Hypothesis Generation During Foodborne-Illness Outbreak Investigations

Abstract

Hypothesis generation is a critical, but challenging, step in a foodborne outbreak investigation. The pathogens that contaminate food have many diverse reservoirs, resulting in seemingly limitless potential vehicles. Identifying a vehicle is particularly challenging for clusters detected through national pathogen-specific surveillance, as cases can be geographically dispersed and lack an obvious epidemiological link. Moreover, state and local health departments may have limited resources to dedicate to cluster and outbreak investigations. These challenges underscore the importance of hypothesis generation during an outbreak investigation. In this review, we present a framework for hypothesis generation focusing on three primary sources of information, typically used in combination: (1) known sources of the pathogen causing illness; (2) person, place, and time characteristics of cases associated with the outbreak (descriptive data); and (3) case exposure assessment. Hypothesis generation can narrow the list of potential food vehicles and focus subsequent epidemiologic, laboratory, environmental, and traceback efforts, ensuring that time and resources are used more efficiently and increasing the likelihood of rapidly and conclusively implicating the contaminated food vehicle.

Competencies for Public Health Professionals and Epidemiologists Who Detect and Investigate Enteric Disease Outbreaks

“…These are more complex training topic areas and require different modalities, such as the Integrated Food Safety Centers of Excellence Hypothesis Generation for Foodborne Illness Extension for Community Healthcare Outcomes series. 14 In contrast to the highest-ranking competencies, all tiers consistently ranked the lowest-ranking competencies, with all 3 tiers ranking legal authority and quality improvement lower than other competencies. These competencies could have a low priority, respondents may have found these competencies difficult to understand, or respondents did not view them as having a clear connection to their routine work.…”

“…These are more complex training topic areas and require different modalities, such as the Integrated Food Safety Centers of Excellence Hypothesis Generation for Foodborne Illness Extension for Community Healthcare Outcomes series. 14…”

Improving Foodborne Disease Surveillance and Outbreak Detection and Response Using Peer Networks—The Integrated Food Safety Centers of Excellence

“…This training model connects professionals with each other and subject matter experts and uses examples (eg, outbreak scenarios) as a platform for in-depth discussion 14,15. This model has been particularly useful in preparing epidemiologists and laboratory scientists for transitioning to WGS-based subtyping for cluster detection and tackling nuanced topics such as hypothesis generation 16. Additional training opportunities offered by IFS CoEs include just-in-time trainings, asynchronous on-demand trainings, case studies and tabletop exercises, and training programs customized for specific agencies or jurisdictions (Table 2).…”