Outbreak characteristics associated with identification of contributing factors to foodborne illness outbreaks

Brown, Laura G.; Hoover, E. Rickamer; Selman, Carol; Coleman, Erik W.; Rogers, Helen Schurz

doi:10.1017/s0950268817001406

Cited by 29 publications

(22 citation statements)

References 8 publications

(7 reference statements)

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“…For example, for most outbreaks the investigators initiated an environmental assessment within a day of learning about the outbreak, which is a positive indicator because experts recommend initiating environmental assessments as quickly as possible ( 15 ). Research also indicates that timely and comprehensive environmental assessments are associated with identifying factors contributing to outbreaks, which is an important goal of outbreak investigations ( 14 ). On the other hand, for certain outbreaks, investigators took considerably longer (from 8 days to >14 days) to initiate contact, suggesting a need for improvement in timeliness of environmental assessments.…”

Section: Discussionmentioning

confidence: 99%

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Foodborne Illness Outbreaks at Retail Establishments — National Environmental Assessment Reporting System, 16 State and Local Health Departments, 2014–2016

Lipcsei

Brown

Coleman

et al. 2019

MMWR Surveill. Summ.

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Problem/Condition State and local public health departments report hundreds of foodborne illness outbreaks each year to CDC and are primarily responsible for investigations of these outbreaks. Typically, investigations involve epidemiology, laboratory, and environmental health components. Health departments voluntarily report epidemiologic and laboratory data from their foodborne illness outbreak investigations to CDC through the Foodborne Disease Outbreak Surveillance System (FDOSS); however, minimal environmental health data from outbreak investigations are reported to FDOSS. Period Covered 2014–2016. Description of System In 2014, CDC launched the National Environmental Assessment Reporting System (NEARS) to complement FDOSS surveillance and to use these data to enhance prevention efforts. State and local health departments voluntarily report data from their foodborne illness outbreak investigations of retail food establishments. These data include characteristics of foodborne illness outbreaks (e.g., agent), characteristics of establishments with outbreaks (e.g., number of meals served daily), food safety policies and practices of these establishments (e.g., glove use policies), and characteristics of outbreak investigations (e.g., timeliness of investigation activities). NEARS is the only available data source that includes characteristics of retail establishments with foodborne illness outbreaks. Results During 2014–2016, a total of 16 state and local public health departments reported data to NEARS on 404 foodborne illness outbreaks at retail establishments. The majority of outbreaks with a suspected or confirmed agent were caused by norovirus (61.1%). The majority of outbreaks with identified contributing factors had at least one factor associated with food contamination by a worker who was ill or infectious (58.6%). Almost half (47.4%) of establishments with outbreaks had a written policy excluding ill workers from handling food or working. Approximately one third (27.7%) had a written disposable glove use policy. Paid sick leave was available for at least one worker in 38.3% of establishments. For most establishments with outbreaks (68.7%), environmental health investigators initiated their component of the investigation soon after learning about the outbreak (i.e., the same day) and completed their component in one or two visits to the establishment (75.0%). However, in certain instances, contacting the establishment and completing the environmental health component of the investigation occurred much later (>8 days). Interpretation Most outbreaks reported to NEARS were caused by norovirus, and contamination of food by workers who were ill or infectious contributed to more than half of outbreaks with contributing factors; these findings are consistent with findings from other national outbreak data sets and highlight the role of workers in foodborne illness outbreaks. The ...

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Section: Discussionmentioning

confidence: 99%

“…Characteristics that have been hypothesized or found to be associated with investigation effectiveness, such as the timeliness of outbreak environmental assessments ( 14 , 15 ). …”

Section: Methodsmentioning

confidence: 99%

Foodborne Illness Outbreaks at Retail Establishments — National Environmental Assessment Reporting System, 16 State and Local Health Departments, 2014–2016

Lipcsei

Brown

Coleman

et al. 2019

MMWR Surveill. Summ.

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“…To improve NORS and CaliciNet report matching, updates to the surveillance systems are routinely implemented based on discussions with reporting agencies about the ways they detect, store, and report outbreaks. Moreover, an effort is underway to link outbreak reports in NORS and the National Environmental Assessment Reporting System (NEARS) to gain additional data on environmental contributing factors and illness prevention policies, such as food worker illness reporting and exclusion 29) . Second, potential collinearity and confounding may exist between the identified risk factors and outcomes of interest.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Foodborne Norovirus Outbreaks – United States, 2009–2015

et al. 2018

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Noroviruses are the leading cause of acute gastroenteritis and foodborne disease in the United States (U.S.). About 1 in 5 reported norovirus outbreaks are spread through foodborne transmission, presenting opportunities for prevention. We describe the epidemiology of U.S. foodborne norovirus outbreaks reported to national surveillance systems, including differences between genotypes. Foodborne outbreaks that occurred during August 2009-July 2015 with norovirus reported as a single confirmed etiology to the National Outbreak Reporting System (NORS) were matched with outbreaks reported to CaliciNet, a U.S. laboratory norovirus outbreak surveillance network. We analyzed these matched outbreaks stratified by genotype for epidemiologic characteristics, including setting, size and duration, health outcomes of case-patients, implicated food, and outbreak contributing factors. Four hundred ninety-three confirmed foodborne norovirus outbreaks were reported in both NORS and CaliciNet. The most common norovirus genotypes reported were GII.4 (52%), GII.6 (9%), and GI.3 (8%). Compared to non-GII.4 outbreaks, GII.4 outbreaks had higher hospitalization rates (12.8 vs. 4.8 per 1,000 cases, P < 0.01). While contaminated foods were identified and reported in only 35% of outbreaks, molluscan shellfish (4% overall) were more often implicated in non-GII.4 outbreaks than in GII.4 outbreaks (7% vs. 1%, P = 0.04). Of the 240 outbreaks reporting at least one contributing factor, food workers were implicated as the source of contamination in 182 (76%), with no difference between GII.4 and non-GII.4 (73% vs 79%, P = 0.3). Foodborne norovirus outbreaks are frequently reported in the U.S., most of which are caused by GII.4 noroviruses. Viruses of this genotype are associated with higher rates of hospitalization; non-GII.4 noroviruses are more frequently associated with contaminated molluscan shellfish. These surveillance data highlight the diversity of noroviruses causing foodborne disease and can help guide appropriate food safety interventions, including worker hygiene, improved food handling and preparation, and further development of norovirus vaccines.

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“…Persistence of microbial pathogens in the food‐facility environment and potential for cross‐contamination of food products during preparation have been implicated as factors contributing to several well‐documented outbreaks of foodborne illness (Brown, Hoover, Selman, Coleman, & Schurz Rogers, ; Ferreira, Wiedmann, Teixeira, & Stasiewicz, ; Heiman et al., ; Jackson et al., ; Munther & Wu, ). In its recommendations for food‐safety plans, based on requirements of the Food Safety Modernization Act, U.S. Food and Drug Administration draft guidance specifies that pathogen persistence and spread within a food facility are controlled and managed predominantly by measures that provide basic environmental and operational conditions needed to produce safe and wholesome foods.…”

Section: Introductionmentioning

confidence: 99%

An Agent‐Based Model for Pathogen Persistence and Cross‐Contamination Dynamics in a Food Facility

Mokhtari

Doren

2018

Risk Analysis

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We used an agent-based modeling (ABM) framework and developed a mathematical model to explain the complex dynamics of microbial persistence and spread within a food facility and to aid risk managers in identifying effective mitigation options. The model explicitly considered personal hygiene practices by food handlers as well as their activities and simulated a spatially explicit dynamic system representing complex interaction patterns among food handlers, facility environment, and foods. To demonstrate the utility of the model in a decisionmaking context, we created a hypothetical case study and used it to compare different risk mitigation strategies for reducing contamination and spread of Listeria monocytogenes in a food facility. Model results indicated that areas with no direct contact with foods (e.g., loading dock and restroom) can serve as contamination niches and recontaminate areas that have direct contact with food products. Furthermore, food handlers' behaviors, including, for example, hygiene and sanitation practices, can impact the persistence of microbial contamination in the facility environment and the spread of contamination to prepared foods. Using this case study, we also demonstrated benefits of an ABM framework for addressing food safety in a complex system in which emergent system-level responses are predicted using a bottom-up approach that observes individual agents (e.g., food handlers) and their behaviors. Our model can be applied to a wide variety of pathogens, food commodities, and activity patterns to evaluate efficacy of food-safety management practices and quantify contamination reductions associated with proposed mitigation strategies in food facilities.

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Outbreak characteristics associated with identification of contributing factors to foodborne illness outbreaks

Cited by 29 publications

References 8 publications

Foodborne Illness Outbreaks at Retail Establishments — National Environmental Assessment Reporting System, 16 State and Local Health Departments, 2014–2016

Foodborne Illness Outbreaks at Retail Establishments — National Environmental Assessment Reporting System, 16 State and Local Health Departments, 2014–2016

Epidemiology of Foodborne Norovirus Outbreaks – United States, 2009–2015

An Agent‐Based Model for Pathogen Persistence and Cross‐Contamination Dynamics in a Food Facility

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