Suzanne Wilson, MPH Food and Waterborne Disease Epidemiologist WVDHHR-Division of Infectious Disease Epidemiology November 17, 2010

 Definition of a Foodborne Outbreak  Preparation steps for an outbreak investigation  Initial action steps for an outbreak investigation  Conducting good interviews

 Two or more persons who experience a similar illness after ingestion of a common food

 Identify Members of Investigation Team  Nurse/Epi, Environmental, Laboratory  Delineate roles/activities for team members  Know how to obtain additional resources  Maintain a network and list of key contacts

 Be educated on clinical features of specific foodborne illness and the specific factors that contribute to these illnesses – stay current!  Establish a system for intake and review of complaints and illness reports  Know your baseline- How many of these do we “normally” get?

 Record information  Signs and symptoms  Date and time of onset  Obtain 72 hour food history  Any other people who are ill  How many people at the activity  Any medical treatment or testing

 If random complaint  check complaint log for similar reports  If reporting on an event (i.e. banquet, wedding)  Obtain information on event organizer  Contact information for attendees

 Contact others on list to identify other potential cases  Systematically look at information to determine plausibility of an outbreak  Are reported symptoms consistent  Any common exposures USE A LINELIST TO DO THIS!

 Keeps all information in one place  Allows for systematic evaluation of cases  Used to make an epicurve  Sample can be found at: ases/OutbreaksorClustersofAnyIllness/tabid/1535 /Default.aspx

Person-to-Person

Point-source

 Develop a case definition  Conduct hypothesis generating interviews  In depth and detail oriented  About 8 to 10 cases  Develop questionnaire  Broad range of exposures

 If outbreak is centered around an event or location  Conduct a risk assessment of the facility and processes  Embargo any leftover food  Track food flow through the facility  Look for what went wrong “When you have a foodborne outbreak, more than one thing went wrong.” Dr. Frank Bryan, CDC

 Handout

 Collect Information on Line listing  Determine transmission mode  Develop case definition  Hypothesis Generating Interviews

 Can be used for :  Verifying outbreak  Searching for additional cases  Determining if cases are associated  Collecting data to determine possible sources A good interview is a MUST!

 Be consistent in interviews  Do your homework to minimize repeat contacts  Target questions to greatest degree possible

 Be prepared-conduct training if needed  Select form to be used

 Establish rapport  Identify self, organization, and reason for investigation  Start with easy questions  Demographics, etc.  Let them know you may be need to re-contact them

 When they cannot remember meals:  Ask about food preferences  Can rule in/out some foods  Identify key days and dates to jog memory (use a calendar)  Review receipts or checkbook  Buffets-need to clearly describe each food item  Recall is better for items from a menu

 Last Meal Bias  Take multi day food history  Explain that pathogens may take days to cause illness  Ask if leftovers are available for testing  Don’t forget the details  Exact restaurant locations

 Ask questions as written on form  Review form before ending interview  Ask if individuals have  Unanswered questions  Additional information  Thank them for their time!!

 Break up into groups of three  Interviewer  Interviewee  Observer