CIFOR Guidelines for Foodborne Disease Outbreak Response and the CIFOR Toolkit: Focus Area 5: Pathogen-Specific Surveillance New York Integrated Center of Food Safety Center of Excellence – October 12, 2016 Shelley M Zansky, PhD Bureau of Communicable Disease Control New York State Department of Health

Background This is the sixth webinar in a series of monthly webinars from the New York Integrated Food Safety Center of Excellence (CoE) Session will cover the CIFOR Toolkit Focus Area 5: Pathogen-Specific Surveillance Supplementary sessions will be devoted to assist states that wish to complete internal evaluations using the metrics and target ranges developed for the 16 CIFOR performance measures. Additional topics will focus on emerging issues in food safety including culture‐independent diagnostic testing, antimicrobial resistance, and advanced molecular detection/whole genome sequencing. All webinars will be recorded and available through the CoE website at http://nyfoodsafety.cals.cornell.edu/

How to Use the CIFOR Toolkit Describe Your Current Activities and Procedures in relation to the Focus Area. Complete the Worksheet as a Team (Workgroup) Epidemiology, Laboratory and Environmental Health Refer to written protocols/procedures Describe your agency’s/jurisdiction’s current activities and procedures based on the Focus Area.

How to Use the CIFOR Toolkit Prioritize CIFOR Recommendations to Address Needed Improvements Review the CIFOR recommendations related to the Focus Area of interest Identify activities and procedures in need of improvement Rate the priority for implementing each recommendation based on its likely impact on foodborne outbreak response

Objectives for Focus Area 5: Pathogen-Specific Surveillance Purpose of Pathogen-Specific Surveillance Goals for Pathogen-Specific Surveillance Define and Review “Keys to Success”

What is Focus Area 5? Purpose: To systematically collect, analyze and disseminate information about laboratory confirmed illnesses or well-defined syndromes as part of prevention and control activities. Goals: Agency/jurisdiction receives from health-care providers and laboratories reports on all cases of disease when certain foodborne pathogens are identified in patients specimens or specific clinical syndromes are recognized (e.g. HUS) and obtains case information in ways that allows timely follow-up of patients and quick detection and investigation of possible outbreaks

Keys to Success Reporting/submission of isolates Testing of specimens Are activities, relationships, and resources that are critical to achieving success in a Focus Area. Applying metrics and measures can help you identify the success of your program or investigation process. Reporting/submission of isolates Testing of specimens Collection of exposure information Detection of clusters/outbreaks Communication Making changes

Reporting/Submission of Isolates State has mandatory reporting of diseases that are likely to have been foodborne, as well as mandatory submission of pathogen isolates or clinical specimens associated with these disease cases. Staff actively solicit case reports and submission of specimens/isolates to improve completeness of reporting. Agency/jurisdiction has a system to rapidly transport specimens/isolates from clinical laboratories to the public health laboratory.

Reporting/Submission of Isolates

Testing of Specimens Public health laboratory has the capacity to quickly process and test specimens/isolates submitted by clinical laboratories, including pathogen confirmation and subtyping.

Testing of Specimens

Collection of Exposure Information Staff collect sufficient demographic and exposure information from patients to recognize possible patterns and associations between cases in a timely fashion.

Collection of Exposure Information

Collection of Exposure Information

Collection of Exposure Information

Detection of Clusters/Outbreaks Staff analyze case information (e.g., demographics, exposure information, subtyping results) to rapidly identify possible clusters or outbreaks.

Detection of Clusters/Outbreaks

Communication Public health laboratory shares test results with epidemiology staff in a timely fashion. Public health laboratory reports test results to national databases in a timely fashion.

Communication

Making Changes Agency/jurisdiction has performance indicators related to pathogen-specific surveillance and routinely evaluates its performance in this Focus Area.

Performance Measure http://www.cifor.us/documents/MetricsReport_Abridge_FINAL.pdf

Performance Measure http://www.cifor.us/documents/MetricsReport_Abridge_FINAL.pdf

Performance Measure http://www.cifor.us/documents/MetricsReport_Abridge_FINAL.pdf

Performance Measure http://www.cifor.us/documents/MetricsReport_Abridge_FINAL.pdf

Performance Measure http://www.cifor.us/documents/MetricsReport_Abridge_FINAL.pdf

Helpful Tips for Using the Toolkit Don’t get distracted by the volume Be clear on the process Keep moving – don’t get caught up in too much detail Focus on a few realistic changes End with specific action plans with time frames and responsible persons Appoint a facilitator and a recorder for each discussion

Why Should My State Use the Toolkit? Improve overall foodborne outbreak investigation and response Enhance partnerships with agencies/partners in foodborne outbreak investigations Identify areas needing improvement that may have gone unrecognized

Where to Find the CIFOR Products Online at: www.cifor.us Paper copies are also available from CSTE Contact Dhara Shah at dshah@cste.org Examples of CIFOR product use by other states: http://www.coefoodsafetytools.org/

Next Scheduled NY CoE CIFOR Webinars Still being finalized Course announcement and link to register is posted on the DOH Learning Management System (LMS): www.nylearnsph.com

Resources Comments or questions for NY CoE can be directed to: Paula Huth, NY CoE Program Coordinator 518-473-4439 or Paula.Pennell-Huth@health.ny.gov Integrated Food Safety CoE Websites: NY CoE: http://nyfoodsafety.cals.cornell.edu/ CDC: http://www.cdc.gov/foodsafety/centers/

Questions