On saturday May 19th, Buckeye County Health Department Staff are continuing to perform phone interviews with affected individuals. The hospital reports 3 new cases today: 2 students and 1 staff member from Northside Elementary School. The superintendent of Buckeye County School District contacts Buckeye County Health Department to discuss whether or not the school should be closed until a cause can be determined. On sunday May 20th, Preliminary analysis of the data from the initial phone interviews reveals that all cases, including those at the hospital, are limited to the individuals at the school, nursing home and surrounding neighborhood. The hospital reports 1 new case and the nursing home reports 2 new cases today. No cause has yet been identified. The PIO prepares a press release describing what is happening and what steps are being taken to investigate and control the outbreak. On monday May 21st at 9:00 AM , Buckeye School District elects to close Northside Elementary School pending further investigation. The hospital and nursing home report all cases are negative for the most common causes of atypical pneumonia (see note above). Buckeye County Health Department (BCHD) conducts a conference call with the State Health Department (SHD) and Ms. Dolor, the IP from Smallsville Hospital to determine what additional samples should be submitted for further testing and where they should be sent. After reviewing the histories and the consensus of the expert opinions, they decide to perform additional tests for Francisella tularensis, Hantavirus and Coxiella burnetti. Ms. Dolor agrees to collect the samples that the experts recommend and ship them overnight to the corresponding lab. On wednesday May 23rd at 11:00 AM, The hospital reports two new cases today; no new cases have been identified at the nursing home or elementary school. You also received a call from the SHD reporting the results of the additional tests for the first 6 patients: All six were positive for Q-Fever (Coxiella burnetii) on PCR. Q-Fever is a nationally notifiable disease in the US, so the BCHD and the SHD contact the Centers for Disease Control and Prevention (CDC) to report these cases and to request assistance in continuing the epidemiologic investigation. The PIO prepares another press release. Because Q-Fever is a Zoonotic disease associated with agriculture as well as a designated Class B Bioterrorism agent, the Buckeye County Health Department and the SHD deliberate about who else should be involved in the investigation and response. On wednesday, May 23 at 11:30 am BCHD, SHD, State Animal Health Office (SAHO), Local Law Enforcement, Federal Bureau of Investigation (FBI), CDC and United States Department of Agriculture (USDA) conduct a conference call. The decision is made to have each agency investigate the possible source of the outbreak most relevant to their area of expertise. ï· BCHD, with support from SHD and CDC, will focus on the patients and explore possible foodborne and occupational sources of exposure. ï· The Local Law Enforcement and the FBI will investigate possible bioterrorism or a criminal act as the source of exposure. SAHO, in conjunction with USDAâAPHISâVS, will investigate any link to agriculture and test the hypothesis that this outbreak is the result of airborne contamination from nearby farms. At 2:00 PM It is decided to visit all farms within a 3 mile radius upwind of the elementary school and nursing home since that is where most of the cases are clustered. A 3 mile radius is chosen based on information gathered from study of the 2007â2010 Q-Fever outbreaks in the Netherlands (Roest, 2011). SDA/BAH and USDA will also inspect farms that were visited by affected individuals within the past 30 days. On thursday, may 24th SAHO and USDA identify 3 active livestock producers within a 3 mile radius of the elementary school and nursing home. BCHD has also identified 2 additional farms visited by affected individuals within the last 30 days. Veterinary Medical Officers (VMO) from SAHO and USDA are dispatched to interview these producers. On friday, may 25th No new cases are reported today. SAHO field staff have identified a sheep farm (Farm A) located 0.5 miles west of Northside Elementary School and Greis Nursing Home that had an unusually high rate of abortion in the flock in February. At that time fetuses were sent to State Animal Disease Diagnostic Laboratory and Coxiella burnetti was identified as the cause. At the time, no restrictions were placed on the farm and veterinary instructions encompassed management of abortion cases and occupation safety instructions. Placentas and other birthing materials were collected with manure from the barn and placed in a manure storage area on the farm. Farm A has 300 sheep on premises, and they do not receive visitors or take out the animals for exhibition purposes. They also do not directly sell milk or milk products. However, the owner of the sheep farm reports spreading untreated manure on his fields on April 30th. These fields are in close proximity and upwind from the Elementary school and nursing home.
Question: NOW THAT THE VMOs HAVE COMPLETED THEIR FARM EVALUATION, WHAT SHOULD BE THE NEXT STEP(S)?
