When food attacks: Innovations in foodborne illness outbreak response

Every year in the U.S., 48 million people get sick with foodborne illness, 128,000 are hospitalized and 3,000 people die. At the Centers for Disease Control and Prevention, those numbers drive ever-evolving and creative efforts to stop foodborne outbreaks in their tracks.

At a Monday Annual Meeting session on “Recipe for Success: CDC Programs Build Capacity for State and Local Foodborne Disease Response,” presenters highlighted the many ways CDC is strengthening on-the-ground efforts and supporting promising new practices. First up, the Integrated Food Safety Centers of Excellence, which were established with the signing of the 2011 Food Safety Modernization Act — the most sweeping reform of food safety in over 70 years, said presenter Elizabeth Pace, a public health advisor at CDC.

The centers — located in Colorado, Florida, Minnesota, New York, Oregon and Tennessee — are headquartered in state health departments and collaborate with academic partners. Their goals? Strengthen surveillance and investigation, train public health staff, educate future food safety workers, improve information systems, and evaluate and disseminate best practices.

Since the centers were established, Pace said the number of products they’ve put out has “exploded.” Today, more than 100 Food Safety Center of Excellence products are available for public health practitioners to browse, download and put into action. For example, the Florida center created a series of videos that introduce novice investigation team members to the topic of foodborne illness, its burden and history. Other available tools include interview questionnaire templates and foodborne illness complaint resources.

Next up, FoodCORE — or Foodborne Disease Centers for Outbreak Response and Enhancement — which began in 2009 to boost the ability of state and local public health agencies to respond to foodborne illness outbreaks. Today, said session presenter Anna Newton, an epidemiologist with CDC, the 10 FoodCORE centers cover about 18 percent of the U.S. population and are helping to strengthen surveillance, speed up lab testing capacity, and improve the pace and timeliness of outbreak investigations.

Already, practices developed via FoodCORE are having an impact, Newton told attendees. For example, there’s been a significant increase in the use of a lab technique known as pulsed-field gel electrophoresis, which enables scientists to create a DNA fingerprint for a bacteria isolate. That fingerprint can then be used to determine if a particular case of illness or contaminated food is connected to a larger outbreak. (Pretty cool.) FoodCORE has facilitated a 14 percent increase in the use of pulsed-field gel electrophoresis for salmonella, E. coli and listeria. In addition, scientists are able to complete the lab test much quicker now, from 13 days down to just five.

Finally, presenter Kaleb Price, a public health advisor at CDC, told attendees about OutbreakNet Enhanced, which began in 2015 and builds on OutbreakNet, which has been around since the 1990s. Previously, OutbreakNet operated in 56 jurisdictions around the country. But with additional funding available in 2015, CDC decided to “fill in the gap” between OutbreakNet and FoodCore, Price said. Thus, OutbreakNet Enhanced was born to help state and local health departments improve their ability to detect, investigate and control foodborne outbreaks.

Each of the 18 OutbreakNet Enhanced sites must partner with an Integrated Food Safety Center of Excellence on a project to improve surveillance and response. In the first year, projects have focused on creating training videos for new epidemiologists, establishing student interview teams and strengthening interview questionnaires, among others.

In the coming year, Price said CDC hopes to bring in about eight additional sites if funding becomes available and increase peer-to-peer learning.

“We’re building the plane as we’re flying it,” he told attendees.

To learn more about the CDC programs and browse their tools and resources, click on the links above.