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Improving inclusion and exclusion criteria in foodborne illness outbreak investigations: a case study

  • M. J. Firestone (a1), P. Lee (a1) and C. W. Hedberg (a1)

Abstract

The practice of foodborne illness outbreak investigations has evolved, shifting away from large-scale community case-control studies towards more focused case exposure assessments and sub-cluster investigations to identify contaminated food sources. Criteria to include or exclude cases are established to increase the efficiency of epidemiological analyses and traceback activities, but these criteria can also affect the investigator's ability to implicate a suspected food vehicle. A 2010 outbreak of Salmonella ser. Hvittingfoss infections associated with a chain of quick-service restaurants (Chain A) provided a useful case study on the impact of exclusion criteria on the ability to identify a food vehicle. In the original investigation, a case-control study of restaurant-associated cases and well meal companions was conducted at the ingredient level to identify a suspected food vehicle; however, 21% of cases and 22% of well meal companions were excluded for eating at Chain A restaurants more than once during the outbreak. The objective of this study was to explore how this decision affected the results of the outbreak investigation.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: M. J. Firestone, E-mail: fire0018@umn.edu

References

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1.Centers for Disease Control and Prevention (2019) Surveillance for Foodborne Disease Outbreaks, United States, 2017, Annual Report. Atlanta, GA: U.S. Department of Health and Human Services, CDC. Available online: https://www.cdc.gov/fdoss/pdf/2017_FoodBorneOutbreaks_508.pdf.
2.Centers for Disease Control and Prevention (2017) Foodborne Diseases Active Surveillance Network (FoodNet): FoodNet 2015 Surveillance Report (Final Data). Atlanta, GA: U.S. Department of Health and Human Services, CDC. Available online: https://www.cdc.gov/foodnet/reports/annual-reports-2015.html.
3.Centers for Disease Control and Prevention (2016) Investigating Outbreaks. Atlanta, GA: Centers for Disease Control and Prevention.
4.Dwyer, DM et al. (1994) Use of case-control studies in outbreak investigations. Epidemiologic Reviews 16, 109123.
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7.Illinois Department of Public Health (2010) Summary of S. ser Hvittingfoss Outbreak, April-June 2010. Springfield, IL: Illinois Department of Public Health.
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9.Flanders, A (2008) Economic Impact of Georgia Tomato Productions Value Losses Due to the US Salmonella Outbreak. Athens, GA: Center for Agribusiness & Economic Development. Available online: https://athenaeum.libs.uga.edu/handle/10724/18683.
10.Lee, P and Hedberg, CW (2016) Understanding the relationships between inspection results and risk of foodborne illness in restaurants. Foodborne Pathogens and Disease 13, 582586.
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Keywords

Improving inclusion and exclusion criteria in foodborne illness outbreak investigations: a case study

  • M. J. Firestone (a1), P. Lee (a1) and C. W. Hedberg (a1)

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