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BACKGROUND: Each year foodborne diseases (FBD) cause illness in approximately 1 in 6 Americans, resulting in 128,000 hospitalizations and 3,000 deaths. Resources are decreasing and impacting the ability of public health officials to identify, respond to, and control FBD outbreaks. Geographically dispersed outbreaks present an added challenge of multijurisdictional coordination across all levels of the public health system. FoodCORE provides targeted resources to state and local health department participants to improve the completeness and timeliness of laboratory, epidemiology, and environmental health (EH) activities for FBD surveillance and outbreak response.
METHODS: FoodCORE Centers were selected through competitive award and implemented work plans designed to make outbreak response activities faster and more complete in their jurisdiction. Performance metrics, developed through a collaborative process involving FoodCORE Centers and CDC, are used to quantitatively evaluate the impact and effectiveness of program activities. Strategies resulting in faster, more complete surveillance and response are documented so they can be shared with other local and state FBD programs across the United States. The current centers are Colorado, Connecticut, Minnesota, New York City, Ohio, Oregon, South Carolina, Tennessee, Utah, and Wisconsin.
RESULTS: From October 2010 to December 2013, the Centers increased the proportion of Salmonella, Shiga toxin-producing E. coli, and Listeria (SSL) isolates undergoing molecular subtyping from 86% to 99% and reduced the average time to complete the testing from a median of 8 days to 4 days. The proportion of SSL case-patients with an attempted epidemiologic interview increased from 93% to 99% and the average time to first attempt was reduced from a median of 4 days to 2 days. During 2013, more than 300 environmental health assessments were conducted. FoodCORE Centers have developed model practices on streamlining and standardizing case-patient interviewing, isolate receipt and testing, and student interview teams. Additional model practices are forthcoming.
CONCLUSIONS: FoodCORE Centers have leveraged additional resources to strengthen their FBD programs to conduct better, faster, and more complete laboratory surveillance and outbreak investigations. These improvements have helped the Centers identify and solve outbreaks more quickly within their jurisdiction as well as contribute critical information to help solve multistate outbreaks quickly and remove contaminated foods from commerce. Lessons learned are documented and disseminated through the FoodCORE model practices. These strategies can inform efforts to improve outbreak response in other state and local health departments or international public health settings with similar infrastructures for FBD surveillance and response.