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CIFOR Guidelines To Improve Investigations

FSI solves every food borne illness outbreak in the land.  It works out of ultra modern laboratories.  It is led by a soft-spoken, professional with reddish hair who flies above politics and protects the beautiful people who work for him from outside influences.

Oh no, wait.  That’s CSI Miami.  Solving food borne illness outbreaks is a little more, well messy.

That’s because the originating jurisdiction for an outbreak can be any one of 2,794 local health districts in the United States.  Only Hawaii and Rhode Island are not carved up into local districts.

Most local health districts are units of county governments.  Some are units of state governments.  Most have local boards with powers to regulate, set fees, adopt an annual budget, hire and fire management, impose taxes, and ask voters to pass levies.

Per capita spending on local health districts varies widely by the states, according to a recent study by the National Association of County and City Health Officials.  States like California, Alaska, Utah and a half dozen others spend over $50 per person on public health districts.   A dozen others, including Texas, New Jersey, and Nevada, spend less $20 per person.

Rich and poor health districts lead investigations with no standard approach for a response to an outbreak.   “Why is this? Simply put, no one set of steps is appropriate for all outbreaks,” the Council to Improve Foodborne Outbreak Response (CIFOR) wrote in its new “Guidelines for Foodborne Disease Outbreak Response.”

“The response varies with the outbreak and surrounding circumstances  (e.g., etiologic agent, number of cases, and likely source of exposure).  The response also varies depending on the agencies involved, available resources, and the expertise of investigators,” CIFOR explained.

CIFOR, an organization of seven professional associations and three federal agencies, came up with the guidelines as a “reference document for comparison with existing procedures.”

The guidelines are intended to improve outbreak investigations and provide a basis for changing local policies and procedures.

The guidelines encourage local health districts to take advantage of resources state and national governments have put together to help them.   Among these are:

  1. The Foodborne Diseases Active Surveillance Network (FoodNet) is the principal foodborne disease component of CDC’s Emerging Infections Program (EIP). FoodNet is a collaborative project of the CDC, ten EIP sites, the U.S. Department of Agriculture (USDA), and the Food and Drug Administration (FDA). The project consists of active surveillance for foodborne diseases and related epidemiologic studies designed to help public health officials better understand the epidemiology of foodborne diseases in the United States.
  2. PulseNet is a national network of public health and food regulatory agency laboratories coordinated by the Centers for Disease Control and Prevention (CDC). The network consists of: state health departments, local health departments, and federal agencies (CDC, USDA/FSIS, FDA). PulseNet participants perform standardized molecular sub typing (or “fingerprinting”) of foodborne disease-causing bacteria by pulsed-field gel electrophoresis (PFGE). PFGE can be used to distinguish strains of organisms such as Escherichia coli O157:H7, Salmonella, Shigella, Listeria, or Campylobacter at the DNA level. DNA “fingerprints,” or patterns, are submitted electronically to a dynamic database at the CDC. These databases are available on-demand to participants–this allows for rapid comparison of the patterns.
  3. NARMS is a collaboration among Centers for Disease Control and Prevention (CDC), FDA’s Center for Veterinary Medicine, and USDA’s Food Safety and Inspection Service and Agricultural Research Services. The National Antimicrobial Resistance Monitoring System (NARMS) for Enteric Bacteria was established in 1996, within the framework of the CDC’s Emerging Infections Program’s Epidemiology and Laboratory Capacity Program and FoodNet.
  4. The National Outbreak Reporting System (NORS) or Outbreak Net is CDC’s online system for collecting data about outbreaks.

CIFOR’s guidelines also encourage planning before an outbreak occurs.   Planning should include deciding which outside agencies should be brought in, the establishment of a core response team, identification of resources, establishment of procedures for taking information from ill persons and keeping records.

The guidelines make it clear that local districts should seek help from appropriate state and federal agencies.

Speed and accuracy are the two key ingredients of all outbreak investigations, according to the guidelines. “One cannot be sacrificed for the other. Speed and accuracy can help public health officials

  • Stop an outbreak quickly and prevent additional illnesses;
  • Prevent future outbreaks by identifying the circumstances that led to the current outbreak;
  • Identify new hazards, including new agents, new food vehicles, new agent-food interactions, and other unsuspected gaps in the food-safety system;
  • Maintain the public’s confidence in the food supply and in the public health system; and
  • Empower the public to protect itself from food-safety problems.”

CIFOR includes the Council of State and Territorial Epidemiologist (CSTE); the National Association of County and City Health Officials (AFDO); Association of Food and Drug Officials (AFDO); the Association of Public Health Laboratories (ASTHO); the National Association of State Departments of Agriculture (NASDA); the National Environmental Health Association (NEHA); the Food Safety and Inspection Service (FSIS) of the U.S. Department of Agriculture (USDA) and FDA and CDC in the U.S. Department of Health and Human Services (HHS).

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