# Presentation: 264500

- Regional Perspective
- Exposure Vs Disease

## Regional Impacts

- Connecting Outbreak to Cause
- Regulatory Issue

**Notes:**
I am a microbiologist with the Regional 10 laboratory and have been involved in CAFOs from a courtcase and sample processing perspective.  I did speak with regional people about their concerns and some of their concerns are reflected in this introduction.  A number of their concerns are being addressed by other sessions as well.  A concern to me regarding the issue of CAFOs and determining the effect of this kind of contamination on public health, deals specifically with the fact that often times, the cause of the illness is never truelly discerned.  I would like to present a couple of case studies that demosntrate this and then discuss how ORD could help the regions in this perplexing problem.....

## Case Studies

- New York State Fair
*E. coli* O157:H7
- 921 Illnesses
- 116 confirmed cases of *E. coli*
- Contaminated Well head
- Cause not defined
- Septic Contamination from  4-H housing?
- Barnyard runoff ?

**Notes:**
Case study #1.  This occured outside of Region 10, actually in Region ??  And it occured some years back in 2001 in New York during the state fair.  A small number of people who attended the fair that year became sick a few days later; including a large number of 4-H children.  The children demonstrated classical signs of E. coli O157:H7 including one or two cases of hus.  The well was tested after the fact and was shown to be contaminated with E. coli (standard type) and further investigations into the cause demonstrated one of two possible causes --   contamination with drainfield run off from the 4-H housing or barnyard animal runoff that contaminated the well.  Because testing was performed too long after the fair and the incident, testing was unable to determine the cause.  Ideally, when the outbreak was identified, samples would have been taken to confirm the source of the enterohemorrhagic E. coli.  

## Eastern Washington

- Big Gun over-spray from fields to family garden
*Cryptosporidium *confirmed in young family member
- Cause not defined
- Day care?
- Exposure to contaminated strawberries?

**Notes:**
Case #2 occurred in Region 10 in Eastern Washington in an area that has several very large dairy operations, that maintain several hundred head of cattle.  These large farms typically spray the cattle waste from the dairy on their pastures using what is known as "big guns".  This allows them to decrease the amount of waste that needs to be hauled off or composted.  This practice is completely legal as long as 1) they spray when it is not raining and 2) the ground is not frozen.  In both cases, the point is to decrease the amount of environmental runoff.  When these "big guns" are spraying the untreated manure on the fields, if they arenot aimed properly or application is done when there is a stiff wind, it is not unheard of for the spray to end up quite a ways outside of the intended field.  Such was the case here.  A neighbor living on a property adjacent to an application field would get large amounts of overspray onto her garden during the summer.  Well, not surprisingly, a young family member visiting her grandmother was infected with confirmed Cryptosporidium shortly (1 - 1 1/2 weeks) after having eaten unwashed strawberries in the garden.  Again, the source of these organisms was not determined.  Was it the day care where she spent some of her afternoons or was it the unwashed contaminated strawberries.  Again, epidemiological studies may have been able to aide in differentiating the cause.  

## ORD Assistance -  Connection

- Epidemiological investigations
- Microbial Source Tracking
- Rapid Test Methods

**Notes:**
So, what can ORD help the regions with?  Epidemiological training would be a start, so that when investigating such farms or sites, the inspectors within the regions would have some idea of how to conduct a basic epi investigation.  Although this new science is in its infancy, Microbial source tracking may prove to be beneficial in determining the source of the contamination.  As always, rapid test methods that don't require several days for results would be helpful.  Some of the molecular type methods, such as real time PCR or rapid PCR will eventually  be beneficial as well.  In particular, rapid test methods to detect the presence and quantification of specific pathogens may be advisable.  There may be cases whre pathogenic organisms are present with no associated fecal indicators.  

## Regulatory Issue

- Change in NPDES regulation
- Requiring permit and allowing discharge
- Protective of Public Health??
- Difficult for Inspectors

**Notes:**
In its recently modified NPDES permit process for CAFOs, EPA proposes the use of Best Management Practices, permits for CAFOs and allowable discharges under certain circumstances --  based on 24 hour rainfall event.  The concern with inspectors with this new regulation is that the process will be more of a paper shuffle with appropriate BMPs, permit, waste management plan and much less of a hands on inspection that may reveal real problems at the site.  The BMPs that require a reduction of 50 - 60 
% of the pathogens will not adequately protect public health; the POTWs are required to provide significantly higher reductions.