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From page 31... ... Senior Epidemiologist, Acute and Communicable Disease Program, Oregon Public Health Services CASE STUDIES Case studies of three important foodborne disease outbreaks are presented to illustrate how disease surveillance works in the United States and the evolution of outbreak investigative methods. These outbreaks can be reviewed in detail in the original literature (see also Barrett et al., 1994; Bell et al., 1994; CDC, 2004; Cody et al., 1999; Griffin et al., 1994) Read the entire page →
From page 32... ... In the United States, communicable disease epidemiology and disease surveillance practices are largely set by state government agencies, not by the federal government. The federal government is a significant source of funding for state programs, and it is a source of logistic and technical support for state agencies, but has surprisingly little authority to investigate disease outbreaks or Read the entire page →
From page 33... ... As a result, while the approach is broadly similar in most states, there are considerable variations in public health practice from jurisdiction to jurisdiction. In addition to legal differences, public health agencies vary considerably in funding, staffing levels, and degrees of experience and expertise, and these differences result in different capacities. Read the entire page →
From page 34... ... PROCESSING DISEASE REPORTS The legal requirements and mechanisms for reporting potential foodborne diseases are completely merged with reporting laws for all communicable diseases. All reports for all diseases funnel through the same public health agencies. Read the entire page →
From page 35... ... For most enteric infections the lag from first laboratory identification to local health department notification to investigation to report to state authorities is 2 to 4 days. THE ROLE OF THE PUBLIC HEALTH LABORATORY Communicable disease epidemiology requires partnerships with effective public health laboratories (PHLs) Read the entire page →
From page 36... ... Laboratory subtyping data are added to the epidemiological case database. Molecular subtyping data are also shared with other laboratories around the country through CDC's national PulseNet network (http:// www.cdc.gov/pulsenet/) Read the entire page →
From page 37... ... Outbreak cases and outbreak investigations have proven to be disproportionately important to public health practice (Keene, 1997) Read the entire page →
From page 38... ... coli O157 PFGE pattern might be reported within a short time period. These investigations may begin slowly, but quickly become high-priority investigations, often involving multiple epidemiologists and complicated liaisons with other public health agencies inside and outside the state (e.g., other state health departments, CDC, and state and federal regulatory agencies, such as the Food and Drug Administration [FDA] Read the entire page →
From page 39... ... OUTBREAK INVESTIGATIONS While following certain general patterns, each outbreak investigations is unique. In Oregon, local health agencies take the lead in the investigation and control of most Type 1 outbreaks, which tend to be less complicated. Read the entire page →
From page 40... ... Oregon state epidemiologists are always available to consult with local health departments and offer technical advice, often designing questionnaires and performing data analysis after interviews conducted by local staff. One of a pool of staff epidemiologists is always available on call outside normal office hours and if necessary, staff are usually available to travel on short notice to support or direct investigations in the field. Read the entire page →
From page 41... ... Contaminated foods are often long gone before outbreaks are even recognized, or contamination may occur at such a low and intermittent level as to be very difficult to detect. Confirmation means establishment of strong epidemiological evidence linking consumption of a product to illness, corroborated by biological plausibility and usually compatible information about product distribution, even if not (yet) Read the entire page →
From page 42... ... . OUTBREAK REPORTING We ask our state or local health department epidemiologists to summarize outbreak investigations, using a standardized questionnaire.11 This practice is state-specific, and many states do not track investigations as completely as we do. Read the entire page →
From page 43... ... One of the biggest hurdles is convincing people in medical institutions and local health agencies that outbreaks do not reflect badly on them; indeed, it is just the opposite. We know that common-source clusters are occurring with great regularity everywhere and that we hear of only a minority that take place. Read the entire page →
From page 44... ... Epidemiologists, laboratorians, regulators, and academics have attempted to integrate reports from outbreak investigations and other surveillance data, laboratory characterization of pathogens, and food sampling programs conducted by regulatory agencies and industry to achieve a "big picture" of the causes of foodborne disease. While progress has been made, these efforts have proven frustratingly inconclusive. Read the entire page →
From page 45... ... 1997. An outbreak of Escherichia coli O157:H7 infections traced to jerky made from deer meat. Read the entire page →

From page 31...

... Senior Epidemiologist, Acute and Communicable Disease Program, Oregon Public Health Services CASE STUDIES Case studies of three important foodborne disease outbreaks are presented to illustrate how disease surveillance works in the United States and the evolution of outbreak investigative methods. These outbreaks can be reviewed in detail in the original literature (see also Barrett et al., 1994; Bell et al., 1994; CDC, 2004; Cody et al., 1999; Griffin et al., 1994)