><ul><li>Young children </li></ul></ul><ul><ul><li>Baby chicks as pets </li></ul></ul><ul><ul><li>Seasonal pattern </li></ul></ul><ul><ul><li>Montevideo, Typhimurium serotypes </li></ul></ul><ul><li>Appear healthy </li></ul><ul><li>Mail-order hatcheries </li></ul>
    8. 8. Recent Outbreaks <ul><li>Salmonella Montevideo, Outbreak Strain A </li></ul><ul><ul><li>Hatchery A </li></ul></ul><ul><li>Salmonella Montevideo, Outbreak Strain B </li></ul><ul><ul><li>Hatchery B </li></ul></ul><ul><li>Salmonella Johannesburg </li></ul><ul><ul><li>Hatchery C </li></ul></ul><ul><li>Salmonella Thompson </li></ul><ul><ul><li>Hatchery D </li></ul></ul><ul><li>Salmonella Typhimurium </li></ul><ul><ul><li>Hatchery C </li></ul></ul>
    9. 9. Salmonella Montevideo Outbreak Strain A, 2005-2009 <ul><li>Outbreaks annually since 2005 </li></ul><ul><li>Human Salmonella infections linked to contact with live baby poultry from Hatchery A </li></ul><ul><li>Multiple environmental samples from hatchery match the outbreak strain </li></ul><ul><li>Case-patients primarily children </li></ul><ul><li>Hatchery working with USDA-NPIP to improve hatchery sanitation, administered autogenous vaccine </li></ul>
    10. 10. Isolates of Salmonella Montevideo in PulseNet-USA by Year, 1999-2009 Outbreak Strain A Other strains
    11. 11. Salmonella Montevideo Outbreak Pattern B, 2007-2009 <ul><li>Outbreaks annually since 2007 </li></ul><ul><li>Human Salmonella infections linked to contact with live poultry from Hatchery B </li></ul><ul><li>Multiple specimens from poultry and environment of 3 case-patient households matched outbreak strain </li></ul><ul><li>This outbreak is different from previous live poultry contact outbreaks: </li></ul><ul><ul><li>Cases less concentrated in spring months </li></ul></ul><ul><ul><li>Proportion of adults was higher than children </li></ul></ul><ul><ul><li>Patients reported purchasing birds primarily for meat and eggs </li></ul></ul><ul><li>Hatchery working with USDA-NPIP, administering autogenous vaccine </li></ul>
    12. 12. Salmonella Montevideo Outbreak Pattern B, 2009 <ul><li>One family reunion, two weddings catered by unlicensed caterer in North Dakota </li></ul><ul><li>41 PFGE confirmed cases </li></ul><ul><ul><li>Onset date range from 6/13/2009 - 6/17/2009 </li></ul></ul><ul><li>Food prepared in caterer’s home kitchen </li></ul><ul><li>Caterer owns 20-25 chicks sourced from Hatchery B </li></ul><ul><li>Suspect cross-contamination in kitchen </li></ul>
    13. 13. Isolates of S . Montevideo in PulseNet, Pattern 21 Outbreak Strain and Non-Outbreak Strains, 1999-2009 (N=6,412) Number of Isolates Year * Data as of July 10, 2009
    14. 14. Salmonella Johannesburg, 2009 <ul><li>7 case-patients from 4 states </li></ul><ul><ul><li>Median age: 1 year (range <1 to 5 years) </li></ul></ul><ul><li>86% exposed to baby poultry </li></ul><ul><li>Poultry traced to common hatchery, Hatchery C </li></ul><ul><li>Day care attended by a case-patient has back yard flock of chickens </li></ul><ul><li>Outbreak strain isolated from chickens at day care </li></ul>
    15. 15. Salmonella Thompson, 2009 <ul><li>25 case-patients from 7 states </li></ul><ul><ul><li>Median age: 19 years (range: <1 to 86 years) </li></ul></ul><ul><li>77% exposed to baby poultry </li></ul><ul><li>31% exposed to adult poultry </li></ul><ul><li>54% exposed at home </li></ul><ul><li>Poultry traced to common hatchery, Hatchery D </li></ul>
    16. 16. Multistate Outbreak of Salmonella Typhimurium Infections Linked to Live Poultry from a Mail-Order Hatchery, 2009
    17. 17. Outbreak Detection, Pennsylvania <ul><li>May, 2009 </li></ul><ul><ul><li>PulseNet identified an isolate of Salmonella Typhimurium </li></ul></ul><ul><ul><ul><li>Indistinguishable pulsed-field gel electrophoresis (PFGE) pattern </li></ul></ul></ul><ul><ul><ul><li>Outbreak strain – 0905PAJPX-1 </li></ul></ul></ul><ul><ul><li>States had begun initial evaluation of cases using general form </li></ul></ul><ul><ul><li>CDC contacted states with outbreak strain </li></ul></ul>
    18. 18. Isolates of Salmonella Typhimurium with the Outbreak Strain in PulseNet by Upload Date (N=139), February – September, 2009 Isolation Date # of Isolates
    19. 19. CA 1 CT 5 WI 3 KY 3 MD 5 MA 16 MI 6 NH 2 NJ 7 NY 34 NC 2 OH 2 PA 30 RI 2 UT 8 VA 7 AL 1 AK DE 2 Isolates of Salmonella Typhimurium with the Outbreak Strain in PulseNet by State (N=139), February – September, 2009 1-5 6-10 11 and over IL 1 MO 1 ND 1
    20. 20. Salmonella Typhimurium 0905PAJPX-1 Patient Characteristics (n=139) <ul><li>Female – 49% </li></ul><ul><li>Median age – 12 years (range: 0 – 79 yr) </li></ul>Age group # case patients % 0 – 5 years 50 36% 6 – 19 years 30 22% > 20 years 51 37% Unknown 8 5%
    21. 21. Initial Investigation <ul><li>State and local health department conducted initial patient interviews </li></ul><ul><ul><li>Exposure to live baby poultry </li></ul></ul><ul><ul><li>Reported purchasing/contacting live poultry at feed stores </li></ul></ul><ul><li>Epi-Aid requested by Pennsylvania </li></ul><ul><ul><li>Case-control study </li></ul></ul><ul><ul><li>Feed store survey </li></ul></ul>
    22. 22. Case Definition <ul><li>Illness after February 23, 2009 </li></ul><ul><li>Yielding Salmonella Typhimurium from a clinical specimen with PFGE Xba I pattern JPXX01.0302 </li></ul><ul><li>Living in Pennsylvania and New York states </li></ul>
    23. 23. Case-Control Study Methods <ul><li>Developed questionnaire tool modeled after past live poultry contact survey </li></ul><ul><li>Enrolled case-patients from Pennsylvania and New York </li></ul><ul><li>Control Selection </li></ul><ul><ul><li>One control for each case-patient </li></ul></ul><ul><ul><li>Geographic matching </li></ul></ul><ul><ul><ul><li>Reverse phone lookup generated by case-patient address </li></ul></ul></ul><ul><ul><li>Age matching ( 0-3 years; 4-17 years; 18-39 years; >40 years) </li></ul></ul>
    24. 24. Questionnaire <ul><li>Clinical information </li></ul><ul><ul><li>Illness, past medical history </li></ul></ul><ul><li>Contact with animals </li></ul><ul><li>Attending event or visiting location with animals </li></ul><ul><li>Contact with live poultry </li></ul><ul><li>Purchase of live poultry </li></ul><ul><li>Poultry management practice in home </li></ul><ul><li>Supplemental questionnaire for National Poultry Improvement Plan </li></ul><ul><ul><li>Sex and breeds of birds purchased </li></ul></ul>
    25. 25. Exposure % Cases (n=37) % Controls (n=33) mOR CI Live poultry contact 50 9 13 2-552.5 Chick contact 43 3 13 2-552.5 Duckling contact 24 3 8 1.1-355 Household member with poultry contact 41 9 6 1.3-55.2 Visiting a feed store 32 6 6 1.3-55.2 Visiting Feed Store X 27 6 5 1.1-46.9
    26. 26. Descriptive Statistics – Case patients <ul><li>Types of contact with live poultry* (n=18) </li></ul><ul><ul><li>Touched live poultry – 89% </li></ul></ul><ul><ul><li>Held poultry – 61% </li></ul></ul><ul><ul><li>Kissed poultry or put near mouth – 22% </li></ul></ul><ul><li>Purchased live poultry at a feed store (n=10) </li></ul><ul><li>Received no information from place of purchase – 60% </li></ul><ul><li>Cases who reported contact with poultry in a home (n=17) </li></ul><ul><li>Poultry kept inside home – 35% </li></ul><ul><ul><li>Poultry kept in basement – 29% </li></ul></ul>*Respondents could select more than one means of contact.
    27. 27. Additional Laboratory Findings <ul><li>Multiple-Locus Variable-Number Tandem Repeat Analysis (MLVA) performed on PA & NY isolates (n=49) </li></ul><ul><li>Matched MLVA pattern seen for 36 (73%) </li></ul><ul><ul><li>19 PA and 17 NY cases </li></ul></ul><ul><ul><li>Suggests point source of infection </li></ul></ul>
    28. 28. Feed Store Survey <ul><li>Evaluate poultry management practices at agricultural feed stores in PA </li></ul><ul><ul><li>Number and types of birds sold </li></ul></ul><ul><ul><li>Hatcheries used; method of delivery from hatchery </li></ul></ul><ul><ul><li>Method of packaging for sale </li></ul></ul><ul><ul><li>Medication and antibiotic use </li></ul></ul><ul><ul><li>Display of birds in store; hand-washing station and signs </li></ul></ul><ul><ul><li>Customer education provided </li></ul></ul><ul><ul><li>Knowledge of Salmonella and its association with live poultry </li></ul></ul>
    29. 29. Feed Store Survey Results <ul><li>102 agricultural feed stores contacted by either in-store visit or by phone </li></ul><ul><li>50 stores identified as having sold poultry in 2009 </li></ul><ul><li>Live Poultry Sales </li></ul><ul><ul><li>Season of sales: March – May </li></ul></ul><ul><ul><li>~ 60 to 20,000 birds sold per season </li></ul></ul><ul><ul><li>Mainly chicks and ducklings </li></ul></ul><ul><ul><li>No artificial coloring of birds </li></ul></ul>
    30. 30. Feed Store Customers <ul><li>Feed Store X </li></ul><ul><ul><li>Display of live poultry in store </li></ul></ul><ul><li>Other Farm and Feed Stores </li></ul><ul><ul><li>“ Chick Days” for Order-only purchases </li></ul></ul><ul><ul><li>Long-time customers (smaller feed stores) </li></ul></ul><ul><ul><li>No display of poultry in some stores </li></ul></ul>
    31. 31. Feed Store Survey Comparison 2006 & 2009 New Mexico 2006 Pennsylvania 2009 Awareness that poultry can cause Salmonella 46/54 (85%) 38/50 (76%) Warn customers that poultry can cause Salmonella 26/54 (56%) 14/50 (28%)
    32. 32. Hatchery Traceback <ul><li>Feed Store X utilizes Hatchery C </li></ul><ul><ul><li>Delivery with US Postal Service </li></ul></ul><ul><li>Other feed stores utilize various hatcheries </li></ul><ul><ul><li>Many use local hatcheries </li></ul></ul><ul><ul><li>Delivery by private hatchery truck </li></ul></ul>
    33. 33. Public Education <ul><li>All persons should wash their hands with soap and warm water for at least 20 seconds after touching live poultry or surfaces in contact with live poultry </li></ul><ul><li>Live poultry should not be kept in facilities with children aged <5 years </li></ul><ul><li>Children aged <5 years should not be allowed to have direct contact with live poultry </li></ul><ul><li>Chicks and other live poultry should not be given as gifts to young children </li></ul><ul><li>Live poultry should be kept separate from areas where food and drinks are prepared or consumed </li></ul><ul><li>All surfaces that come into contact with live poultry (e.g., hands, floors, tables, rugs, shipment boxes, dust, and chicken enclosures) might be contaminated with Salmonella </li></ul>
    34. 34. Recommendations for Feed Stores <ul><li>Provide educational material for customers </li></ul><ul><li>Warning signs and hand-washing stations by displayed poultry </li></ul><ul><li>Chick days for order only purchase </li></ul><ul><li>Keeping poultry in back of store to limit customer access </li></ul><ul><li>Displaying poultry in covered or glass tanks out of reach of children </li></ul><ul><li>Follow advice in 2009 Compendium of Measures to Prevent Diseases Associated with Animals in Public Settings </li></ul><ul><ul><li>http://www.cdc.gov/mmwR/PDF/rr/rr5805.pdf </li></ul></ul>
    35. 35. Poultry Specific Questionnaire
    36. 36. Summary <ul><li>Multiple live poultry-associated outbreaks identified in recent years </li></ul><ul><li>Multiple outbreak strains linked to single hatcheries annually </li></ul><ul><li>Peak season for live poultry sales is March-May, though sales occur year round </li></ul><ul><li>Feed stores are aware of risks, but few warn customers </li></ul><ul><li>State and local health departments should consider educational messages targeted at feed stores and the public </li></ul><ul><li>CDC requests states to use poultry specific questionnaire </li></ul>
    37. 37. Contact Information <ul><li>Casey Barton Behravesh DVM, DrPH, DACVPM </li></ul><ul><li>LCDR, U.S. Public Health Service </li></ul><ul><li>Outbreak Response and Prevention Branch (proposed); Centers for Disease Control and Prevention </li></ul><ul><li>Phone: (404) 639-0367 Fax: (404) 639-2205 e-Mail: dlx9@cdc.gov </li></ul><ul><li>Anagha Loharikar, MD </li></ul><ul><li>LT, U.S. Public Health Service </li></ul><ul><li>Epidemic Intelligence Service, Class of 2009 </li></ul><ul><li>Enteric Disease Epidemiology Branch; Centers for Disease Control and Prevention </li></ul><ul><li>Phone: (404) 639-3510 Fax: (404) 639-2205 e-Mail: igd2@cdc.gov </li></ul>
    38. 38. Selected Zoonotic Diseases Conference Call October 7, 2009

    ×