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BACKGROUND: During the summer of 2013, there was a sharp increase in the number of illnesses due to Vibrio parahaemolyticus reported to the Massachusetts Department of Public Health (MDPH) Bureau of Infectious Disease (BID). A comprehensive response was mounted by local and state agencies, including the MDPH Epidemiology Program (EPI), MDPH Food Protection Program (FPP), and the Department of Fish and Game Division of Marine Fisheries (DMF) but was overwhelmed by the volume of cases. Significant challenges were encountered in conducting timely case investigation and in sharing of information between agencies. Improvements were developed and implemented prior to the 2014 season.
METHODS: A Vibrio Working Group was formed consisting of representatives from BID, FPP, DMF, the MDPH Bureau of Laboratory Sciences, and the Massachusetts Environmental Police. The state’s web-based surveillance and case management system, the Massachusetts Virtual Epidemiologic Network (MAVEN), was enhanced by BID staff to capture all information collected on the CDC Cholera and Other Vibrio Reporting Surveillance (COVIS) reporting form. With all pertinent information collected electronically, COVIS data could be extracted from MAVEN and sent to CDC. Vibrio cases in MAVEN were designated as immediate events, allowing real-time email notification of new cases and rapid response by LBOH and MDPH epidemiologists.
RESULTS: A standard operating procedure was drafted and presented to BID and FPP staff in conjunction with formal trainings. New guidance on V. parahaemolyticus illness case investigation was disseminated to LBOHs and a webinar was held to walk through changes in MAVEN. The median time to complete a case investigation was cut in half, from nine days in 2013 to four days in 2014. Complete seafood traceback information was obtained on 15 cases with actionable food exposures, resulting in one oyster harvest area closure. The Vibrio Working Group met twice monthly from April through October 2014.
CONCLUSIONS: Changes made following the 2013 increase in V. parahaemolyticus infection incidence improved the timeliness of case interview and traceback investigation, enhanced communication between local and state agencies, and streamlined the sharing of investigative findings, resulting in timelier public health response.