Outbreak eak Data f a for Foodb dborn rne I Ill llness Source - - PowerPoint PPT Presentation

Outbreak eak Data f a for Foodb dborn rne I Ill llness Source A Attri ributio ion: From

• m G

Good

• od t

to

• Great

Patric ricia M. G Grif riffin in, MD

Chief, E nteric Diseases E pidemiology Branch Division of Foodborne, Waterborne, and E nvironmental Diseases National Center for E merging and Zoonotic Infectious Diseases Pew Foundation February 1, 2012

National Center for E merging and Zoonotic Infectious Diseases Division of Foodborne, Waterborne, and E nvironmental Diseases

This work is about getting data for policy from investigated outbreaks

(not about detecting or investigating outbreaks)

Inves estigated ed O Outbrea eak Data: From

• m Good
• od to
• Great

 Surveilla

illance of in investig igated outbreaks is is u uniq ique

 A peek

eek beh ehind the e scen enes es

 Estimation

• n of
• f food
• odbor
• rne illness source attribution
• n

 Extracting the data --

• - mak

aking es estimates need eeded ed for policy

Investigated outbreak data source: F

• odborne Disease Outbreak S

urveillance S ystem (FDOS S )

Smartpho hone ne A Ana nalogy gy

PulseN eNet et NARM RMS

Lis isteria ia I Init itia iativ ive

NND NDSS-LED EDS Fo FoodNet Cal aliciNet et NVEAI AIS FDOSS SS

 Food

• odbor
• rne Diseas

ease e Outbreak eak Survei eillan ance e System em ( (FDOSS) i is

• ne

e of the m e maj ajor “ap apps”

• It collects data on investigated
• utbreaks

Developed ed: 1973 Because: e: Outbreaks are the major way we learn what foods are causing illness and how to prevent it. Now: : S tates report hundreds of outbreaks each year through the National Outbreak R eporting S ystem (NOR S ). The data is used to determine pathogen-food combinations to target for prevention.

Cap aptures data a from inves estigated ed o

• utbrea

eaks

• n
• n agent

nts, food

• ods, and

settings respo ponsib ible le for illn illness

FDOSS SS

Foodborne D e Disea ease Outbreak S Surveillance System

Goa

• als of
• f

Inves estigated ed Outbreak eak Surveill illance

 Des

escribe e char arac acter eristics of outbreak eaks

• Determine major foods causing illness
• Determine major agents causing foodborne illness
• Determine settings for foodborne illness
• Determine factors that repeatedly contribute to foodborne illness
• utbreaks

 Obtai

ain data a that can an be u e used ed to es estimate e food

• odbor
• rne

illn illness s source attrib ibutio ion

Investigated outbreak data source: F

• odborne Disease Outbreak S

urveillance S ystem (FDOS S )

What i is Unique a about Inves estigated ed O Outbrea eak Survei eillance? e?

 Col

• llects reports on
• n grou
• ups of
• f peop
• ple
• with the same illness
• (rather than individuals with that illness)

 The

e food that cau aused ed the e illnes ess can an often en be e det eter ermined ed with cer ertai ainty

• (rarely possible with individual illnesses)

 Outbreak

eak r rep eports contai ain a a weal ealth of d data

• broad range of illnesses, foods, settings
• even

“unsolved” outbreaks provide information on symptoms, agents, settings

Har arvesting an and E Extrac acting Data a from Outbreak aks – an O Oliv ive Oil il Analo logy

Inves estigated ed O Outbrea eak Data: From

• m Good
• od to
• Great

 Surveilla

illance of in investig igated outbreaks is is u uniq ique

 A peek

eek beh ehind the e scen enes es

 Estimation

• n of
• f food
• odbor
• rne illness source attribution
• n

 Extracting the data --

• - mak

aking es estimates need eeded ed for policy

Investigated outbreak data source: F

• odborne Disease Outbreak S

urveillance S ystem (FDOS S )

Step eps along the w e way t to dis issemin inatin ing data on investig igated outbr breaks

Possible

• utbreak!

Investigates

• utbreak

E nters data into CDC form Data downloaded into CDC database Data accuracy and quality checked Data ready for analysis and dissemination

Investigated outbreak database is the Foodborne Disease Outbreak S urveillance S ystem

Heal ealth de dept pt. CD CDC electronic

Step eps along the w e way t to dis issemin inatin ing data on investig igated outbr breaks

Possible

• utbreak!

Investigates

• utbreak

E nters data into standard form

Heal ealth de dept pt.

 CDC is

is im improvin ing da data flo low from s state and lo d local l healt lth depar artments

• providing standards and forms for reporting

Step eps along the w e way t to dis issemin inatin ing data on investig igated outbr breaks

Possible

• utbreak!

Investigates

• utbreak

E nters data into standard form

Heal ealth de dept pt.

 CDC is

is im improvin ing da data flo low from s state and lo d local l healt lth depar artments

• providing standards and forms for reporting
• providing personal consultation

Epid idemio iolo logis ists at C CDC r ready to help lp s states wit ith in investig igated o

• utbreak r

reportin ing!

American S amoa Commonwealth of the Northern Mariana Islands R epublic of the Marshall Islands US Virgin Islands Pu Puerto Ri Rico Gu Guam Repu publ blic o

• f

Pal alau au

Step eps along the w e way t to dis issemin inatin ing data on investig igated outbr breaks

Possible

• utbreak!

Investigates

• utbreak

E nters data into standard form

Heal ealth de dept pt.

 CDC is

is im improvin ing da data flo low from s state and lo d local l healt lth depar artments

• providing standards and forms for reporting
• providing personal consultation
• conducting webinar trainings

Webi binar Trainings to Improve the Q Qua uantity a and nd Quality o

• f

Outbrea eak R Rep eports

Topic Dat ate Atten endees ees Re Result 2009 Outbreak S urveillance Data Aug 2011 ~50 attendees from 25 states, CDC ~60 more

• utbreaks reported

for 2009 Bacterial toxin- mediated outbreaks Nov 2011 ~85 attendees from 24 states, FS IS , CDC CDC notified of several outbreaks Improving food attribution using

• utbreak data

Feb 2012 Foodborne outbreaks and the law May 2012

Other CDC p prog

• grams cont
• ntribute to
• quan

antity an and qual ality of inves estigated ed o

• utbrea

eak data, for example le…

 PulseN

eNet et pr provides subt btype pe data

 NARMS provides

es res esistan ance e data

 Food

• odNet cond

nduc ucts m model sur urveillanc nce

 Food

• odCORE im

improves outbreak in investig igatio ion techni hnique ues

Step eps along the w e way t to dis issemin inatin ing data on investig igated outbr breaks

Possible

• utbreak!

Investigates

• utbreak

E nters data into standard form Data downloaded into CDC database Data accuracy and quality checked Data ready for analysis and dissemination

Investigated outbreak database is the Foodborne Disease Outbreak S urveillance S ystem

Heal ealth de dept pt. CD CDC electronic

Step eps along the w e way t to dis issemin inatin ing data on investig igated outbr breaks

Investigated outbreak database is the Foodborne Disease Outbreak S urveillance S ystem

Data downloaded into CDC database Data accuracy and quality checked CD CDC

 CDC is making en

enhancemen ents t to i improve e data a quantity and qu qualit lity

Enhancem emen ents t to Improve e Dat ata Quan antity an and Q Qual ality

 To dep

eploy i in 2012: chan anges es that mak ake e rep eporting eas easier er for s state e an and local als

• NOR

S Direct (so states can move info directly from their database into NOR S )

• NOR

S download (so states can download their info from the CDC database)

• Updated guidance on how to improve their reports

 Envis

isio ioned: a program that will ill contin inue to im improve quan antity an and qual ality o

• f outbreak

eak r rep eports, m model eled ed on PulseN eNet et

Step eps along the w e way t to dis issemin inatin ing data on investig igated outbr breaks

Investigated outbreak database is the Foodborne Disease Outbreak S urveillance S ystem

Data downloaded into CDC database Data accuracy and quality checked CD CDC

 CDC is making en

enhancemen ents t to i improve e data a quantity and qu qualit lity

 CDC i

is getting inves estigated ed outbreak ak data a ver erified a and out fas aster

CDC is Getti tting Investi tigated Outb tbreak Data Ver erified ed a and Out Faster er

 CDC hired

ed a and t trained ed n new peo eople e to do the e wor

• rk
• NOR

S 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 enhan

ancing d datab abas ase to mak ake dat ata cor

• rrection
• ns g

go

• faster

(to d deploy i in 2 2012) 12)

Inves estigated ed O Outbrea eak Survei eillance a e and PulseN eNet et Have M Many Sim imila ilarit itie ies

PulseN eNet et Surveilla illance Inves estigated ed Outbreak eak Surveilla illance S cope National National Purpose Detect outbreaks E xtract actionable info from reports of investigated outbreaks Unit of measure Isolates and cluster Outbreaks Data flow S tate and locals to CDC S tate and locals to CDC CDC role Set standards, assure quality data, analyze data Set standards, assure quality data, analyze data Data flow method E lectronic E lectronic CDC S upport for data flow from states PulseNet microbiologist in every state 1 part-time epidemiologist in most states

Data quantity and quality are essential for both systems to have impact.

Ele lectronic ic Data T Transmis issio ion

to

• PulseN

eNet et

PFGE patterns National database at CDC Public health laboratories

Ele lectronic ic D Data Transmis issio ion t to

Food

• odbor
• rne Disea

ease O e Outbrea eak Survei eillance S e System em

Reports National database at CDC Public health epidemiologists

Quan antity an and Qual ality o

• f Outbreak

ak Data a is K Key to Getting Good Estimates

• f
• f Food
• odbor
• rne Illness Sou
• urce Attribution
• n

 Outbreak

eak d det etec ection an and inves estigation is j just one p e par art of the e proces

• ess. Outbreak

eak reporting ng is essential to docu cument

• food source
• agent
• contributing factors
• setting
• severity

Quan antity an and Qual ality o

• f Outbreak

ak Data a is K Key to Getting Good Estimates

• f
• f Food
• odbor
• rne Illness Sou
• urce Attribution
• n

 Analyses o

• f man

any outbreak eak inves estigations ar are e need eeded ed to s

• show t

that particular food

• od-pathogen

en pai airs ar are e important causes of illn illness

 Ther

eref efore, to es estimate e food

• odbor
• rne i

illness source attribution from outbreaks, we need eed

• capacity in state and local health depts

to report investigated outbreaks,

• a CDC quality assurance team
• a CDC IT team
• a CDC analytics team

Inves estigated ed O Outbrea eak Data: From

• m Good
• od to
• Great

 Surveilla

illance of in investig igated outbreaks is is u uniq ique

 A peek

eek beh ehind the e scen enes es

 Estimation

• n of
• f food
• odbor
• rne illness source attribution
• n

 Extracting the data --

• - mak

aking es estimates need eeded ed for policy

Investigated outbreak data source: F

• odborne Disease Outbreak S

urveillance S ystem (FDOS S )

Foodborne illn llness source a attribu butio ion is is estim imatio ion, and nd e estimation n ha has challenges

The US E Econ

• nom
• my

“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

The US S Econ

• nom
• my:

Somet etimes es mea easuring w what has alrea eady occurred ed is a Sisyphean task

The q e quar arter erly GDP ( (gross domestic product) gr growth h rate i is pub ublishe hed and revised 7 t times “When you’re building forecasts

• n a baseline that’s shifting,

it can be very, very difficult.”

S teve Landefeld, Director, Bureau of E conomic Analysis

A W Way to Think about Foodborne Illn llness Source A Attrib ibution Estim imates

• Like o

e other er es estimates es, food

• odbor
• rne illness s

source attribution es estimates es will be t e the b e bes est we h e have e bas ased ed on data a avai ailab able e now

• Could differ

eren ent met ethods f for extrac acting d data a give e differ eren ent res esults? Y es, and this can help to identify the best method

• Should we

e expec ect es estimates es to be e revised? Y es, as data and methods improve, estimates should be revised

• Why r

revise estimates? Because we want to use the best data and the best methods to inform decision-making

Inves estigated ed O Outbrea eak Data: From

• m Good
• od to
• Great
• Surveilla

illance of in investig igated outbreaks is is u uniq ique

• A peek

eek beh ehind the e scen enes es

• Estimation
• n of
• f food
• odbor
• rne illness source attribution
• n
• Extracting the data --
• - mak

aking es estimates need eeded ed for policy

Investigated outbreak data source: F

• odborne Disease Outbreak S

urveillance S ystem (FDOS S )

Inves estigated ed O Outbrea eak Data ar are E Extrac acted an and S Shar ared i in Man any Ways

• Foodborne

e Outbreak eak Online e Datab abas ase e (FOOD)

• Res

esponses es to data a req eques ests

• Scie

ientif ific ic a artic icle les

• MMW

MMWR reports

Inves estigated ed O Outbrea eak Data ar are E Extrac acted an and S Shar ared i in Man any Ways

• Foodborne

e Outbreak eak Online e Datab abas ase e (FOOD)

• Res

esponses es to data a req eques ests

• Scie

ientif ific ic a artic icle les

• MMW

MMWR reports

http://wwwn.cdc.gov/foodborneoutbreaks/

Foodborne Outbr break Onlin ine Database ( (FOOD)

FOOD is G Get etting B Bet etter er

• 2009

2009 data was available August 2011 2011

• 2010 data will

ill be availa ilable mid id-2012 2012

• Enhan

ancem emen ents b bas ased ed on u user er f feed eedbac ack

• 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

ed F FAQ an and web ebsite i e in 2011

Inves estigated ed O Outbrea eak Data ar are E Extrac acted an and S Shar ared i in Man any Ways

• Foodborne

e Outbreak eak Online e Datab abas ase e (FOOD)

• Res

esponses es to data a req eques ests

• Scie

ientif ific ic a artic icle les

• MMW

MMWR reports

• annual
• cumulative

Investigated outbreaks State and local reporting groups (>50) Investigated outbreaks CDC IT group Investigated outbreaks CDC QA group Investigated outbreaks CDC analysis group

Inves estigated ed O Outbrea eak Data: From

• m Good
• od to
• Great
• Surveilla

illance of in investig igated outbreaks is is u uniq ique

• A peek

eek beh ehind the e scen enes es

• Estimation
• n of
• f f

food

• od bor
• rne i

illness sou

• urce a

attribution

• Extracting the data --
• - mak

aking es estimates need eeded ed for policy

Investigated outbreak data source: F

• odborne Disease Outbreak S

urveillance S ystem (FDOS S )

The F arm (2000) by Alexis Rockman 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 P revention Thank you