Our vision: Healthier communities, Excellence in healthcare Our values: Teamwork, Honesty, Respect, Ethical, Excellence, Caring, Commitment, Courage Preparing for Fieldwork Prepared by Dr Craig DaltonPublic Health Physician Hunter New England Population Health Advanced Foodborne Disease Outbreak Workshop Viet Nam

2 Outline  Strategic – important – but often forgotten –Assemble the Outbreak Control Team –Define the objectives –Communication with stakeholders  Tactical –Administrative permissions –Travel approvals –Equipment and supplies

3 Assemble the outbreak control team Page 5: Foodborne Disease Outbreaks: Guidelines for Investigation and Control

4 Who might be in your OCT?…  Who have you had in your OCT that has been very helpful?  Who do you wish you could have in your OCT in the future?

5 Outbreak control team  Who is in charge of the investigation – who is the leader?  Who needs to know…what…when?  Will there be joint inspections?  The team needs to confirm all this and the investigation objectives and then document it in a brief statement.

6 Define the objectives of the investigation  What are you trying to achieve by when?  Are you doing enhanced case finding? –Using hospitals, clinics, or laboratories  Are you launching a cohort study? –How long do you want it to take?  Are you doing a trace-back of the food source?  Clear objectives prevents confusion among investigators and collaborators

7 OCT Investigation Plan (Called an EPI-1 by CDC..it should include:)  Background to the outbreak includes: –No. of cases, setting, any descriptive epidemiology available, suspicions as to the cause  Agreed objectives of the outbreak investigation  OCT membership and coordinator/leader  Communication plan –Daily meeting time/teleconferences, media statements, contact with industry or cases, agreements across jurisdictions.

8 Restaurant X Outbreak Investigation Plan - 21/5/09 Background: 20 cases of vomiting were reported among 40+ customers of a buffet at Restaurant X in the City Complex. Most were ill within 6 hours of the buffet and most had no other contact with each other prior to the buffet. Four cases, who were apparently healthy before the event, have been admitted to intensive care at a local hospital including the city mayor and his wife. A list of ill and well persons and a copy of the menu is held by the organiser of the private party. Objectives: Conduct hypothesis generating interviews Implicate food vehicle through cohort study Conduct case-finding to determine if other guests of the restaurant were affected before or after this event. Collect specimens from cases and send to laboratory. Conduct environmental investigation to identify risks for foodborne illness and collect and test left over foods. Explore clinical status of patients to understand reason for ICU admission Outbreak Control Team John Snow – MOH Epidemiologist and Outbreak Coordinator Jean Jones – MOH epidemiologist Snow White – City Authority Environmental Health Officer Louis Pasteur – MOH laboratory scientist Jane Doe – Clinical Doctor at City Hospital David Smith – MOH Media spokesperson Communication plan Daily OCT teleconferences at 11am and 4pm till further notice. All media statements via David Smith after clearance through JS and in consultation with Mayors Office. New results of epi, environmental, and lab investigations ed to OCT at close of business daily. Daily update to organiser of party and restaurant by John Snow (respecting confidentiality).

9 Defining roles and responsibility ObjectiveLeader Overall coordinationJohn Snow Conduct hypothesis generating interviewsJJ MOH Conduct case-finding to determine if other guests of the restaurant were affected before or after this event. JJ MOH Conduct environmental investigation to identify risks for foodborne illness and collect and test left over foods. SW City EHO Implicate food vehicle through cohort study JJ MOH Explore clinical status of patients to understand reason for ICU admission JD City Hospital

10 Administrative and Travel Approvals  Local approvals  Travel approvals

11 Outbreak Investigation Kit  Equipment for: – collecting specimens in the field – personal protective equipment  Don’t wait for an outbreak to put it together!  Annex 9. WHO Foodborne Disease Outbreaks: Guidelines for Investigation and Control excellent resource and list of outbreak investigation kit equipment – use as checklist  What do you have in your outbreak investigation kit?

12 Outbreak Investigation Kit

13  This guide increases chance that patient will give you a specimen.  Available at:

14 Special note on stool specimens  No one is going to love your specimens as much as you!  Treat them like your children –Where are they? –Who is looking after them? –What are they doing to them?  Don’t rely on other people to pick them up for you.  Pick them up yourself and bring them home!

15 Causes of food poisoning, Viet Nam Year Causes of food poisoning Micro organism ChemicalsNatural toxinsUnidentified causes (56. 5%) 18 (12, 4%) 33 (22. 7%) 12 (8.3%) (51.4%) 12 (8.3%) 39 (27. 1%) 19 (13. 2%) (38.8%) 18 (10.9%) 42 (25.5%) 41 (24. 8%) (6. 1%) 2 (0. 8%) 54 (21.9%) 176 (71. 3%) (7. 8%) 1 (0. 5%) 52 (25. 4%) 136 (66. 3%) ? 2010 Goal ???0%?

16 Thank you  With grateful acknowledgements of all the foodborne disease epidemiologists in OzFoodnet and Hunter New England Population Health Hunter New England Population Health is a unit of the Hunter New England Area Health Service. Supported by funding from NSW Health through the Hunter Medical Research Institute. Developed in partnership with the University of Newcastle.