Food safety groups unveil outbreak response guidance

Jul 15, 2009 (CIDRAP News) – A national consortium of groups that have a stake in managing foodborne illness outbreaks today released guidelines for outbreak response, a document that includes model practices for each investigation stage, giving local and state officials a baseline for assessing their current procedures.

The group that authored the 200-page guidance report, the Council to Improve Foodborne Outbreak Response (CIFOR), is a multidisciplinary partnership of seven professional organizations and three federal agencies that seek to increase collaboration among a range of food safety officials. Its cochairs are the Council of State and Territorial Epidemiologists (CSTE) and the National Association of County and City Health Officials (NACCHO).

Scott E. Holmes, manager of the Lincoln-Lancaster County Health Department's environmental public health division in Lincoln, Neb., told CIDRAP News that it took 2 years to develop the guidelines, which underwent rounds of extensive review and modification. Holmes is NACCHO's representative on CIFOR.

"The main thing is that this provides state and local departments with the best practices," Holmes said, adding that there are currently no standardized methods for conducting a foodborne outbreak investigation. For example, some local and state departments use a shotgun approach with their food exposure surveys, while others typically use more targeted survey methods. Some states subtype isolates from patient specimens and submit them to national databases as soon as they receive them, rather than batching them.

He said the CIFOR guidelines also give local and state officials a solid framework for achieving federal standards that address outbreak response.

In a nutshell, the guidance promotes faster and better response methods that revolve around better communication and more uniform reporting between local and state officials, he said. For example, surveillance systems and incident logs should be compiled in a manner that's easily accessible to other agencies. "This truly would identify patterns that aren't being identified now," Holmes said.

Applying the guidelines isn't going to be a major cost for local and state departments, he predicted. "It's more a matter of doing the actions correctly," he said, adding that adopting a model practice for some can be as simple as reorganizing how the response work gets done.

In the overview section, the authors state that the guidelines are meant to be flexible and include a range of approaches with the rationale for each of them. For example, the guidance details the role of the Incident Command System (ICS), but acknowledges that not all agencies use this system.

The guidelines start with a chapter on the fundamental concepts of surveillance and foodborne disease, followed by sections on planning, outbreak detection, investigation, and control measures. It also includes sections on specific topics such as multijurisdictional outbreaks, legal considerations, and performance indicators for foodborne disease programs.

Craig Hedberg, PhD, a foodborne disease expert at the University of Minnesota in Minneapolis, who wrote three of the guideline chapters and was a member of the CIFOR guidance work group, said the new document will serve as a yardstick for measuring future outbreak response activities.

However, he said public officials' willingness to implement the model practices will be the factor that improves the nation's overall outbreak response. "As noted in the forward, it will only be as effective as our commitment to turn the guidelines into action," he said.

The US Department of Health and Human Services (HHS) and the US Department of Agriculture (USDA) today praised the new CIFOR guidelines. Tom Vilsack, USDA secretary, said in an HHS statement that was e-mailed to journalists that improving food safety is one of President Obama's top priorities.

"Last week the Obama Administration took an important step forward by introducing tougher standards to reduce Salmonella contamination and E coli outbreaks, and the guidelines announced today will help government further that goal," he said.

In March Obama created a Food Safety Working Group, and on Jul 7 it announced its key steps for improving food safety, which included tougher standards to reduce Salmonella contamination, tighter enforcement at beef facilities, building a new trace-back and response system, and improving federal food safety oversight.

HHS Secretary Kathleen Sebelius thanked CIFOR for its vital contribution toward food safety. Sebelius and Vilsack cochair Obama's food safety group.

"The guidelines show that by working together, we can all dramatically improve our food safety system and further protect the public health," she said. "We hope to further this collaborative effort through the Food Safety Working Group."

See also:

Jul 15 CIFOR press release

CIFOR guidelines for foodborne outbreak response

Jul 7 CIDRAP News story "Officials release food safety plan, egg safety rules"

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