BACKGROUND: Each year foodborne diseases cause illness in approximately 1 in 6 Americans, resulting in 128,000 hospitalizations and 3,000 deaths. Limited resources impact the ability of public health officials to identify, respond to, and control foodborne disease outbreaks. CDC developed the OutbreakNet, OutbreakNet Enhanced (OBNE), and Foodborne Disease Centers for Outbreak Response Enhancement (FoodCORE) programs to build state and local capacity for improved detection, investigation, and control of foodborne outbreaks.
METHODS: CDC used a tiered approach to fund three programs to improve foodborne disease surveillance and outbreak response throughout the United States. OutbreakNet provided a baseline level of support for epidemiologic activities in 55 jurisdictions. FoodCORE, the highest funded tier, began as a pilot in three states in 2009 to build structural capacity in epidemiology, laboratory, and environmental health. Since its inception, FoodCORE was expanded from three to 10 centers. To fill the gap between OutbreakNet and FoodCORE, CDC launched a middle tier of funding in August 2015, OBNE, which now includes 18 participating sites. State and local health departments use FoodCORE and OBNE funds to build capacity in ways that will improve their foodborne disease investigation process; most sites have hired additional epidemiologists, student interviewers, and/or laboratorians.
RESULTS: Participants in the higher funded tiers of FoodCORE and OBNE have more specific program requirements, including routine reporting of performance measures. From October 2010 to December 2015, FoodCORE centers reduced the mean time to complete Salmonella and Shiga toxin-producing Escherichia coli (STEC) serotyping from 6.5 to 3.3 days. The proportion of completed Salmonella, STEC, and Listeria case-patient interviews increased from 93% to 99%, while the mean time to attempt an interview decreased from 3.7 days to 1.1 days. Model practices on streamlining and standardizing case-patient interviewing, isolate receipt and testing, and building student interview teams are available on the FoodCORE website. In 2015, OBNE sites began to implement plans to improve surveillance and interviewing of Salmonella, STEC, and Listeria cases.
CONCLUSIONS: Collaboration and integration across the OutbreakNet, OBNE, and FoodCORE programs have created a comprehensive framework for foodborne disease outbreak response capacity building at the state and local level. FoodCORE centers continue to document successes and model practices to inform efforts to improve outbreak response. OBNE has improved epidemiology capacity and established collaborative partnerships with other state and federal programs, and will continue to do so as it expands to additional sites in 2017.