1. Surveillance and Detection – Implications for Response
Epi-Ready
Surveillance and Detection – Implications for Response
Module 4

2. Module Objectives
By the end of this module, participants will be able to describe the various methods used to detect foodborne illness and determine if a response action is necessary.
Identify the various surveillance systems available to detect foodborne illness.
Compare and contrast pathogen-specific surveillance and complaint- based surveillance to detect foodborne illness.
Identify initial outbreak response activities.

3. Surveillance
Public health surveillance is a system that acquires, organizes, and interprets data for action to prevent and control disease the population.

4. Characteristics of Effective Surveillance
There is a willingness to participate in the surveillance activity.
Very few barriers to use – accessible.
Acceptable
This is the value of the system to identify illness when it is actually present.
Positive Predictive Value
This is a measure of the surveillance system’s ability to detect disease as it is intended.
Sensitive
This is a measure of the system’s ease of use.
Simple
The ability of the system to acquire data rapidly enough to take action to prevent additional disease.
Timely

5. Methods of Surveillance
Active
Passive

6. Pathogen-specific (Laboratory)
Types of Surveillance
Pathogen-specific (Laboratory)
Complaint-based
Sentinel
Syndromic

7. Burden of Illness Pyramid
Reported to Health Department/CDC 2%
100%
Adapted from a CDC Source

8. Syndromic Surveillance
Surveillance of health-related data prior to diagnosis
Clinical or non-clinical
Used continuously or for special events
National Syndromic Surveillance Program

9. Sentinel Surveillance
Selected group of “reporters” that provide high quality information
Active Surveillance
FoodNet
FoodNet Sites

10. Laboratory Surveillance Systems
Pathogen-specific in nature
High quality data
very sensitive and has a positive predictive value
Not always procedurally simple or timely

11. Timeframe of Laboratory Analysis - Salmonella
Consumption of Food
Person Becomes Ill
Stool Sample Collected
Salmonella Identified
Isolate received by Public Health
Case confirmed as Part of an Cluster
1 – 3 days
1 – 5 days
0 – 7 days
2 -10 days
5 to 28 days to identify an illness as part of a cluster through PulseNet
Adapted from a CDC source

12. Laboratory Surveillance Systems
PulseNet
CaliciNet
CryptoNet
NARMS
CDC

13. PulseNet Main laboratory cluster detection method
Considered molecular epidemiology
DNA Analysis
Important system to detect multistate outbreaks

14. CaliciNet Norovirus surveillance network Started in 2009
Outbreak surveillance of norovirus at genetic level
Monitors circulating norovirus strains
50% more norovirus illness in years when there is a new strain of the virus circulating
Source: CDC

15. CryptoNet Established in 2010
One species now is 30, many with multiple subtypes
Culture-independent identification
Oocysts of Cryptosporidium
Source: CDC

16. NARMS Established in 1996, nationwide in 2003
Collaboration of state and local public health with:
CDC (humans)
FDA (retail meats)
USDA (food animals)
Covers 18 antimicrobial agents in:
Salmonella
Shigella
E. coli
Campylobacter
Certain Vibrio species

17. Epidemiologic Surveillance Systems
Case-based, passive systems
Laboratory Reporting/Provider Notifications
Generally regulatory in nature
System is sensitive and has positive predictive value

18. National Notifiable Disease Surveillance System
Important component of all public health system
Reporting of infectious, noninfectious and outbreak conditions
Major foodborne illness pathogens are listed as well foodborne disease outbreaks
States may add conditions
States require timely reporting
Provider- Local/State PH
Local PH – State PH
Source: CDC

19. Foodborne Illness Complaint Surveillance
Based on complaints of illness
Coordination and follow- up enhances the system
Need for uniform practice of investigation across jurisdictions

20. Electronic and Social Media

21. The Interview Process
Primary tool to gather information from complainants and case-patients regarding possible exposure.
Standardized approach
Quite place to interview
Assure confidentiality
Probe for additional information
Make associations
Don’t give advice
Translation services
Remind them of their importance

22. Activity
This table group exercise will demonstrate how to conduct an interview using a food history form. Choose a person to be interviewed and an interviewer. The remaining members of the table group will be evaluators.
This activity should take 15 minutes. Instructors will be available to assist as necessary.

23. Thoughts on the Exercise
Was this exercise easy or difficult?
Did you obtain a full five-day history?
What approaches were helpful?

24. Place/date of meal consumed
Type of Complaint
Date of Illness onset
Number ill in party
Symptoms
Suspected Source
Place/date of meal consumed
Comments
2/13/18
Illness
2/11/18 1
nausea vomiting
Ham Sandwich
starting to feel better
illness
2/12/18 8
nausea vomiting diarrhea
wedding buffet
Buffet on 6th 2/10/18
Most of the party is sick now
Unsanitary conditions
Joe's Beer Barn
Bathrooms need cleaned
2/14/18
double vision
does not eat away from home
home canned corn on 2/12 2
bloody diarrhea
chicken
That BBQ Place South of Town 2/9/18
spouse not sick 3
all you can eat night
Buffet on 6th 2/11/18
2/15/18
vomiting
no recall 4
diarrhea fever chills
oysters
House of Seafood 2/12/18
2/16/18
cobb salad
2/17/18
facial flushing mouth burns
sushi
House of Seafood 2/15/18
called in by Dr. J. at ED
unsanitary conditions
no glove use
2/18/18
diarrhea
hamburger
Joe's Beer Barn 2/17/18
Activity
Work in table groups to determine how you would approach this list of complaints received at the Health Department.
Use the space in the participant’s manual to record your thoughts.
15 minute activity minutes working in groups and 5 minutes for class discussion.

25. Moving to Response–Cluster Detection
What do you know?
What information is missing?
How will you find the information that is missing?

26. Laboratory-Identified Clusters
Pathogen identified by DNA analysis indicate clusters of disease
Long lag periods from exposure to identification as part of a cluster may be unavoidable
Recall becomes a challenge
Provides specificity to the epidemiologic investigator
CIDT identified illness, by itself, will not identify a cluster

27. Complaint-based Cluster Identification
Good record keeping and prompt response necessary
Good for the identification of:
Illness with short incubation periods
Illness isolated to a single jurisdiction – usually a single event
Recall bias – last meal bias
Focus on food histories and geographic information
Provider notification without laboratory identification handled as a complaint

28. Summary
Identified the various surveillance systems available to detect foodborne illness
Compared and contrasted pathogen-specific surveillance and complaint-based surveillance to detect foodborne illness
Identified initial outbreak response activities

29. Laboratory Investigation
Coming Up Next
Laboratory Investigation