National Outbreaks and Incidents Bob Adak HPA Centre for Infections

Outbreaks Most outbreaks of foodborne disease are investigated by Health Protection Units and Local Authorities: –Outbreaks where most of the cases live within the area covered by a single unit; –There is an identified setting which is in an area covered by a single unit; a restaurant or hotel; a hospital, school etc. The Centre for Infection only becomes involved to give specialist advice if invited by the leader of the local investigation team.

Outbreaks Some outbreaks are investigated by the HPA Regional Unit: –Cases are distributed across an area covered by a number of HPUs but within one HPA region; –The workload requirements demand that additional resources need to be deployed to provide support an individual HPU.

National Outbreaks Outbreaks are investigated by the HPA Centre for Infections when cases of infectious disease are distributed across more than one HPA region. –unless transmission is linked to an identified setting, ie CfI would not take the lead in investigating an outbreak linked to a wedding reception or a conference where cases might live in various parts of the country these outbreaks remain under the jurisdiction of HPUs.

National Outbreaks The HPA is responsible for collecting epidemiological and microbiological data which can then be used by regulatory authorities as part of the evidence needed to make interventions or to mount prosecutions: –Home authorities eg Birmingham City Council in the Cadburys case; –The Food Standards Agency eg salmonella in eggs, recalls of salad vegetables from national retailers.

International Outbreaks When cases are found to be distributed in more than one country (this includes Scotland, Wales and Northern Ireland) the coordination falls to the nation which identified the index case. –CfI would normally coordinate investigations when the index case is in England; –CfI would act as a link for investigations in England which are coordinated by a foreign centre.

Identification of National Outbreaks CfI LabBase 2 Laboratory Reports Clinical laboratories

Laboratory Pathogen Patient identifier Date of birth Gender Specimen type (faeces, blood etc) Specimen date (sometimes) Foreign travel (sometimes) Laboratory Reports

Identification of National Outbreaks CfI LabBase 2 CfI Department of Gastrointestinal, Emerging and Zoonotic Infections Exceedence Reports Laboratory Reports Clinical laboratories

Exceedence Reports

Identification of National Outbreaks CfI LabBase 2 CfI Department of Gastrointestinal, Emerging and Zoonotic Infections Exceedence Reports Risk Assessment HPA Executive Laboratory Reports Clinical laboratories

Identification of National Outbreaks CfI LabBase 2 CfI Department of Gastrointestinal, Emerging and Zoonotic Infections Exceedence Reports Risk Assessment HPA Executive Decision to investigate Outbreak Control Team Laboratory Reports Clinical laboratories

Investigation of National Outbreaks Reviewing micro findings. Liaising with HPUs, LAs and Labs to get good descriptive epidemiology. Reconnaissance

Investigation of National Outbreaks Hypothesis Generation Reviewing micro findings. Liaising with HPUs, LAs and Labs to get good descriptive epidemiology. Collecting detailed patient histories from cases. Reconnaissance

Investigation of National Outbreaks Hypothesis Generation Hypothesis Testing Reviewing micro findings. Liaising with HPUs, LAs and Labs to get good descriptive epidemiology. Collecting detailed patient histories from cases. Case-control studies, collecting specific data from cases and controls, site visits and food/env sampling and testing. Reconnaissance

Providing epi/micro findings to enforcement agencies (FSA & LAs) and HPUs. Investigation of National Outbreaks Hypothesis Generation Hypothesis Testing Risk Communication Reviewing micro findings. Liaising with HPUs, LAs and Labs to get good descriptive epidemiology. Collecting detailed patient histories from cases. Case-control studies, collecting specific data from cases and controls, site visits and food/env sampling and testing. Reconnaissance

Providing epi/micro findings to enforcement agencies (FSA & LAs) and HPUs. Investigation of National Outbreaks Hypothesis Generation Hypothesis Testing Risk Communication Intervention Reviewing micro findings. Liaising with HPUs, LAs and Labs to get good descriptive epidemiology. Collecting detailed patient histories from cases. Case-control studies, collecting specific data from cases and controls, site visits and food/env sampling and testing. Prosecutions, product withdrawals, advice to the public. Reconnaissance

Local Authorities Providing epi/micro findings to enforcement agencies (FSA & LAs) and HPUs. Investigation of National Outbreaks Hypothesis Generation Hypothesis Testing Risk Communication Intervention Reviewing micro findings. Liaising with HPUs, LAs and Labs to get good descriptive epidemiology. Collecting detailed patient histories from cases. Case-control studies, collecting specific data from cases and controls, site visits and food/env sampling and testing. Prosecutions, product withdrawals, advice to the public. Reconnaissance

The End