Lab Matters Fall 2022 - Page 15


Improving Foodborne Outbreak Response and Solving More Outbreaks

By Kirsten Larson , manager , Food Safety
Since 2006 , The Council to Improve Foodborne Outbreak Response ( CIFOR ) has worked to improve methods to detect , investigate , control and prevent foodborne outbreaks ( FBOs ). As a founding member , APHL regularly proposes new projects based on opportunities for improvement as discerned by members and staff . APHL staff , member representatives and laboratory subject matter experts provide input on CIFOR product development to ensure that tools are accurate , up to date and applicable to the public health laboratory community .
Tools and Resources Designed with Public Health Laboratories in Mind
CIFOR recently developed and updated several tools and products to evaluate program performance , enhance collaboration among stakeholders , improve outbreak surveillance , and provide model practices in FBO investigations .
CIFOR Guidelines for Foodborne Disease Outbreak Response ( 3rd Edition )
The CIFOR Guidelines are a comprehensive source of information on foodborne disease investigation and control for local , state , territorial , tribal , and federal health agencies . The guidelines describe model practices for detecting and responding to FBOs and outline the roles of key organizations . Several public health laboratory members contributed to the development of the Third Edition Guidelines , which incorporate significant changes , including :
• The implementation of whole genome sequencing ( WGS ) and culture-independent diagnostic tests ( CIDTs ).
• The integration of consumercomplaint systems with pathogen-specific surveillance .
• The importance of after-action reviews .
• Discipline-specific metrics pulled from existing programs such as FoodCORE and OutbreakNet Enhanced .
APHL is developing web-based modules intended to provide a highlevel overview of each chapter in the Third Edition Guidelines . The modules will be available on the APHL Training Portal in fall 2022 .
Third Edition CIFOR Toolkit
The CIFOR Toolkit serves as a companion piece to the CIFOR Guidelines and provides hands-on tools to help agencies identify which recommendations work best within their jurisdictions . The toolkit will help local and state health departments to :
• Understand the CIFOR Guidelines
• Assess outbreak detection and investigation procedures
• Implement appropriate recommendations .
APHL recommends that public health laboratories meet with epidemiologists and environmental health staff within their respective jurisdictions to work through sections of the toolkit . A coordinated , multidisciplinary approach ensures that improvements are made across the whole food safety system . Members who are interested in hosting local or regional CIFOR Toolkit meetings can contact Kirsten Larson at Kirsten . larson @ aphl . org .
Outbreaks of Undetermined Etiology ( OUE ) Guidelines
The OUE Guidelines are intended to provide adequate FBO specimens for second-tier testing and pathogen discovery should an etiology prove elusive . Recommendations include :
• Specimen collection and shipping protocols
• Suggested rule-out testing
• Storage criteria for negative specimens .
OUEs present an opportunity for public health investigators to expand our understanding of foodborne disease etiology , detect widespread CIDT failure due to mutations in detection targets , and identify practical and exciting pathways for public health laboratories to enter the world of metagenomics .
The US Centers for Disease Control and Prevention ( CDC ) is currently developing an advanced metagenomics pipeline for foodborne OUEs . Once developed and validated , the pipeline will be made available to state and local public health laboratories . APHL is excited to be working with CDC to help validate and roll out the pipeline in a phased approach , with Phase 1 beginning in the fall of 2022 . Public health laboratories interested in participating in this project are encouraged to contact Kirsten Larson at Kirsten . larson @ aphl . org .
Public health laboratories are encouraged to utilize CIFOR tools and resources to assess , strengthen and enhance their FBO response capabilities , especially in collaboration with cross-discipline professionals working within their jurisdiction . g
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