Improving Response to Foodborne Disease Outbreaks in the United States

Abstract

Context Each year foodborne diseases (FBD) affect approximately 1 in 6 Americans, resulting in 128,000 hospitalizations and 3,000 deaths. Decreasing resources impact the ability of public health officials to identify, respond to, and control FBD outbreaks. Geographically dispersed outbreaks necessitate multijurisdictional coordination across all levels of the public health system. Rapid response depends on rapid detection. Objective Targeted resources were provided to state and local health departments to improve completeness and timeliness of laboratory, epidemiology, and environmental health (EH) activities for FBD surveillance and outbreak response. Design Foodborne Disease Centers for Outbreak Response Enhancement (FoodCORE) centers, selected through competitive award, implemented work plans designed to make outbreak response more complete and faster in their jurisdiction. Performance metrics were developed and used to evaluate the impact and effectiveness of activities. Participants Departments of Health in Connecticut, New York City, Ohio, South Carolina, Tennessee, Utah, and Wisconsin. Results From the first year (Y1) of the program in October 2010 to the end of second year (Y2) in December 2012, the centers completed molecular subtyping for a higher proportion of Salmonella, Shiga toxin-producing E. coli, and Listeria (SSL) isolates (86% vs 98%) and reduced the average time to complete testing from a median of 8 to 4 days. The centers attempted epidemiologic interviews with more SSL case-patients (93% vs 99%) and the average time to attempt interviews was reduced from a median of 4 to 2 days. During Y2, nearly 200 EH assessments were conducted. FoodCORE centers began documenting model practices such as streamlining and standardizing case-patient interviewing. Conclusion Centers used targeted resources and process evaluation to implement and document practices that improve the completeness and timeliness of FBD surveillance and outbreak response activities in several public health settings. FoodCORE strategies and model practices could be replicated in other jurisdictions to improve FBD response.

Evaluating the Timeliness of Enteric Disease Surveillance in British Columbia, Canada, 2012-13

“…We found six studies which used comparable methods to measure the timeliness of surveillance in North America and Europe in the last decade [3–8]. Most of our findings were comparable to these other jurisdictions.…”

“…Our findings were compared to similar data published from 2005–2015 identified through a literature search using Medline and through a review of the grey literature available on the Internet [ 3 – 8 ].…”

“…The time from sample receipt at the PHL to reporting of PFGE results to provincial epidemiologists was much longer in BC (17–33 days) than it is in some US states (4-5 days) [8]. The time from sample collection to notifying the regional health authority was a little shorter in BC, as was the time to first attempt to interview.…”

“…If this process is measured in a consistent way, we can improve our understanding of surveillance and identify steps requiring improvement. Several regions and countries have conducted this work which led to changes to improve timeliness [ 3 – 8 ].…”

Epidemiology of foodborne disease outbreaks from 2011 to 2016 in Shandong Province, China

“…[ 29 ] Efforts to better understand the gaps in foodborne outbreak response, including laboratory, epidemiologic, and environmental health capacity, may ultimately inform strategies to overcome the challenges of limited public health resources. [ 30 ] Globally, due to limitations of laboratory capacities in diagnosis of etiology, most of foodborne outbreak agents remain unknown. [ 31 , 32 ]…”