Fairfield Department of Health
April 21-29th, 2015
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Larry Hanna, RS- Health Administrator
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Gwen Shafer, RN, Director of Nursing
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Mark Aebi, MD-Health Commissioner,
Medical Director
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Role of Health Department during outbreak
Activities, timelines and events during the
outbreak
Botulism- History and case definition
At around 10:45 on April 2st, I was walking
past Diana Stover’s, RN office. Diana is our
Communicable Disease Nurse, Diana called me
in and said “I just received a call from FMC
regarding a possible cast of Botulism” she said
it could be related to wild mushrooms. Diana
gave FMC the phone number for CDC so they
could request antitoxin (H-Bat).
IC
Larry
Operations
Logistics
Fiscal
Planning
Gwen
Kathie
Paulette
Merrilee
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Sietske deFijter, ODH
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Kim Qwinn, ODH
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Carolyn McCarthy, CDC
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Brendan Jackson, CDC
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“As we discussed by telephone I am filing a
public records request for all documents and
emails regarding the Botulism Outbreak in
Lancaster”.
“We are requesting any documents that tell us
the source of the food that caused the
outbreak. Who supplied it. We are NOT asking
about the person’s personal health
information”.
 Potato
Salad Made From Home
Canned Potatoes Likely Cause of
Botulism Outbreak

Public Health Officials Urge Proper Home
Canning Techniques
 Keep
your Board of Health
informed.
 ICS Flexibility
 Expenses
 County Coroner
 Don’t forget to praise staff
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Activation of the Epi Team & request support
from the region’s Tier 2 Epi
1st Food questionnaire interviews and the line
list were created and started on the first day.
Support from CDC and ODH’s ORBIT Team
with the ongoing investigation and response.
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Approximately 10:45am, FDH received initial
notification of a suspected Botulism case @ FMC
(ICU). The suspect food is wild mushrooms.
By 1pm - 3 suspect cases, 7 in ED, possibly 50
implicated. Suspect food was homemade potato
salad from a church potluck.
Anti-toxin – initial release was 5 doses based on
patients, Increased to 50 doses as numbers
increased
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17 suspected, 16 under observation, 1 death
Food samples obtained (FDH), Clinical samples
obtained (FMC)
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FMC Press Conference @ 1200
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Coordination conference calls
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ORBIT Team arrives at FDH with in-house CDC EIS
Officer.
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CDC Epi Aid Team arrives
Wellness Checks on asymptomatic attendees (FMC
and Lancaster PD)
And continued essential functions of response
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Lab Findings:
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◦ 2 patients testing positive (stool) for Type A
◦ 2 food items testing positive for Type A: potato
salad and macaroni & cheese – possible crosscontamination.
Counts:
Day 5- Saturday
 Continuing food questionnaires- Epi Aid Team attempted to
get questionnaires on patients in Columbus hospitals.
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Continuing daily conference calls
Day 6- Sunday
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Started Post-exposure questionnaires
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Case definition was being further defined to capture any
potato salad (2 commercial and 1 homemade at potluck).
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Started to see attendees who were originally asymptomatic
returning to FMC with symptoms.
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Continuing to see attendees who were originally asymptomatic
returning with symptoms, numbers declined.
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Final wellness checks on asymptomatic attendees.
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Outreach meeting to church congregation. FDH deactivates ICS
Weds. (Apr. 29 – Day 10)
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ORBIT/Epi Aid complete a final analysis on the food histories

Of 77 persons who consumed potluck food, 29 (38%) met a case definition
 24 confirmed
 5 probable

All except 2 patients initially presented to FMC; many were transferred to 6
Columbus metropolitan-area hospitals, requiring substantial coordination.
 25 patients (86%) received H-BAT
 11 (38%) were intubated
 By April 28, 18 patients (62%) had been discharged from hospitals.
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Illness onset had a median of 2 days after the potluck (range: 1-6 days).
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Clinical specimens were positive for botulinum neurotoxin type A and Clostridium
botulinum type A.
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Of 24 food specimens collected from the dumpster; 6 specimens (5 containing
potato salad and 1 of macaroni and cheese that may have been crosscontaminated), were positive for botulinum neurotoxin type A.
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Fairfield Medical Center:
4.
Set up their own IC Center
Assisted with food questionnaires
Set up a Hot Line for people to call in
DX, Treatment and transported
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Working with the local hospital:
1.
2.
3.
Strength- They were a great support to community & Health
Department during the event, helped with questionnaires, hot
line and education to community
Weakness- Understanding of local, state and federal public
health role during an outbreak
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Staffing- after hours, weekend and overtime
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Continuing daily operations during outbreak
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Stress between agencies
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Fairfield Department of Health has good
community, regional, state and national
support.
You always will think of ways to improve in
your “after action plan” regardless how well
you think the event went.
It is amazing how well your staff come
together during a crisis!
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Initial presentation of patient
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Subsequent patients
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Symptoms of botulism
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Pathophysiology of toxin illness
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A confirmed case of outbreak-associated botulism
was defined as compatible illness in a person who
ate food from the potluck and had
A) laboratory-confirmed botulism or
B) no laboratory confirmation but > 2 signs or
1 sign and > 2 symptoms of botulism.
Of the 77 persons who consumed potluck food, 29
(38%) met the case definition
Median age 64 (range 9-87 years of age)
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Our Numbers
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Previous outbreaks
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Health department meeting with the church
Public support
Education pieces:
- Safe Canning Resources, Links to USDA
and CDC
-Sanitarians prepared “Food Safety Tips
for Successful Community Meals”
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Dealing with the Press : written release vs
new conference
Importance of working off the same line list
and pitfalls
Value of daily conference calls
Educational pieces surprise
Role definition confusion with hospital
Circumstances sometimes favor outcomes
Staffing is key in a crisis
Delegation of tasks to people not familiar
“Large Outbreak of Botulism Associated with
a Church Potluck-Ohio 2015”
Published in the MMWR Notes from the Field,
July 31, 2015