Transcript Slide 1

CIFOR
Council to Improve Foodborne
Outbreak Response
CIFOR Guidelines
and
CIFOR Toolkit
Donald J. Sharp, MD, DTM&H
Food Safety Office
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control, Atlanta
CIFOR: History and Structure
• 2005 – Organizational discussions
• 2006 – First full meeting and first projects
identified
• Structure
– Council (AFDO, APHL, ASTHO, CSTE, NACCHO,
NASDA, NEHA, FSIS, FDA and CDC)
– Workgroups for identified projects
• Co-Chaired by CSTE/NACCHO
CIFOR: Purpose
To improve detection, investigation,
control, reporting, and prevention of
outbreaks of foodborne illnesses at the
local, state, and federal levels
CIFOR: Process
• Systems approach used to identify and
prioritize barriers in the foodborne outbreak
detection, investigation, control, prevention
system
• Workgroups are formed to develop projects
that address the barriers
• Funding identified (CDC: projects, FDA:
workgroup meetings)
CIFOR
Guidelines for Foodborne
Disease Outbreak Response
Released July, 2009
Guidelines Development
• Experts from local, state and federal agencies
• Epidemiology, environmental health, laboratory
science and communications
• Workgroup wrote major chapters
• Coordinated by technical advisors and lead author
• Key informant interviews, technical experts, external
reviewers and a public comment
Guidelines Purpose
Provides model recommendations
• Target local and state agencies, high or low
capacity
• Cover preparation, detection, investigation,
control and follow-up
• Provide all agencies a common foundation
• Describe the roles of all key organizations
Guidelines Chapters
• Overview
• Fundamental Concepts of Public Health Surveillance
and Foodborne Disease
• Planning and Preparation
• Foodborne Disease Surveillance and Outbreak
Detection
• Investigation of Clusters and Outbreaks
• Control Measures
• Special Considerations for Multijurisdictional
Outbreaks
• Performance Indicators
• Legal Preparedness for Surveillance and Control
Chapter 4:
“Foodborne Disease Surveillance
and Outbreak Detection”
•
•
•
•
•
Introduction
Overview
Pathogen-specific surveillance
Notification/complaint systems
Syndromic surveillance
• 20 pages in length
Guidelines Intended Usage
• Reference document that complements existing
procedures to:
– Fill gaps
– Update agency-specific procedures
– Create missing procedures
– Target training of program staff
• Not intended to replace current procedure manuals.
• Released in electronic and in hard-copy formats
• Distributed to state and local health departments.
Guidelines Implementation Barriers
• A multitude of recommendations—198 pages
• Recommendations require different resources
and have different levels of impact
• Recommendations include well-accepted
activities seen as effective in most settings
and “cutting edge” activities, evaluated only
in limited settings.
• Implementation of any recommendation
depends on careful consideration and a host
of factors.
TOOLKIT
CIFOR
Guidelines Toolkit
Released Feb 4, 2011
CIFOR Toolkit Purpose
A process (and supporting materials) to help
agencies and jurisdictions:
• Better understand their current foodborne
disease outbreak response activities
• Assess their needs for
improvement
• Identify appropriate
recommendations from the CIFOR
Guidelines
• Make plans to implement recommendations.
CIFOR Toolkit - Target Audience
• Interdisciplinary groups
that work together to respond
to outbreaks
• Agency staff focused on
specific elements of outbreak response
• Professional groups providing guidance or
training to their members
• Individuals (“champions”) who can get the
process started for an agency or
jurisdiction.
CIFOR Toolkit - Components
• Instructions for toolkit process
• Worksheets to record findings and decisions
• Sample worksheet pages completed for a
fictitious local health department
• Tips for facilitators
• A participant evaluation form
Response Activities Categorized
• “Tracks” and “Focus Areas”
• Smaller, bite-sized pieces of outbreak
response
• Cover most critical aspects of outbreak
investigation common to most jurisdictions
and outbreaks
• Allow systematic examination of activities
• Focus on most important areas
Tracks and Focus Areas
Planning and
preparation
Surveillance
and Outbreak
Detection
Investigation of
Clusters and
Outbreaks
• Relationships
• Notification/
• Initial steps
• Necessary
complaint
• Epidemiological
resources
systems
investigation
• Communication • Pathogen-specific • Environmental
surveillance
investigation
• Laboratory
investigation
Plus: Making changes
Control
Measures
• Control of
source
• Food recall
• Control of
secondary
spread
Toolkit “Keys to Success”
• Help explain what is in each Focus Area
• Consist of critical activities, relationships,
resources for each Focus Area
• If few Keys to Success are in place, should
consider prioritizing that Focus Area
Toolkit Steps and Worksheets
For each Focus Area:
1. Describe your current activities and
procedures compared to the Keys to Success
2. Prioritize CIFOR recommendations to
address needed improvements
3. Make plans to implement selected CIFOR
recommendations
TRACK: SURVEILLANCE AND OUTBREAK DETECTION
FOCUS AREA 5: PATHOGEN-SPECIFIC SURVEILLANCE
• FOCUS AREA GOAL: Agency receives reports from
health-care providers and laboratories on all cases of
disease when certain foodborne pathogens are identified
and obtains case information in a way that allows for
timely follow-up of patients and quick detection and
investigation of possible outbreaks.
• Step 1: Describe your current activities and
procedures in this focus area:
Considering the keys to success on the previous page,
describe your agency’s current activities and
procedures in this focus area. Indicate which might
need work to improve your agency’s response to
foodborne disease outbreaks.
TRACK: SURVEILLANCE AND OUTBREAK DETECTION
FOCUS AREA 5: PATHOGEN-SPECIFIC SURVEILLANCE
Step 2. Prioritize CIFOR recommendations to
address needed improvements
Having identified activities and procedures in need of
improvement, review the CIFOR recommendations related to this
Focus Area. Rate the priority for implementing each
recommendation based on its likely impact on foodborne outbreak
response at your agency and available resources.
TRACK: SURVEILLANCE AND OUTBREAK DETECTION
FOCUS AREA 5: PATHOGEN-SPECIFIC SURVEILLANCE
Step 3. Make plans to implement selected
CIFOR recommendations
For each CIFOR recommendation selected in the previous step,
identify who might take the lead in implementing the
recommendation and the timeframe for implementation. Consider
other factors that might influence the implementation of a
recommendation.
CIFOR Guidelines and Toolkit
• Download hardcopies from the CIFOR website
(www.cifor.us)
• Users can pick and choose which documents to
download
• Best to use online version with your team
• On line forms are “fill-able”
• Evaluation planned for next year
Thank you!!