FoodCORE: Enhancing foodborne disease outbreak response

In 2011, the Centers for Disease Control and Prevention (CDC) monitored 15–40 potential food poisoning clusters each week and investigated more than 200 multistate clusters of foodborne disease in people. These investigations led to 17 recalls of contaminated foods.
The foods involved in these clusters are many and varied, which can complicate the investigation of foodborne disease outbreaks. Fast and effective outbreak investigations are therefore needed to identify and remove contaminated food from the market to prevent additional illnesses. Identifying contaminated foods and learning how the contamination happened also help public health officials develop ways to prevent similar outbreaks in the future. However, most state health departments lack the resources to perform comprehensive foodborne disease surveillance and to conduct rapid, coordinated detection and response to multistate outbreaks. FoodCORE is a program supported by CDC that helps states improve their capacity to detect and respond to multistate foodborne disease outbreaks.

What is FoodCORE?

“FoodCORE” stands for Foodborne Diseases Centers for Outbreak Response Enhancement. The FoodCORE centers work together to develop new and better methods to detect, investigate, respond to, and control multistate outbreaks of foodborne diseases. Efforts are primarily focused on outbreaks caused by bacteria, including Salmonella, Shiga toxin-producing Escherichia coli (STEC), and Listeria. The ability to detect and investigate viral and parasitic foodborne disease outbreaks will also be strengthened.

FoodCORE in action

Investigating outbreaks of foodborne disease

Figure 1 (larger version)

During the program’s first year (October 1, 2010 to September 30, 2011), the FoodCORE laboratories received a total of 8,264 Salmonella, 916 STEC, and 89 Listeria isolate-yielding specimens; of these, 7,677 (93%) Salmonella, 787 (86%) STEC, and 83 (93%) Listeria isolates, respectively, were from patients with distinct cases of illness. FoodCORE resources supported additional capacity for epidemiologic interview and investigation, resulting in an increased proportion of ill persons for whom epidemiology programs attempted an interview. Data from the first half of year one were combined and used as a comparative baseline for the last quarter of year one. For Salmonella infections, the average proportion of ill persons with an attempted interview increased from 88% (range 53-100%) at baseline to 94% (range 78-100%) during the last quarter. The average proportion of attempted interviews for ill persons with STEC infection increased from 90% (range 60-100%) during baseline, to 97% (range 89-100%) during the last quarter. For Listeria infections, the average proportion of cases with an attempted interview remained at 100% for all of year one.
In addition to attempting an interview for the majority of reported ill persons, FoodCORE centers also improved the timeliness of interviews. The average turn-around time from notification to first attempted interview decreased as follows: for Salmonella cases, from 1.3 days (range 0-3 days) during baseline to 0.6 days (range 0-2 days) during the last quarter; for STEC infections, from 2.7 days (range 1-5 days) during baseline to 0.6 days (range 0-1 day) during the last quarter; and for Listeria infections, from 7 days (range 3-11 days) during baseline to 0.7 days (range 0-1 day) during the last quarter.

Better, faster, and more complete foodborne outbreak investigations

Leveraging laboratory, epidemiology, and environmental health capacity, the centers have successfully used FoodCORE resources to improve the way they conduct outbreak investigations and to strengthen routine foodborne disease response activities. FoodCORE centers have built capacity for both routine and surge responses, making faster, more complete investigations possible. Using FoodCORE resources, the centers have solved outbreaks that would not have been solved otherwise, thereby preventing illnesses. These additional resources have supported collection and analysis of foodborne disease-related data and records, resulting in more rapid food recall actions. Identifying suspected and confirmed contaminated foods associated with illness helps mitigate ongoing outbreaks, but also informs prevention and education efforts to keep similar outbreaks from happening in the future.
FoodCORE is establishing model practices for the detection, investigation, response, and control of foodborne diseases. FoodCORE centers work collaboratively to identify and implement public health practices that can help shorten the time it takes to identify a source of infection and pinpoint how and why contamination occurred, in order to limit additional illnesses and help prevent future outbreaks.