Headquarters U S Air Force Integrity Service Excellence

Headquarters U. S. Air Force Integrity - Service - Excellence Foodborne Illness Outbreak IDMT Training

Objectives n Training Objectives n Define key aspects/steps of a Foodborne Illness (FBI) Outbreak. n Understand Public Health responsibilities during a Foodborne Illness Outbreak. Integrity - Service - Excellence 2

Overview n Define n Foodborne Illness Outbreak Epidemiologic Steps of an Outbreak Investigation n Public Health Roles and Responsibilities Integrity - Service - Excellence 3

Definition n Foodborne Illness – disease carried or transmitted to people by food. n Two main types of Foodborne Illness Infection n Intoxication n n Outbreak – an epidemic limited to localized increase in the incidence of disease Integrity - Service - Excellence 4

Epidemiologic Steps of an Outbreak Investigation n Prepare for field work n Establish the existence of an outbreak n Verify the diagnosis n Construct a working case definition n Find cases systematically and record information n Perform descriptive epidemiology n Develop hypotheses n Evaluate hypotheses epidemiologically Integrity - Service - Excellence 5

Epidemiologic Steps of an Outbreak Investigation n As necessary, reconsider, refine, and re-evaluate hypotheses n Compare and reconcile with laboratory and/or environmental studies n Implement control and prevention measures n Initiate or maintain surveillance n Communicate findings Integrity - Service - Excellence 6

Prepare for Field Work n Before a confirmation in increased cases or after the confirmation? n Be prepared n n n n Required Forms *(AF Form 431, 432, and CDC 52. 13) Tools to take samples (notify lab) Place to keep samples cold Gloves Camera Notebook/pen Plan of action Integrity - Service - Excellence 7

Establish the Existence of an Outbreak n More cases of disease than historically indicated n Common cause or related to each other n No changes in local procedures Integrity - Service - Excellence 8

Verify the Diagnosis n Properly identify n Rule out laboratory error n n Foodborne Illness testing Take a history Interview patient with AF Form 431 n Document time distribution of those affected n Integrity - Service - Excellence 9

Verifying the Diagnosis n AF Form 431, Food Poisoning Outbreak – Individual Case History (72 hours) Integrity - Service - Excellence 10

Verify the Diagnosis n AF Form 432, Time Distribution of Persons Affected (Onset data) Integrity - Service - Excellence 11

Construct a Working Case Definition n Clinical Criteria* n Fever Abdominal cramps n Diarrhea n Integrity - Service - Excellence 12

Find Cases Systematically and Record Information n Healthcare practitioners n Medical facilities n Alerting the public* Integrity - Service - Excellence 13

Perform Descriptive Epidemiology n Summarizing data n Time (epidemic curve) Integrity - Service - Excellence 14

Perform Descriptive Epidemiology n Summarizing data n Place n Person n Susceptibility n Age n Race n Sex n Medical status n Opportunities for exposure n Occupation n Leisure activities n Medications, tobacco, drugs Integrity - Service - Excellence 15

Develop Hypotheses n The hypotheses should address: n Source of the agent Mode of transmission n Exposures that caused the disease n Integrity - Service - Excellence 16

Evaluate Hypotheses Epidemiologically n Plausibility n Laboratory testing of patient for foodborne illness n Laboratory testing of suspect food Integrity - Service - Excellence 17

As Necessary, Reconsider, Refine, & Re-Evaluate Hypotheses n Necessity Reconsider n Refine n Re-evaluate n Integrity - Service - Excellence 18

Compare & Reconcile with Lab and/or Environmental Studies n Provide the proof n Laboratory results (human & food) n Inspection findings Integrity - Service - Excellence 19

Implement Control and Prevention Measures n Control & Prevention n Educate the population/food facility Treat the ill n Dispose of contaminated food n Learn from the outbreak investigation n Integrity - Service - Excellence 20

Initiate or Maintain Surveillance n Continue to monitor the situation n Is it getting better or worse? n Are the control methods even working? Integrity - Service - Excellence 21

Communicate Findings n Briefing for the local authorities/base/medical group/public health n Written report/documentation for historic value/training n Report of foodborne illness outbreak Integrity - Service - Excellence 22

Communicate Findings n CDC 52. 13, Investigation of a Foodborne Outbreak Send to MAJCOM/SGP n In the 50 states also send to the state health department n Integrity - Service - Excellence 23

Public Health Roles and Responsibilities n Conduct annual in-service training on foodborne illness n Investigate and report all foodborne illness outbreaks to MAJCOM/SGP and the state health department n Report each confirmed case in accordance with current AF reportable event guidelines. Integrity - Service - Excellence 24

Public Health Roles and Responsibilities n Ultimate goal n Preventing them from happening in the first place. Integrity - Service - Excellence 25

Summary n Define n Foodborne Illness Outbreak Epidemiologic Steps of an Outbreak Investigation n Public Health Roles and Responsibilities Integrity - Service - Excellence 26

QUESTIONS? Integrity - Service - Excellence

Tool Kit n References: n AFI 48 -116, Food Safety Program n Principles of Epidemiology in Public Health Practice, Third Edition, Updated May 2012 from the Centers for Disease Control and Prevention (CDC) n US Department of Health and Human Services, Food and Drug Administration (FDA) Food Code Integrity - Service - Excellence 28

Tool Kit n Websites: n Approved Source n http: //phc. amedd. army. mil/topics/foodwater/ca/Pages/Do. DApp roved. Food. Sources. aspx n CDC Food Safety Homepage n http: //www. cdc. gov/foodsafety/investigations. html n USAFSAM/PHR Website n https: //gumbo 2. wpafb. af. mil/epi-consult/index. cfm n Food Protection n https: //gumbo 2. wpafb. af. mil/epi-consult/foodprotection/ Integrity - Service - Excellence 29

Tool Kit n Websites: n Armed Forces Reportable Medical Events Guidelines & Definitions n n https: //gumbo 2. wpafb. af. mil/epiconsult/reportableevents/documents/Tri. Service%20 Reportable%20 Events, %20 Guidelines%20 and%20 Ca se%20 Definitions%20(2012). pdf Air Force Disease Reporting System internet (AFDRSi) n Go to the following link: https: //gumbo 2. wpafb. af. mil/epiconsult/reportableevents/ n This page will give you information and training on AFDRSi n https: //data. nmcphc. med. navy. mil/afdrsi/Login. aspx (AFDRSi Website) Integrity - Service - Excellence 30

USAFSAM Contact Information n USAFSAM Public Health Education Division n Mr. James Gage, Chief, Education and Training Branch DSN: 798 -4130 n Commercial: (937) 938 -4130 n Email: james. gage. 2@us. af. mil n Integrity - Service - Excellence 31