Outbreak Data for Foodborne Illness Source Attribution: From Good to Great
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1 Outbreak Data for Foodborne Illness Source Attribution: From Good to Great Patricia M. Griffin, MD Chief, Enteric Diseases Epidemiology Branch Division of Foodborne, Waterborne, and Environmental Diseases National Center for Emerging and Zoonotic Infectious Diseases Pew Foundation February 1, 2012 National Center for Emerging and Zoonotic Infectious Diseases Division of Foodborne, Waterborne, and Environmental Diseases
2 This work is about getting data for policy from investigated outbreaks (not about detecting or investigating outbreaks)
3 Investigated Outbreak Data: From Good to Great Surveillance of investigated outbreaks is unique A peek behind the scenes Estimation of foodborne illness source attribution Extracting the data -- making estimates needed for policy Investigated outbreak data source: Foodborne Disease Outbreak Surveillance System (FDOSS)
4 Smartphone Analogy Foodborne Disease Outbreak Surveillance System (FDOSS) is one of the major apps It collects data on investigated outbreaks PulseNet FoodNet NNDSS-LEDS FDOSS NARMS CaliciNet Listeria Initiative NVEAIS
5 Foodborne Disease Outbreak Surveillance System FDOSS Developed: 1973 Captures data from investigated outbreaks on agents, foods, and settings responsible for illness Because: Outbreaks are the major way we learn what foods are causing illness and how to prevent it. Now: States report hundreds of outbreaks each year through the National Outbreak Reporting System (NORS). The data is used to determine pathogen-food combinations to target for prevention.
6 Goals of Investigated Outbreak Surveillance Describe characteristics of outbreaks Determine major foods causing illness Determine major agents causing foodborne illness Determine settings for foodborne illness Determine factors that repeatedly contribute to foodborne illness outbreaks Obtain data that can be used to estimate foodborne illness source attribution Investigated outbreak data source: Foodborne Disease Outbreak Surveillance System (FDOSS)
7 What is Unique about Investigated Outbreak Surveillance? Collects reports on groups of people with the same illness (rather than individuals with that illness) The food that caused the illness can often be determined with certainty (rarely possible with individual illnesses) Outbreak reports contain a wealth of data broad range of illnesses, foods, settings even unsolved outbreaks provide information on symptoms, agents, settings
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9 Harvesting and Extracting Data from Outbreaks an Olive Oil Analogy
10 Investigated Outbreak Data: From Good to Great Surveillance of investigated outbreaks is unique A peek behind the scenes Estimation of foodborne illness source attribution Extracting the data -- making estimates needed for policy Investigated outbreak data source: Foodborne Disease Outbreak Surveillance System (FDOSS)
11 Steps along the way to disseminating data on investigated outbreaks Health dept. Possible outbreak! Investigates outbreak Enters data into CDC form electronic CDC Data downloaded into CDC database Data accuracy and quality checked Data ready for analysis and dissemination Investigated outbreak database is the Foodborne Disease Outbreak Surveillance System
12 Steps along the way to disseminating data on investigated outbreaks Health dept. Possible outbreak! Investigates outbreak Enters data into standard form CDC is improving data flow from state and local health departments providing standards and forms for reporting
13 Steps along the way to disseminating data on investigated outbreaks Health dept. Possible outbreak! Investigates outbreak Enters data into standard form CDC is improving data flow from state and local health departments providing standards and forms for reporting providing personal consultation
14 Epidemiologists at CDC ready to help states with investigated outbreak reporting! Puert o Rico Guam Republic of Palau American Samoa Commonwealth of the Northern Mariana Islands Republic of the Marshall Islands US Virgin Islands
15 Steps along the way to disseminating data on investigated outbreaks Health dept. Possible outbreak! Investigates outbreak Enters data into standard form CDC is improving data flow from state and local health departments providing standards and forms for reporting providing personal consultation conducting webinar trainings
16 Webinar Trainings to Improve the Quantity and Quality of Outbreak Reports Topic Date Attendees Result 2009 Outbreak Surveillance Data Bacterial toxinmediated outbreaks Aug 2011 Nov 2011 ~50 attendees from 25 states, CDC ~85 attendees from 24 stat es, FSIS, CDC ~60 more outbreaks reported for 2009 CDC notified of several outbreaks Improving food attribution using outbreak data Feb 2012 Foodborne outbreaks and the law May 2012
17 Other CDC programs contribute to quantity and quality of investigated outbreak data, for example PulseNet provides subtype data NARMS provides resistance data FoodNet conducts model surveillance FoodCORE improves outbreak investigation techniques
18 Steps along the way to disseminating data on investigated outbreaks Health dept. Possible outbreak! Investigates outbreak Enters data into standard form electronic CDC Data downloaded into CDC database Data accuracy and quality checked Data ready for analysis and dissemination Investigated outbreak database is the Foodborne Disease Outbreak Surveillance System
19 Steps along the way to disseminating data on investigated outbreaks CDC Data downloaded into CDC database Data accuracy and quality checked CDC is making enhancements to improve data quantity and quality Investigated outbreak database is the Foodborne Disease Outbreak Surveillance System
20 Enhancements to Improve Data Quantity and Quality To deploy in 2012: changes that make reporting easier for state and locals NORSDirect (so states can move info directly from their database into NORS) NORS download (so states can download their info from the CDC database) Updated guidance on how to improve their reports Envisioned: a program that will continue to improve quantity and quality of outbreak reports, modeled on PulseNet
21 Steps along the way to disseminating data on investigated outbreaks CDC Data downloaded into CDC database Data accuracy and quality checked CDC is making enhancements to improve data quantity and quality CDC is getting investigated outbreak data verified and out faster Investigated outbreak database is the Foodborne Disease Outbreak Surveillance System
22 CDC is Getting Investigated Outbreak Data Verified and Out Faster CDC hired and trained new people to do the work NORS Data Unit expanded to meet demands for data September 2010: 3 people (1 doctoral, 2 MPH) now: 6 people (1 doctoral, 5 MPH) CDC is enhancing database to make data corrections go faster (to deploy in 2012)
23 Investigated Outbreak Surveillance and PulseNet Have Many Similarities PulseNet Surveillance Scope National National Investigated Outbreak Surveillance Purpose Detect outbreaks Ext ract actionable info from reports of investigated outbreaks Unit of measure Isolates and cluster Outbreaks Data flow State and locals to CDC State and locals to CDC CDC role Set standards, assure quality data, analyze data Data flow method Electronic Electronic CDC Support for data flow from states PulseNet microbiologist in every state Set standards, assure quality data, analyze data 1 part-time epidemiologist in most states Data quantity and quality are essential for both systems to have impact.
24 Public health laboratories Electronic Data Transmission to PulseNet PFGE patterns National database at CDC
25 Electronic Data Transmission to Foodborne Disease Outbreak Surveillance System Public health epidemiologists Reports National database at CDC
26 Quantity and Quality of Outbreak Data is Key to Getting Good Estimates of Foodborne Illness Source Attribution Outbreak detection and investigation is just one part of the process. Outbreak reporting is essential to document food source agent contributing factors setting severity
27 Quantity and Quality of Outbreak Data is Key to Getting Good Estimates of Foodborne Illness Source Attribution Analyses of many outbreak investigations are needed to show that particular food-pathogen pairs are important causes of illness Therefore, to estimate foodborne illness source attribution from outbreaks, we need capacity in state and local health depts to report investigated outbreaks, a CDC quality assurance team a CDC IT team a CDC analytics team
28 Investigated Outbreak Data: From Good to Great Surveillance of investigated outbreaks is unique A peek behind the scenes Estimation of foodborne illness source attribution Extracting the data -- making estimates needed for policy Investigated outbreak data source: Foodborne Disease Outbreak Surveillance System (FDOSS)
29 Foodborne illness source attribution is estimation, and estimation has challenges
30 The US Economy The risk that the economy has entered a substantial downturn appears to have diminished over the past month or so. -Ben Bernanke, Fed chairman, June 9, 2008, during the middle of what would later be recognized as the longest and deepest recession since World War II
31 The US Economy: Sometimes measuring what has already occurred is a Sisyphean task The quarterly GDP (gross domestic product) growth rate is published and revised 7 times When you re building forecasts on a baseline that s shifting, it can be very, very difficult. Steve Landefeld, Direct or, Bureau of Economic Analysis
32 A Way to Think about Foodborne Illness Source Attribution Estimates Like other estimates, foodborne illness source attribution estimates will be the best we have based on data available now Could different methods for extracting data give different results? Yes, and this can help to identify the best method Should we expect estimates to be revised? Yes, as data and methods improve, estimates should be revised Why revise estimates? Because we want to use the best data and the best methods to inform decision-making
33 Investigated Outbreak Data: From Good to Great Surveillance of investigated outbreaks is unique A peek behind the scenes Estimation of foodborne illness source attribution Extracting the data -- making estimates needed for policy Investigated outbreak data source: Foodborne Disease Outbreak Surveillance System (FDOSS)
34 Investigated Outbreak Data are Extracted and Shared in Many Ways Foodborne Outbreak Online Database (FOOD) Responses to data requests Scientific articles MMWR reports
35 Investigated Outbreak Data are Extracted and Shared in Many Ways Foodborne Outbreak Online Database (FOOD) Responses to data requests Scientific articles MMWR reports
36 Foodborne Outbreak Online Database (FOOD)
37 FOOD is Getting Better 2009 data was available August data will be available mid-2012 Enhancements based on user feedback more information on each outbreak (e.g., contaminated ingredient) added in 2011 data can be sorted by each attribute added in 2011 new search fields--planned for 2012 Updated FAQ and website in 2011
38 Investigated Outbreak Data are Extracted and Shared in Many Ways Foodborne Outbreak Online Database (FOOD) Responses to data requests Scientific articles MMWR reports annual cumulative
39 Investigated outbreaks State and local reporting groups (>50) Investigated outbreaks CDC QA group Investigated outbreaks CDC IT group Investigated outbreaks CDC analysis group
40 Investigated Outbreak Data: From Good to Great Surveillance of investigated outbreaks is unique A peek behind the scenes Estimation of food borne illness source attribution Extracting the data -- making estimates needed for policy Investigated outbreak data source: Foodborne Disease Outbreak Surveillance System (FDOSS)
41 Thank you The Farm (2000) by Alexis Rockm an The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention
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