foodborne diseases and outbreaks1 foodborne disease outbreak investigation team training: module 1...

Foodborne diseases and outbreaks 1

Foodborne Disease Outbreak Investigation Team Training:

Module 1 – Foodborne Diseases and Outbreaks


Module Learning Objectives

At the end of this module, you will be able to

1. Describe what is meant by “foodborne disease.”

2. List examples of common foodborne disease causative agents.

3. Define the terms “outbreak” and “cluster.”

4. List the goals of a foodborne disease outbreak investigation.

5. Describe the desirable knowledge and skills included on a foodborne outbreak investigation team.


BREAKING NEWS

• Students and teachers Students and teachers rushed to hospitalrushed to hospital

• Nausea, vomiting, Nausea, vomiting, stomach pain, and stomach pain, and dizziness after lunch dizziness after lunch at school cafeteriaat school cafeteria

• Health department Health department team dispatched to team dispatched to school and hospital to school and hospital to investigateinvestigate

• Students and teachers Students and teachers rushed to hospitalrushed to hospital

• Nausea, vomiting, Nausea, vomiting, stomach pain, and stomach pain, and dizziness after lunch dizziness after lunch at school cafeteriaat school cafeteria

• Health department Health department team dispatched to team dispatched to school and hospital to school and hospital to investigateinvestigate


Group Discussion

• Do you think the illnesses are foodborne? • Do you think the illnesses represent an outbreak? • If this is a foodborne outbreak, who would you involve

in the investigation?

Divide into groups by table.

1.Briefly introduce yourself to others at your table.

2.Re-read the news report at end of module and answer these questions.

Time limit: 5 minutes

Be prepared to share your thoughts with the class.


• Illness caused by ingestion of contaminated food

• Symptoms often affecting stomach or intestinal tract including

– Nausea and vomiting

– Diarrhea

– Abdominal pain

• Sometimes nonspecific symptoms and symptoms outside GI tract, depending on agent

• Young children, pregnant women, elderly, and immunocompromised persons at greatest risk for severe illness

Foodborne Disease


• An estimated 1 in 6 people suffers from foodborne illness each year in the United States leading to an estimated– 48 million illnesses– 128,000 hospitalizations – 3,000 deaths

• More than 1,000 outbreaks detected annually• $35 billion in medical costs, lost productivity,

illness related mortality each year

Foodborne Disease

Source: Centers for Disease Control and Prevention http://www.cdc.gov/foodborneburden/index.html


BacteriaBacillus cereusCampylobacterClostridium botulinum Clostridium perfringensEscherichia coli Shiga toxin-producing E. coli Enterotoxin producing E. coli Enteroinvasive E. coli Enteropathogenic E. coli Listeria monocytogenesSalmonella, non-typhoidSalmonella TyphiShigellaStaphylococcus aureusVibrioYersinia enterocolitica

Common Causative AgentsVirusesNorovirus AstrovirusHepatitis A virus

ParasitesCryptosporidium Cyclospora cayetanensisEntamoeba histolyticaGiardia intestinalisTrichinella

Chemicals/otherHeavy metalsPesticidesFungal toxinsFish toxins


Chemicals/other (5%)

Parasites (<1%)

Viruses (54%)

Bacteria (40%)

Source: Centers for Disease Control and Prevention based on data from 2008

Frequency of Causative Agents in Foodborne Outbreaks in the United States

NorovirusSalmonella (18%)Clostridium perfringens (6%)STEC (5%)Campylobacter (4%)


• Variety of foods associated with foodborne illnesses

• Almost any food can be a vehicle for disease but food and production/processing must

– Allow opportunity for contamination by causative agent

– Allow agent (or toxin) to survive (not be inactivated) and

– (For some agents) support proliferation of agent and/or elaboration of preformed toxins

• Common food-causative agent pairings

Food Vehicles


• Pathogens associated with food can also be spread through other modes– Waterborne– Person-to-person– Animal-to-person

• Multiple modes of transmission possiblein a single outbreak

… Also Other Modes of Transmission


Definition of Outbreak

• Two or more cases of a similar illness among individuals who have had a common exposure

• Critical components of definition– Same diagnosis or symptoms and signs

suggestive of same illness– Clear association between cases, with or

without a recognized common source


Definition of Cluster

• More cases than expected for given geographic location and time

• No immediately obvious association between cases

• Suggestive of an outbreak but needs further exploration to make determination


Class Question

Is this an outbreak?

Development of nausea and vomiting in three friends within 30 minutes of eating at a restaurant.


Class Question


Diarrhea and abdominal pain due to Salmonella Agona (an unusual serotype only seen once before) in 24 persons in one state.


Class Question


A single case of botulism.


Primary Goals of Outbreak Investigations• Stop current outbreak as soon as possible by

implementing effective control measures and • Prevent similar outbreaks in future.

To achieve these goals, you must rapidly identify the cause of the outbreak including:– People at risk (and characteristics)– Causative agent– Mode of transmission and vehicle– Source of contamination– Contributing factors– Environmental antecedents


you need an Outbreak Investigation Team.

> The team

To do all these things ….


Outbreak Investigation Team

• Composition varies but almost always needs knowledge and skills in– Environmental health– Epidemiology– Laboratory– Public health education– Communications– Leadership

• Usually includes environmental health investigator, epidemiology investigator and/or public health nurse, and laboratory investigator

> The team


The env’t health investigator focuses on the contaminated food:• Receives and interprets foodborne

illness complaints• Investigates suspected food and/or

food establishment− Interviews food workers and managers− Examines food storage, handling, preparation − Identifies factors that resulted in food

contamination− Collects environmental and food samples− Collects paperwork

• Implements control measures

The Team: Env’t Health Investigator

> The team


The Team: Epidemiologic Investigator

• Analyzes data from pathogen- specific surveillance and identifies clusters

• Characterizes cases by time, place, and person• Plans epidemiologic studies• Interviews cases and healthy controls• Analyzes and interprets results of epidemiologic

studies

The epidemiologic investigator focuses on cases:

> The team


The Team: Public Health Nurse

• Interviews patients• Collects clinical specimens from

patients• Administers questionnaires for

epidemiologic studies• Advises patients on how to prevent spread of

illness• Provides public health education

The public health nurse focuses on patients:

> The team


The Team: Laboratory InvestigatorThe laboratory investigator focuses on specimens:• Analyzes clinical, food, and

environmental specimens• Interprets test results• Advises team about tests and collection, handling,

storage, and transport of specimens• Coordinates additional testing by partner labs

> The team


The Team: Other Skill Sets

Other persons often included on outbreak investigation team:

•Public health officer•Public health educator•Clerical staff•Public information officer•Regulatory investigators

• Interpreters• Veterinarians• Health care providers• Industry members

> The team


The Team: Together

• Work together and support each other• Team responsibilities

− Develop hypotheses about outbreak source− Prioritize and assign activities− Interpret investigation findings− Determine how far to take an investigation− Develop public messages − Decide on control measures

> The team


1. Examine the roles and responsibilities listed under each outbreak investigation team member.

2. Insert your name and the names of your team members in the appropriate cells.

3. Which responsibilities are not covered? How might these gaps be filled?

4. Are there others included on your team? What do they do?

Group ExerciseWorking alone or with others who are from the same jurisdiction, complete the outbreak investigation team matrix at the end of the module.

Time limit: 10 minutes


Quick Quiz


Quick Quiz

1. Which of the following causative agents is the most common cause of foodborne disease outbreaks in the United States?

A. Viruses

B. Bacteria

C. Parasites

D. Chemicals


Quick Quiz

2. Some foodborne pathogens can also be spread by water, from person-to-person, and from animal-to-person.

A. True

B. False


Quick Quiz

3. An outbreak is an increase in the number of cases of a particular disease greater than is expected for a given time and geographic location.

A. True

B. False


Quick Quiz

4. Which of the following is a primary goal for undertaking foodborne disease outbreak investigations?

A. To study the natural history of the causative agent

B. To train staff

C. To stop the current outbreak by implementing effective control measures

D. To respond to public concerns


Quick Quiz

5. Knowledge and skills from all of the following disciplines should be represented on every foodborne outbreak investigation team EXCEPT

A. Environmental health

B. Epidemiology

C. Laboratory

D. Industry members

foodborne diseases and outbreaks1 foodborne disease outbreak investigation team training: module 1...

Documents

foodborne diseases

foodborne illness

year foodborne disease

school cafeterianausea

stomach pain

hospital nausea

disease control

terms outbreak