FoodCORE: Foodborne Diseases Centers for Outbreak Response Enhancement - Improving Foodborne Disease Outbreak Response Capacity in State and Local Health Departments

Background: Each year foodborne diseases (FBD) cause illness in approximately 1 in 6 Americans, resulting in 128,000 hospitalizations and 3,000 deaths. Limited resources negatively impact the ability of public health officials to identify, respond to, and control FBD outbreaks. Geographically dispersed outbreaks present an added challenge of coordination across multiple jurisdictions and all levels of the public health system. FoodCORE, a capacity building program, provides targeted resources to participating health department to improve the completeness and timeliness of laboratory, epidemiology, and environmental health activities for FBD surveillance and outbreak response.   

Methods: FoodCORE Centers implement work plans designed to make outbreak response activities faster and more complete in their jurisdiction. Performance metrics, developed through a collaborative process involving FoodCORE Centers and CDC, are used to quantitatively evaluate the impact and effectiveness of program activities. Strategies resulting in faster, more complete surveillance and response are documented and shared with other FBD programs. The current Centers, selected through competitive award, are Colorado, Connecticut, Minnesota, New York City, Ohio, Oregon, South Carolina, Tennessee, Utah, and Wisconsin. 

Results: From October 2010 to December 2013, the Centers increased the proportion of Salmonella, Shiga toxin-producing E. coli, and Listeria (SSL) isolates with molecular subtyping from 86% to 99% and reduced the average time to complete this testing from a median of 8 days to 4 days. Centers increased the proportion of SSL case-patients contacted for epidemiologic interviews from 93% to 99% and attempted these interviews faster, reducing the average time to attempt an interview from a median of 4 days to 2 days. The Centers document the practices that result in these improvements and have developed model practices on streamlining and standardizing case-patient interviewing, isolate receipt and testing, and student interview teams. Additional model practices are forthcoming.

Conclusions: FoodCORE Centers have leveraged additional resources to strengthen their FBD programs to conduct better, faster, and more complete laboratory surveillance and outbreak investigations. These improvements have helped the Centers identify and solve outbreaks more quickly within their jurisdiction and have allowed them to contribute critical information to help quickly solve multistate outbreaks and remove contaminated foods from commerce. Lessons learned are documented as FoodCORE model practices and disseminated to other programs to inform efforts to improve outbreak response in settings with similar infrastructures.