Investigation of a Salmonella

Thompson Outbreak at a
Local London Restaurant

Overview
Background Information
The investigation process:
Information gathering: Case
interviews, premise follow-up/
investigation, team meetings and
food samples.

Collaboration with partner

agencies
Risk Assessment: decisions made
Lessons Learned

Background Information
MLHU Outbreak response team: PHN (Joanne Dow),
Outbreak lead PHI (Carrie Warring) and District PHI
(Randy Walker); managers David Pavletic and Tristan
Squire-Smith.
Outbreak
Lead

District PHI

Other PHIs

IDC
Managers

Directors/MO
H

Background Information
S. Thompson common sources: beef, bread,
chicken, cilantro, eggs, lettuce, peanuts, pet
treats, potato salad, roast beef, salmon,
tomatoes (PHO, 2014).
Middlesex-London investigated a sub-cluster of
19 outbreak confirmed cases
15 cases reported eating at the same restaurant
in London
Two cases from Oxford also ate at same
restaurant

National and Provincial

Public Health Agency of
Canada (PHAC) created the
OICC on July 2nd 2014
National cases (75, expect
14)
Public Health Ontario ONOICC initiated on August 12,
2014
Ontario cases (51, expect 9)
As of August 16th, 2014
OICC- Outbreak
investigation coordinating

Timeline

Case Interviews
Joanne Dow
Single interviewer
Provides memo regarding suspect
exposures
Collaborates with Outbreak Lead
Information sharing with Public Health Ontario
(PHO)

Local Restaurant
Located downtown
London, Ontario
No special events
during incubation
(Victoria Park)
Very popular: high
volume of customers
Mediterranean food
items: Shawarma,
Falafel, Salads etc

Investigation
2 Cases reported on July 16th 2014
Then, 7 Cases reported on Friday July
25th (5 pending).
Only 2 cases report the Shawarma
food premise
PHO/PHAC shift focus to grocery store
food items (national/provincial
outbreak)
Recalls: paprika and pepper for
Salmonella

Investigation
5 suspect food premises (2 cases for the
Shawarma restaurant)
PHIs asked to complete investigations at all
implicated premises
In addition: document ingredients used
(spices), product source (name, supplier, lot
codes etc)
Changes to recipes, ingredients or suppliers
HACCP audits
Staff illness / other complaints

Food Samples

July 31st 2014

Red Cabbage
Oregano
Parsley S. Thompson
Shawarma
Mala Salad
Aug. 1 (7 exposures)

Parsley?
CFIA follow up:
Perishable food item
(fresh product)
Typically not cooked
Common ingredient
High turnover
Difficult to trace
Distribution
(national/
provincial ?)
Increase in cases?

Outbreak Team Meeting

Management
Outbreak Lead
IDC PHN
District PHI/ PHIs
Food Chart created
to distinguish
ingredients
Chicken most
common
Submit 2 chicken
samples

Food Samples
Obtained food samples (raw chicken and
marinated raw chicken)
Then 2 chicken suppliers discovered (CFIA,
OMAFRA)
Determined frequency of delivery
Information provided to PHO, OMAFRA and
CFIA (also investigating parsley)
Raw chicken samples submitted: one from
each supplier
Results?

Salmonella Detected

Update
Salmonella detected in:
chopped parsley, oregano, raw chicken and
marinated raw chicken.
E.coli found in Hummus
Not detected in raw chicken samples
submitted from each supplier
Parsley S. Thompson only
Investigation focused on parsley, cross
contamination, hand washing, product
discarded (put on hold), and cleaning/
sanitizing

Partner Agencies

Public Health Agency of Canada

Public Health Ontario
The Canadian Food Inspection Agency
Ontario Ministry of Agriculture, Food and Rural Affairs
Public Health Lab

Risk Assessments

Premise closure?
Media disclosure?
Food premise cooperation, frequency of district inspector visiting premise,
lag in time, ill food handlers(?)

Lessons Learned

Team work: Sharing ideas and open discussion

Collaboration of IDC PHN and Outbreak Lead
Information sharing with partner agencies
Document EVERYTHING

Thank You!

References
Public Health Agency of Canada (2014). National
Enteric Surveillance Program: Weekly report. Week
2014-33. Aug. 10-16, 2014.
Public Health Ontario (2014). Ontario Investigation
Summary: Salmonella Thompson. Updated Oct. 1,
2015
Public Health Ontario (2014). Ontario Salmonellosis
Investigation Tool: Appendix 2 Source attribution of
the common Salmonella serovars. Aug. 2014

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