Methods for generating hypotheses in human enteric illness outbreak investigations: a scoping review of the evidence

Abstract

Enteric illness outbreaks are complex events, therefore, outbreak investigators use many different hypothesis generation methods depending on the situation. This scoping review was conducted to describe methods used to generate a hypothesis during enteric illness outbreak investigations. The search included five databases and grey literature for articles published between 1 January 2000 and 2 May 2015. Relevance screening and article characterisation were conducted by two independent reviewers using pretested forms. There were 903 outbreaks that described hypothesis generation methods and 33 papers which focused on the evaluation of hypothesis generation methods. Common hypothesis generation methods described are analytic studies (64.8%), descriptive epidemiology (33.7%), food or environmental sampling (32.8%) and facility inspections (27.9%). The least common methods included the use of a single interviewer (0.4%) and investigation of outliers (0.4%). Most studies reported using two or more methods to generate hypotheses (81.2%), with 29.2% of studies reporting using four or more. The use of multiple different hypothesis generation methods both within and between outbreaks highlights the complexity of enteric illness outbreak investigations. Future research should examine the effectiveness of each method and the contexts for which each is most effective in efficiently leading to source identification.

The use of multiple hypothesis-generating methods in an outbreak investigation of Escherichia coli O121 infections associated with wheat flour, Canada 2016–2017

“…The hypothesis generation process is a critical step, as the findings inform further investigative activities and the ability to take action [1, 2]. Despite the importance of hypothesis generation, it is often not well described in published outbreak investigation reports, limiting the ability of investigators to learn from other experiences [3]. In some investigations, a hypothesis is easily identified, but in other investigations, particularly those involving novel or unusual food products, the hypothesis generation phase can be challenging and complex.…”