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An estimated 1 in 6 Americans experience foodborne illness each year. Surveillance for foodborne illness is conducted through pathogen-based surveillance programs like FoodNet. In 2010, a total of 1,915 laboratory-confirmed cases of these nine pathogens were reported and 26 outbreaks were investigated in Tennessee. Complaint-based surveillance can identify foodborne illness more rapidly for public health investigation and detects a wider range of commonly occurring etiologies not detected by culture-based surveillance methods. In January 2012, the Tennessee Department of Health began centralized complaint-based surveillance of foodborne illness to identify potential outbreaks.
METHODS:
A standard complaint form was instituted statewide. Consumers experiencing illness report complaints to their local health departments or call the Foodborne Illness Complaint Hotline, managed at the central office. Additionally, local health departments report complaints to the central office. All restaurants named as a potential source of illness are inspected by the state’s environmental health and food protection section. Complaint data are analyzed every 2 weeks by epidemiology staff. The purpose of the evaluation was to describe the volume, type, and geographic distribution of complaints and to make recommendations for future use, including additional sources of data.
RESULTS:
The complaint-based surveillance system is a simple, flexible system. Over 10 months, 152 complaints were received totaling 267 illnesses. Only 43% of Tennessee counties reported a foodborne illness complaint. No cross-jurisdictional outbreaks were identified through the surveillance system. The average time between illness onset and complaint was 4 days. Complaints tended to be from older callers and were primarily restaurant-associated. Over 80% of complaints did not include a full 72-hour food history.
CONCLUSIONS:
Complaint-based surveillance for foodborne illness has the potential to identify outbreaks faster and across jurisdictions in Tennessee. Wider knowledge of the system and the Hotline is needed to facilitate reporting by local health departments and the general public. Collection of food histories needs to be enhanced to allow analysis of temporal exposures not related to a specific restaurant which is subject to last meal bias. We recommend timely epidemiology analysis and data sharing with local health departments to facilitate future reporting. Other recommendations include encouraging use of the system by the general public, conducting follow-up with callers to obtain complete information, and incorporating other data sources, such as complaints received by the Tennessee Department of Agriculture and Poison Control Center.