Improving Response to Foodborne Disease Outbreaks in the United States: Findings of the Foodborne Disease Centers for Outbreak Response Enhancement (FoodCORE), 2010-2012

Abstract

Context: Each year foodborne diseases (FBD) affect approximately 1 in 6 Americans, resulting in 128 000 hospitalizations and 3000 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 the second year (Y2) in December 2012, the centers completed molecular subtyping for a higher proportion of Salmonella, Shiga toxin-producing Escherichia 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.

Figure 1. Mean and range of the proportion of Salmonella, Shiga toxin-producing Escherichia coli (STEC), and Listeria isolates with PFGE subtyping data available for the baseline period of Year 1, all of Year 1, and Year 2*

*For Salmonella, n(baseline)=1618, n(Y1)=7677, n(Y2)=6786; For STEC, n(baseline)=216, n(Y1)=787, n(Y2)=1190; For Listeria, n(baseline)=53, n(Y1)=83, n(Y2)=185.

Figure 2. Average and range of the proportion of Salmonella, Shiga toxin-producing Escherichia coli (STEC), and Listeria case-patients with an attempted interview for the baseline period of Year 1, all of Year 1, and Year 2*

*For Salmonella, n(baseline)=1626, n(Y1)=7039, n(Y2)=6800; For STEC, n(baseline)=194, n(Y1)=820, n(Y2)=1061; For Listeria, n(baseline)=31, n(Y1)=92, n(Y2)=140.