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BACKGROUND: The Council to Improve Foodborne Outbreak Response’s (CIFOR) 2009 “Guidelines for Foodborne Disease Outbreak Detection and Response” includes over 100 performance indicators for foodborne disease programs. In 2013, the CIFOR Metrics Working Group proposed target ranges for 20 performance indicators. Our objectives were to (1) assess Colorado performance, (2) determine which performance indicators would be useful for providing feedback to local public health agencies (LPHA), and (3) provide feedback to CIFOR metrics working group.
METHODS: We assessed 2008-2012 Colorado foodborne surveillance and 2009-2012 outbreak data using CIFOR performance indicator targets.
RESULTS: Of the 20 performance indicators, 14 could be evaluated using available Colorado data. 203 outbreaks were reported between 2009-2012.The overall foodborne illness outbreak rate (8.2 outbreaks per million person) was “high.” Outbreak case exposure assessments (93%), clinical specimen collection (55%), clinical specimen testing (54%) were “acceptable.” Indicators about National Outbreak Reporting System (NORS) reporting varied from “not acceptable” (99% of outbreaks reported to NORS, 42% of outbreaks with a vehicle), to “middle” (55% with etiology), to “high” (57% with contributing factors). 2915 Salmonella and 909 shiga-toxin producing E. coli (STEC) cases were evaluated. For individual cases, confirmed foodborne illness cases exposure histories (83% Salmonella, 93% STEC), isolate submission (96% Salmonella, 94% STEC), and pulsed-field gel electrophoresis subtyping (93% Salmonella, 94% STEC) were “high.” Mean isolate subtyping interval (3 days Salmonella, 4 days STEC) and reporting to PulseNet within four days of isolate receipt (100% STEC, 100% Listeria) were “acceptable.” Most foodborne illness complaints are received by LPHAs. Complaints received by state are recorded in a paper log (“acceptable”), but complaint rates and outbreaks detected from complaints cannot be calculated due to the lack of a statewide complaint system. Colorado investigates all reported clusters, but clusters investigations were not tracked during the study period; cluster investigation intervals and cluster source identification could not be calculated.
CONCLUSIONS: CIFOR metrics were useful for identifying areas for improvement. We identified a need for more NORS reporting training and are considering implementing a unified foodborne illness complaint system. Five indicators representing good foodborne illness and outbreak investigation by LPHA were selected: foodborne illness outbreak rate, outbreak case exposure assessment, outbreak clinical specimen collection, outbreak etiology reporting, and confirmed cases with exposure history. LPHA data is currently being evaluated with these indicators Feedback to CIFOR included standardizing categories to eliminate the ‘high/medium/low’ and ‘acceptable/unacceptable’ levels, as they are hard to systematically implement. Proposed target ranges need further refinement.