Reducing the barriers against analytical epidemiological studies in investigations of local foodborne disease outbreaks in Germany – a starter kit for local health authorities

Werber, Dirk; Bernard, Helen

doi:10.2807/1560-7917.es2014.19.8.20714

Cited by 8 publications

(8 citation statements)

References 10 publications

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“…Simple tools for data entry and analysis, e.g. the linelist tool [8], are available for basic epidemiological comparisons.…”

Section: Discussionmentioning

confidence: 99%

“…The chance of identifying a suspected vehicle can be increased through the application of analytical epidemiological studies (principally cohort studies and case-control studies) [10, 12]. However, these studies are not commonly applied in outbreak investigations [8, 10], particularly not by local health departments, which usually represent the competent authority in local FBDOs, and most FBDOs are local [8].…”

Section: Introductionmentioning

confidence: 99%

“…FBDOs are common and responsible for a high burden of disease in populations and also lead to deaths in developing as well as in developed countries [1, 7]. In Europe, a total of 5363 FBDOs were recorded in 2012 [8, 9], affecting 55 453 people of whom 5118 were hospitalized and 41 died [9].…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of foodborne outbreaks in which use of analytical epidemiological studies contributed to identification of suspected vehicles, European Union, 2007 to 2011

2017

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Foodborne disease outbreaks (FBDOs) occur frequently in Europe. Employing analytical epidemiological study designs increases the likelihood of identifying the suspected vehicle(s), but these studies are rarely applied in FBDO investigations. We used multivariable binary logistic regression analysis to identify characteristics of investigated FBDOs reported to the European Food Safety Authority (2007-2011) that were associated with analytical epidemiological evidence (compared to evidence from microbiological investigations/descriptive epidemiology only). The analysis was restricted to FBDO investigations, where the evidence for the suspected vehicle was considered 'strong', i.e. convincing. The presence of analytical epidemiological evidence was reported in 2012 (50%) of these 4038 outbreaks. In multivariable analysis, increasing outbreak size, number of hospitalizations, causative (i.e. aetiological) agent (whether identified and, if so, which one), and the setting in which these outbreaks occurred (e.g. geographically dispersed outbreaks) were independently associated with presence of analytical evidence. The number of investigations with reported analytical epidemiological evidence was unexpectedly high, likely indicating the need for quality assurance within the European Union foodborne outbreak reporting system, and warranting cautious interpretation of our findings. This first analysis of evidence implicating a food vehicle in FBDOs may help to inform public health authorities on when to use analytical epidemiological study designs.

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“…Simple tools for data entry and analysis, e.g. the linelist tool [8], are available for basic epidemiological comparisons.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Characteristics of foodborne outbreaks in which use of analytical epidemiological studies contributed to identification of suspected vehicles, European Union, 2007 to 2011

2017

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“…This toolbox may include spreadsheets with dummy linelists, epicurves, and routines for univariable analyses. A set of tools has already been generated in Germany [15]. Such type of tools could help to increase the use of analytical epidemiological studies in local investigations.…”

Section: Discussionmentioning

confidence: 99%

The national web-based outbreak rapid alert system in Norway: eight years of experience, 2006–2013

et al. 2015

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In 2005, the Norwegian Institute of Public Health established a web-based outbreak rapid alert system called Vesuv. The system is used for mandatory outbreak alerts from municipal medical officers, healthcare institutions, and food safety authorities. As of 2013, 1426 outbreaks have been reported, involving 32913 cases. More than half of the outbreaks occurred in healthcare institutions (759 outbreaks, 53·2%). A total of 474 (33·2%) outbreaks were associated with food or drinking water. The web-based rapid alert system has proved to be a helpful tool by enhancing reporting and enabling rapid and efficient information sharing between different authorities at both the local and national levels. It is also an important tool for event-based reporting, as required by the International Health Regulations (IHR) 2005. Collecting information from all the outbreak alerts and reports in a national database is also useful for analysing trends, such as occurrence of certain microorganisms, places or sources of infection, or route of transmission. This can facilitate the identification of specific areas where more general preventive measures are needed.

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“…We collected information on the participants' age and sex, symptoms, date of symptom onset and on food exposures at the school's canteen during calendar week 39, as indicated by the canteen's menu plan, which listed four meal choices daily. For data entry and immediate univariable analysis on site, we used the Linelist tool, a spreadsheet file developed at the RKI, to assist in the epidemiologic investigation of local outbreaks [11].…”

Section: Analytical Studiesmentioning

confidence: 99%

Large multistate outbreak of norovirus gastroenteritis associated with frozen strawberries, Germany, 2012

et al. 2014

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, the largest recorded food-borne outbreak in Germany occurred. Norovirus was identified as the causative agent. We conducted four analytical epidemiological studies, two case-control studies and two surveys (in total 150 cases) in secondary schools in three different federal states. Overall, 390 institutions in five federal states reported nearly 11,000 cases of gastroenteritis. They were predominantly schools and childcare facilities and were supplied almost exclusively by one large catering company. The analytical epidemiological studies consistently identified dishes containing strawberries as the most likely vehicle, with estimated odds ratios ranging from 2.6 to 45.4. The dishes had been prepared in different regional kitchens of the catering company and were served in the schools two days before the peaks of the respective outbreaks. All affected institutions had received strawberries of one lot, imported frozen from China. The outbreak vehicle was identified within a week, which led to a timely recall and prevented more than half of the lot from reaching the consumer. This outbreak exemplifies the risk of large outbreaks in the era of global food trade. It underlines the importance of timely surveillance and epidemiological outbreak investigations for food safety.

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Reducing the barriers against analytical epidemiological studies in investigations of local foodborne disease outbreaks in Germany – a starter kit for local health authorities

Abstract: Binary file ES_Abstracts_Final_ECDC.txt matches

Cited by 8 publications

References 10 publications

Characteristics of foodborne outbreaks in which use of analytical epidemiological studies contributed to identification of suspected vehicles, European Union, 2007 to 2011

Characteristics of foodborne outbreaks in which use of analytical epidemiological studies contributed to identification of suspected vehicles, European Union, 2007 to 2011

The national web-based outbreak rapid alert system in Norway: eight years of experience, 2006–2013

Large multistate outbreak of norovirus gastroenteritis associated with frozen strawberries, Germany, 2012

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