Our Food and Waterborne Teams in the Office of Infectious Disease Services led a foodborne outbreak investigation tabletop exercise for almost 110 public health partners last week. Individuals in attendance came from tribal and county health departments, hospitals, state universities, and federal agencies including the Food and Drug Administration (FDA).  This year’s all-day exercise explored an outbreak of hepatitis A linked to contaminated food.

Discussion based tabletop exercises, led by a small-group facilitator, are intended to walk participants through a real-life scenario. Participants are mixed with others from various disciplines including epidemiology, environmental health, public health preparedness, infection prevention, and academia. During the exercise, the group identifies assets and resources that may be needed to deal with a foodborne illness response, any gaps in current processes, as well as the role of public information and communication in outbreak response. These exercises are intended to help participants explore, represent their area of expertise, and make connections with partners in a non-threatening, low-stress learning environment.

The scenario began with a call from a refugee resettlement agency reporting cases of nausea, vomiting and fever amongst refugees a few days after their weekly potluck.  Exercise participants requested information from the agency and hospital infection preventionists in order to guess what organism was causing the illnesses.  Lab reports were read and interpreted to determine next steps, including case interviewing and providing messaging to the refugee agency around the prevention of future cases.

Players were also presented with food histories from imaginary cases of hepatitis A.  These data were analyzed and led participants down a path towards a food truck specializing in smoothies. Then, sanitarians and other environmental health specialists discussed mobile food unit inspections and how violations may lead to foodborne illness.  Exercise players brainstormed questions to ask food handlers during inspections, correcting violations and finally, laboratory testing of potentially contaminated food with the state public health laboratory and federal partners, including FDA.

Before concluding for the day, all the knowledge gained about hepatitis A, epidemiological and environmental investigations and the importance of collaboration were put to the test as the participants practiced public messaging in the form of a press release and setting up prophylaxis clinics to prevent future cases.

Each of the ten breakout rooms had an evaluator taking notes. These notes will be used to create an after-action report with goals to help bridge gaps and provide resources that were identified during the tabletop discussions.  The Office of Infectious Disease Services conducts a tabletop exercise on a different pathogen or public health topic each year before the annual Infectious Disease Training each July. More information about hepatitis A is available through the CDC or ADHS’ foodborne illness homepage.