1. An Integrated Response
Outbreak Response
An Integrated Response
RRT
Investigation Team
GDA
GDPH
FDA
USDA
Other
Local Health Dept

2. Anatomy of an Outbreak investigation
Disease Surveillance
CDC gathers data from States
Epidemiological investigation
CDC & States conduct epi studies and FDA reviews
Laboratory Analysis
Clinical, food, and environmental
Initial Environmental investigation
State/locals evaluate at Point of Service for contamination
Traceback / traceforward
FDA, States and industry track product
Product & Source investigation
FDA and States look for source of contamination

3. Traceback vs. Traceforward
A traceback investigation starts with the consumer or the point-of-service and traces the distribution of the product back to the source.
This is the process used in response to a foodborne illness outbreak.
A traceforward investigation begins with the source/farm or manufacturer/distributor and traces forward to the consumer.
This process is used for a product recall and it can also be useful in outbreak investigations.
Traceability has been a useful tool for many industries particularly when a product recall becomes necessary. FDA’s early tracing activities were primarily “trace forward,” tracing a product from the source/manufacturer to the consumer. These tracing activities were focused on recalling affected lots of foods, drugs, medical devices, and biologics. A traceback is working in the reverse – starting from the consumer’s point-of-purchase and going BACK to find the common point in the supply chain, such as the manufacturer or growing farm (source).

4. Information Collection
Traceback Investigation
Records of Outgoing & Incoming Shipments of cilantro during from 5/19/15 to 6/30/15
Invoices
Bill of Ladings
Trip Tickets
Packing Slips
Purchase Orders
Decipher & Analyze
What do dates mean?
Is Invoice Date & Shipping Date the same?

5. Traceback Flow Diagram
Farms
POS Distributors Packers
This is an actual traceback flow diagram from a produce outbreak, minus the specific info that would normally be in each box. The POS represents the Point of Service and then we work back in the supply chain to find a common pt. You can see there’s several levels of distribution before you find convergence. We’re often asked “Why does it take so long” well, this is one reason…all the information/records need to be collected from multiple points in the supply chain before the puzzle pieces connect. As FYI, this traceback led to a produce farm investigation as well as a recall, consumer alert, and import alert.

8. 2014-2015 RRT Responses at a Glance
What: FL RRT and VA RRT notify GA on Listeria mono found on soft cheese products. Illness in GA.
Who: FL RRT, VA RRT, GA RRT (GDA – Manuf., GDPH – Epi, FDA ATL-DO)
Fred Omatao
Action: GA Distribution, Visit Firm, Traceforward Investigation

9. 2014-2015 RRT Responses at a Glance
What: Norovirus Oyster Outbreak. FDA CORE Assignment to GA RRT investigate firm
Who: WA RRT GA RRT (FDA ATL-DO, CORE, GDA – Seafood)
Action: Visit Firm, Environmental Assessment, Traceforward, Traceback, Implicated Product Identified
Tony Colvin!!!

10. 2014-2015 RRT Responses at a Glance
What: Ciguatera Fish Poisoning Outbreak in FL
Who: FL RRT & GA RRT (FDA ATL-DO, CORE, GDA – Seafood)
Action: Visit Firm, Environmental Assessment, Traceforward, Traceback,
Tony Colvin!!!

11. 2014-2015 RRT Responses at a Glance
What: Fresh Cheese Curd Recall Listeria mono
Who: FL RRT & GA RRT (FDA ATL-DO, GDA – Manufacturing Program)
Action: GA Distribution, Visit Firm, Traceforward Investigation, Recall Effectiveness Check
Tony Colvin!!!

12. 2014-2015 RRT Responses at a Glance
What: Salmonella Pet Treat Feed Recall
Who: VA RRT & GA RRT (GDA – Feed Program )
Action: GA Distribution, Stop Sale Issued, Recall Effectiveness
Tony Colvin!!!

13. 2014-2015 RRT Responses at a Glance
What: Multi-State Listeria mono Outbreak & Blue Bell Ice Cream Recall
Who: GA RRT (GDA – Retail, GDPH – Food Service)
Action: GA Distribution, Press Release, Massive Coordinated Recall Effectiveness Check
Tony Colvin!!!

14. 2014-2015 RRT Responses at a Glance
What: Multi-State Listeria mono Outbreak w/ GA illnesses and Hummus Dip Recall
Who: GA RRT (FDA ATL- DO, GDA – Retail, GDPH – Epidemiology)
Action: GA Distribution, Press Release, Recall Effectiveness Check
Tony Colvin!!!

15. 2014-2015 RRT Responses at a Glance
What: Multi-State Cyclospora Outbreak. GA Cluster and investigation
Who: GA RRT (GDPH – Epi, GDPH – EH, Fulton Co. EH, GDA – Manuf. Program, FDA ATL-DO, FDA CORE
Action: Environmental Assessment, Epidemiologic Investigation, Record Review, Traceback Investigation
Tony Colvin!!!