WHO guidelines for investigation and control of Foodborne Diseases outbreak

Dr Christina Rundi

Ministry of Health Malaysia

Why is there a need for this guideline

bull The investigation and control of foodborne disease outbreaks are multi-disciplinary tasks

bull Skills required in the areas of clinical medicine epidemiology laboratory medicine food microbiology and chemistry food safety and food control and risk communication and management

bull Many outbreaks of foodborne disease are poorly investigated

Reasons these skills are unavailable or because field investigators are not adequately trained

Target groups

bull Public health practitionersbull Food and health inspectors bull District and national medical officers bull Laboratory personnel and bull others who may undertake or participate in the

investigation and control of foodborne disease outbreaks

Focus

bull Focuses on practical aspects of outbreak investigation and controlbull Field level

ndash Guide initial epidemiological environmental and laboratory investigations

ndash Implementation of appropriate control measures and ndash Alert investigators on the need to seek assistance for more

complex situations bull At national and regional levels

- Assist decision-makers in identifying and coordinating resources and in creating an environment appropriate for the successful management of foodborne disease outbreaks

bull Divided into six main sections

Section 1 Practical guide

Summarizes the steps in outbreak investigation (can be used as checklist)

1048729 Preliminary assessment of the situation

1048729 Communication

1048729 Descriptive epidemiology

1048729Food and environmental investigations

1048729 Analysis and interpretation

1048729 Control measures

1048729 Further studies

Section 2 Planning and preparation

21 General

22 Outbreak control team(OCT)

- when to form a OCT

- role of OCT

- composition of team

23 Record keeping

- what records should be kept

24 Communication

- share information with who what to share and why share

Section 3 Surveillance to detect foodborne disease outbreaks

31 Introduction

32 Definitions

- surveillance foodborne disease foodborne disease outbreak sporadic cases clusteroutbreakepidemic

33 Data sources

- source of data for detecting foodborne disease outbreak

34 Interpreting data sources

- how to interpret data from sources

Section 4 Investigation of foodborne disease outbreaks

41 General

42 Epidemiological investigations

- preliminary assessment of the situation

- preliminary hypotheses and plan further action

- Descriptive epidemiological investigations ndash establish case definition identify case interview case collate data analyse data (include how to draw epidemic curve) calculate incubation period determine people at risk develop explanatory hypotheses analytical epidemiological (retrospective cohort and case control)

Section 4 Investigation of foodborne disease outbreaks

43 Environmental and food investigations

- Investigation of food establishments

- Investigation of a suspect food (interview food handlers draw flowchart of the operation conduct outbreak hazard analysis) food and environmental sampling

44 Laboratory investigations

- Microbiological analyses

- Chemical investigations

Section 5 Control measures

51 General

52 Control of source

- Closing food premises

- Removing implicated foods from the market (include communication with the public

- Modifying a food productionpreparation process

53 Control of transmission

- Public advice

- Exclusion of infected persons from work and school personal hygiene infection control protecting risk groups

54 End of outbreak - Review of outbreak outbreak report further studies

Section 6 Features of important foodborne diseases

61 Foodborne pathogens toxins and chemicals of public health importance

62 Major foodborne pathogens predominant clinical features

63 Major foodborne diseases epidemiology and methods of control and prevention

Annexes

1 Glossary

2 Outbreak control meeting draft agenda

minutes of last meeting outbreak update management of outbreak

3 Examples of outbreak investigation forms

Initial response form for disease outbreaks

Initial case report form

Line listing

4 Questionnaire design

5 Sample questionnaires

Annexes

6 Investigation report forms

Outline of outbreak investigation report

7 Statistics

calculating rates median statistical significance testing

8 Situations likely to contribute to foodborne disease outbreaks

9 Procedures and equipment for specimen collection

feces vomitus serum food and environmental specimens

10 The WHO Five Keys to Safer Food

8 Situations likely to contribute to foodborne disease outbreaks

10 The WHO Five Keys to Safer Food

• WHO guidelines for investigation and control of Foodborne Diseases outbreak
• Why is there a need for this guideline
• Target groups
• Focus
• Section 1 Practical guide
• Section 2 Planning and preparation
• Section 3 Surveillance to detect foodborne disease outbreaks
• Section 4 Investigation of foodborne disease outbreaks
• Slide 9
• Section 5 Control measures
• Section 6 Features of important foodborne diseases
• Annexes
• Slide 13
• Slide 14
• Slide 15

Why is there a need for this guideline

bull The investigation and control of foodborne disease outbreaks are multi-disciplinary tasks

bull Skills required in the areas of clinical medicine epidemiology laboratory medicine food microbiology and chemistry food safety and food control and risk communication and management

bull Many outbreaks of foodborne disease are poorly investigated

Reasons these skills are unavailable or because field investigators are not adequately trained

Target groups

bull Public health practitionersbull Food and health inspectors bull District and national medical officers bull Laboratory personnel and bull others who may undertake or participate in the

investigation and control of foodborne disease outbreaks

Focus

bull Focuses on practical aspects of outbreak investigation and controlbull Field level

ndash Guide initial epidemiological environmental and laboratory investigations

ndash Implementation of appropriate control measures and ndash Alert investigators on the need to seek assistance for more

complex situations bull At national and regional levels

- Assist decision-makers in identifying and coordinating resources and in creating an environment appropriate for the successful management of foodborne disease outbreaks

bull Divided into six main sections

Section 1 Practical guide

Summarizes the steps in outbreak investigation (can be used as checklist)

1048729 Preliminary assessment of the situation

1048729 Communication

1048729 Descriptive epidemiology

1048729Food and environmental investigations

1048729 Analysis and interpretation

1048729 Control measures

1048729 Further studies

Section 2 Planning and preparation

21 General

22 Outbreak control team(OCT)

- when to form a OCT

- role of OCT

- composition of team

23 Record keeping

- what records should be kept

24 Communication

- share information with who what to share and why share

Section 3 Surveillance to detect foodborne disease outbreaks

31 Introduction

32 Definitions

- surveillance foodborne disease foodborne disease outbreak sporadic cases clusteroutbreakepidemic

33 Data sources

- source of data for detecting foodborne disease outbreak

34 Interpreting data sources

- how to interpret data from sources

Section 4 Investigation of foodborne disease outbreaks

41 General

42 Epidemiological investigations

- preliminary assessment of the situation

- preliminary hypotheses and plan further action

- Descriptive epidemiological investigations ndash establish case definition identify case interview case collate data analyse data (include how to draw epidemic curve) calculate incubation period determine people at risk develop explanatory hypotheses analytical epidemiological (retrospective cohort and case control)

Section 4 Investigation of foodborne disease outbreaks

43 Environmental and food investigations

- Investigation of food establishments

- Investigation of a suspect food (interview food handlers draw flowchart of the operation conduct outbreak hazard analysis) food and environmental sampling

44 Laboratory investigations

- Microbiological analyses

- Chemical investigations

Section 5 Control measures

51 General

52 Control of source

- Closing food premises

- Removing implicated foods from the market (include communication with the public

- Modifying a food productionpreparation process

53 Control of transmission

- Public advice

- Exclusion of infected persons from work and school personal hygiene infection control protecting risk groups

54 End of outbreak - Review of outbreak outbreak report further studies

Section 6 Features of important foodborne diseases

61 Foodborne pathogens toxins and chemicals of public health importance

62 Major foodborne pathogens predominant clinical features

63 Major foodborne diseases epidemiology and methods of control and prevention

Annexes

1 Glossary

2 Outbreak control meeting draft agenda

minutes of last meeting outbreak update management of outbreak

3 Examples of outbreak investigation forms

Initial response form for disease outbreaks

Initial case report form

Line listing

4 Questionnaire design

5 Sample questionnaires

Annexes

6 Investigation report forms

Outline of outbreak investigation report

7 Statistics

calculating rates median statistical significance testing

8 Situations likely to contribute to foodborne disease outbreaks

9 Procedures and equipment for specimen collection

feces vomitus serum food and environmental specimens

10 The WHO Five Keys to Safer Food

8 Situations likely to contribute to foodborne disease outbreaks

10 The WHO Five Keys to Safer Food

• WHO guidelines for investigation and control of Foodborne Diseases outbreak
• Why is there a need for this guideline
• Target groups
• Focus
• Section 1 Practical guide
• Section 2 Planning and preparation
• Section 3 Surveillance to detect foodborne disease outbreaks
• Section 4 Investigation of foodborne disease outbreaks
• Slide 9
• Section 5 Control measures
• Section 6 Features of important foodborne diseases
• Annexes
• Slide 13
• Slide 14
• Slide 15

Target groups

bull Public health practitionersbull Food and health inspectors bull District and national medical officers bull Laboratory personnel and bull others who may undertake or participate in the

investigation and control of foodborne disease outbreaks

Focus

bull Focuses on practical aspects of outbreak investigation and controlbull Field level

ndash Guide initial epidemiological environmental and laboratory investigations

ndash Implementation of appropriate control measures and ndash Alert investigators on the need to seek assistance for more

complex situations bull At national and regional levels

- Assist decision-makers in identifying and coordinating resources and in creating an environment appropriate for the successful management of foodborne disease outbreaks

bull Divided into six main sections

Section 1 Practical guide

Summarizes the steps in outbreak investigation (can be used as checklist)

1048729 Preliminary assessment of the situation

1048729 Communication

1048729 Descriptive epidemiology

1048729Food and environmental investigations

1048729 Analysis and interpretation

1048729 Control measures

1048729 Further studies

Section 2 Planning and preparation

21 General

22 Outbreak control team(OCT)

- when to form a OCT

- role of OCT

- composition of team

23 Record keeping

- what records should be kept

24 Communication

- share information with who what to share and why share

Section 3 Surveillance to detect foodborne disease outbreaks

31 Introduction

32 Definitions

- surveillance foodborne disease foodborne disease outbreak sporadic cases clusteroutbreakepidemic

33 Data sources

- source of data for detecting foodborne disease outbreak

34 Interpreting data sources

- how to interpret data from sources

Section 4 Investigation of foodborne disease outbreaks

41 General

42 Epidemiological investigations

- preliminary assessment of the situation

- preliminary hypotheses and plan further action

- Descriptive epidemiological investigations ndash establish case definition identify case interview case collate data analyse data (include how to draw epidemic curve) calculate incubation period determine people at risk develop explanatory hypotheses analytical epidemiological (retrospective cohort and case control)

Section 4 Investigation of foodborne disease outbreaks

43 Environmental and food investigations

- Investigation of food establishments

- Investigation of a suspect food (interview food handlers draw flowchart of the operation conduct outbreak hazard analysis) food and environmental sampling

44 Laboratory investigations

- Microbiological analyses

- Chemical investigations

Section 5 Control measures

51 General

52 Control of source

- Closing food premises

- Removing implicated foods from the market (include communication with the public

- Modifying a food productionpreparation process

53 Control of transmission

- Public advice

- Exclusion of infected persons from work and school personal hygiene infection control protecting risk groups

54 End of outbreak - Review of outbreak outbreak report further studies

Section 6 Features of important foodborne diseases

61 Foodborne pathogens toxins and chemicals of public health importance

62 Major foodborne pathogens predominant clinical features

63 Major foodborne diseases epidemiology and methods of control and prevention

Annexes

1 Glossary

2 Outbreak control meeting draft agenda

minutes of last meeting outbreak update management of outbreak

3 Examples of outbreak investigation forms

Initial response form for disease outbreaks

Initial case report form

Line listing

4 Questionnaire design

5 Sample questionnaires

Annexes

6 Investigation report forms

Outline of outbreak investigation report

7 Statistics

calculating rates median statistical significance testing

8 Situations likely to contribute to foodborne disease outbreaks

9 Procedures and equipment for specimen collection

feces vomitus serum food and environmental specimens

10 The WHO Five Keys to Safer Food

8 Situations likely to contribute to foodborne disease outbreaks

10 The WHO Five Keys to Safer Food

• WHO guidelines for investigation and control of Foodborne Diseases outbreak
• Why is there a need for this guideline
• Target groups
• Focus
• Section 1 Practical guide
• Section 2 Planning and preparation
• Section 3 Surveillance to detect foodborne disease outbreaks
• Section 4 Investigation of foodborne disease outbreaks
• Slide 9
• Section 5 Control measures
• Section 6 Features of important foodborne diseases
• Annexes
• Slide 13
• Slide 14
• Slide 15

Focus

bull Focuses on practical aspects of outbreak investigation and controlbull Field level

ndash Guide initial epidemiological environmental and laboratory investigations

ndash Implementation of appropriate control measures and ndash Alert investigators on the need to seek assistance for more

complex situations bull At national and regional levels

- Assist decision-makers in identifying and coordinating resources and in creating an environment appropriate for the successful management of foodborne disease outbreaks

bull Divided into six main sections

Section 1 Practical guide

Summarizes the steps in outbreak investigation (can be used as checklist)

1048729 Preliminary assessment of the situation

1048729 Communication

1048729 Descriptive epidemiology

1048729Food and environmental investigations

1048729 Analysis and interpretation

1048729 Control measures

1048729 Further studies

Section 2 Planning and preparation

21 General

22 Outbreak control team(OCT)

- when to form a OCT

- role of OCT

- composition of team

23 Record keeping

- what records should be kept

24 Communication

- share information with who what to share and why share

Section 3 Surveillance to detect foodborne disease outbreaks

31 Introduction

32 Definitions

- surveillance foodborne disease foodborne disease outbreak sporadic cases clusteroutbreakepidemic

33 Data sources

- source of data for detecting foodborne disease outbreak

34 Interpreting data sources

- how to interpret data from sources

Section 4 Investigation of foodborne disease outbreaks

41 General

42 Epidemiological investigations

- preliminary assessment of the situation

- preliminary hypotheses and plan further action

- Descriptive epidemiological investigations ndash establish case definition identify case interview case collate data analyse data (include how to draw epidemic curve) calculate incubation period determine people at risk develop explanatory hypotheses analytical epidemiological (retrospective cohort and case control)

Section 4 Investigation of foodborne disease outbreaks

43 Environmental and food investigations

- Investigation of food establishments

- Investigation of a suspect food (interview food handlers draw flowchart of the operation conduct outbreak hazard analysis) food and environmental sampling

44 Laboratory investigations

- Microbiological analyses

- Chemical investigations

Section 5 Control measures

51 General

52 Control of source

- Closing food premises

- Removing implicated foods from the market (include communication with the public

- Modifying a food productionpreparation process

53 Control of transmission

- Public advice

- Exclusion of infected persons from work and school personal hygiene infection control protecting risk groups

54 End of outbreak - Review of outbreak outbreak report further studies

Section 6 Features of important foodborne diseases

61 Foodborne pathogens toxins and chemicals of public health importance

62 Major foodborne pathogens predominant clinical features

63 Major foodborne diseases epidemiology and methods of control and prevention

Annexes

1 Glossary

2 Outbreak control meeting draft agenda

minutes of last meeting outbreak update management of outbreak

3 Examples of outbreak investigation forms

Initial response form for disease outbreaks

Initial case report form

Line listing

4 Questionnaire design

5 Sample questionnaires

Annexes

6 Investigation report forms

Outline of outbreak investigation report

7 Statistics

calculating rates median statistical significance testing

8 Situations likely to contribute to foodborne disease outbreaks

9 Procedures and equipment for specimen collection

feces vomitus serum food and environmental specimens

10 The WHO Five Keys to Safer Food

8 Situations likely to contribute to foodborne disease outbreaks

10 The WHO Five Keys to Safer Food

• WHO guidelines for investigation and control of Foodborne Diseases outbreak
• Why is there a need for this guideline
• Target groups
• Focus
• Section 1 Practical guide
• Section 2 Planning and preparation
• Section 3 Surveillance to detect foodborne disease outbreaks
• Section 4 Investigation of foodborne disease outbreaks
• Slide 9
• Section 5 Control measures
• Section 6 Features of important foodborne diseases
• Annexes
• Slide 13
• Slide 14
• Slide 15

Section 1 Practical guide

Summarizes the steps in outbreak investigation (can be used as checklist)

1048729 Preliminary assessment of the situation

1048729 Communication

1048729 Descriptive epidemiology

1048729Food and environmental investigations

1048729 Analysis and interpretation

1048729 Control measures

1048729 Further studies

Section 2 Planning and preparation

21 General

22 Outbreak control team(OCT)

- when to form a OCT

- role of OCT

- composition of team

23 Record keeping

- what records should be kept

24 Communication

- share information with who what to share and why share

Section 3 Surveillance to detect foodborne disease outbreaks

31 Introduction

32 Definitions

- surveillance foodborne disease foodborne disease outbreak sporadic cases clusteroutbreakepidemic

33 Data sources

- source of data for detecting foodborne disease outbreak

34 Interpreting data sources

- how to interpret data from sources

Section 4 Investigation of foodborne disease outbreaks

41 General

42 Epidemiological investigations

- preliminary assessment of the situation

- preliminary hypotheses and plan further action

- Descriptive epidemiological investigations ndash establish case definition identify case interview case collate data analyse data (include how to draw epidemic curve) calculate incubation period determine people at risk develop explanatory hypotheses analytical epidemiological (retrospective cohort and case control)

Section 4 Investigation of foodborne disease outbreaks

43 Environmental and food investigations

- Investigation of food establishments

- Investigation of a suspect food (interview food handlers draw flowchart of the operation conduct outbreak hazard analysis) food and environmental sampling

44 Laboratory investigations

- Microbiological analyses

- Chemical investigations

Section 5 Control measures

51 General

52 Control of source

- Closing food premises

- Removing implicated foods from the market (include communication with the public

- Modifying a food productionpreparation process

53 Control of transmission

- Public advice

- Exclusion of infected persons from work and school personal hygiene infection control protecting risk groups

54 End of outbreak - Review of outbreak outbreak report further studies

Section 6 Features of important foodborne diseases

61 Foodborne pathogens toxins and chemicals of public health importance

62 Major foodborne pathogens predominant clinical features

63 Major foodborne diseases epidemiology and methods of control and prevention

Annexes

1 Glossary

2 Outbreak control meeting draft agenda

minutes of last meeting outbreak update management of outbreak

3 Examples of outbreak investigation forms

Initial response form for disease outbreaks

Initial case report form

Line listing

4 Questionnaire design

5 Sample questionnaires

Annexes

6 Investigation report forms

Outline of outbreak investigation report

7 Statistics

calculating rates median statistical significance testing

8 Situations likely to contribute to foodborne disease outbreaks

9 Procedures and equipment for specimen collection

feces vomitus serum food and environmental specimens

10 The WHO Five Keys to Safer Food

8 Situations likely to contribute to foodborne disease outbreaks

10 The WHO Five Keys to Safer Food

• WHO guidelines for investigation and control of Foodborne Diseases outbreak
• Why is there a need for this guideline
• Target groups
• Focus
• Section 1 Practical guide
• Section 2 Planning and preparation
• Section 3 Surveillance to detect foodborne disease outbreaks
• Section 4 Investigation of foodborne disease outbreaks
• Slide 9
• Section 5 Control measures
• Section 6 Features of important foodborne diseases
• Annexes
• Slide 13
• Slide 14
• Slide 15

Section 2 Planning and preparation

21 General

22 Outbreak control team(OCT)

- when to form a OCT

- role of OCT

- composition of team

23 Record keeping

- what records should be kept

24 Communication

- share information with who what to share and why share

Section 3 Surveillance to detect foodborne disease outbreaks

31 Introduction

32 Definitions

- surveillance foodborne disease foodborne disease outbreak sporadic cases clusteroutbreakepidemic

33 Data sources

- source of data for detecting foodborne disease outbreak

34 Interpreting data sources

- how to interpret data from sources

Section 4 Investigation of foodborne disease outbreaks

41 General

42 Epidemiological investigations

- preliminary assessment of the situation

- preliminary hypotheses and plan further action

- Descriptive epidemiological investigations ndash establish case definition identify case interview case collate data analyse data (include how to draw epidemic curve) calculate incubation period determine people at risk develop explanatory hypotheses analytical epidemiological (retrospective cohort and case control)

Section 4 Investigation of foodborne disease outbreaks

43 Environmental and food investigations

- Investigation of food establishments

- Investigation of a suspect food (interview food handlers draw flowchart of the operation conduct outbreak hazard analysis) food and environmental sampling

44 Laboratory investigations

- Microbiological analyses

- Chemical investigations

Section 5 Control measures

51 General

52 Control of source

- Closing food premises

- Removing implicated foods from the market (include communication with the public

- Modifying a food productionpreparation process

53 Control of transmission

- Public advice

- Exclusion of infected persons from work and school personal hygiene infection control protecting risk groups

54 End of outbreak - Review of outbreak outbreak report further studies

Section 6 Features of important foodborne diseases

61 Foodborne pathogens toxins and chemicals of public health importance

62 Major foodborne pathogens predominant clinical features

63 Major foodborne diseases epidemiology and methods of control and prevention

Annexes

1 Glossary

2 Outbreak control meeting draft agenda

minutes of last meeting outbreak update management of outbreak

3 Examples of outbreak investigation forms

Initial response form for disease outbreaks

Initial case report form

Line listing

4 Questionnaire design

5 Sample questionnaires

Annexes

6 Investigation report forms

Outline of outbreak investigation report

7 Statistics

calculating rates median statistical significance testing

8 Situations likely to contribute to foodborne disease outbreaks

9 Procedures and equipment for specimen collection

feces vomitus serum food and environmental specimens

10 The WHO Five Keys to Safer Food

8 Situations likely to contribute to foodborne disease outbreaks

10 The WHO Five Keys to Safer Food

• WHO guidelines for investigation and control of Foodborne Diseases outbreak
• Why is there a need for this guideline
• Target groups
• Focus
• Section 1 Practical guide
• Section 2 Planning and preparation
• Section 3 Surveillance to detect foodborne disease outbreaks
• Section 4 Investigation of foodborne disease outbreaks
• Slide 9
• Section 5 Control measures
• Section 6 Features of important foodborne diseases
• Annexes
• Slide 13
• Slide 14
• Slide 15

Section 3 Surveillance to detect foodborne disease outbreaks

31 Introduction

32 Definitions

- surveillance foodborne disease foodborne disease outbreak sporadic cases clusteroutbreakepidemic

33 Data sources

- source of data for detecting foodborne disease outbreak

34 Interpreting data sources

- how to interpret data from sources

Section 4 Investigation of foodborne disease outbreaks

41 General

42 Epidemiological investigations

- preliminary assessment of the situation

- preliminary hypotheses and plan further action

- Descriptive epidemiological investigations ndash establish case definition identify case interview case collate data analyse data (include how to draw epidemic curve) calculate incubation period determine people at risk develop explanatory hypotheses analytical epidemiological (retrospective cohort and case control)

Section 4 Investigation of foodborne disease outbreaks

43 Environmental and food investigations

- Investigation of food establishments

- Investigation of a suspect food (interview food handlers draw flowchart of the operation conduct outbreak hazard analysis) food and environmental sampling

44 Laboratory investigations

- Microbiological analyses

- Chemical investigations

Section 5 Control measures

51 General

52 Control of source

- Closing food premises

- Removing implicated foods from the market (include communication with the public

- Modifying a food productionpreparation process

53 Control of transmission

- Public advice

- Exclusion of infected persons from work and school personal hygiene infection control protecting risk groups

54 End of outbreak - Review of outbreak outbreak report further studies

Section 6 Features of important foodborne diseases

61 Foodborne pathogens toxins and chemicals of public health importance

62 Major foodborne pathogens predominant clinical features

63 Major foodborne diseases epidemiology and methods of control and prevention

Annexes

1 Glossary

2 Outbreak control meeting draft agenda

minutes of last meeting outbreak update management of outbreak

3 Examples of outbreak investigation forms

Initial response form for disease outbreaks

Initial case report form

Line listing

4 Questionnaire design

5 Sample questionnaires

Annexes

6 Investigation report forms

Outline of outbreak investigation report

7 Statistics

calculating rates median statistical significance testing

8 Situations likely to contribute to foodborne disease outbreaks

9 Procedures and equipment for specimen collection

feces vomitus serum food and environmental specimens

10 The WHO Five Keys to Safer Food

8 Situations likely to contribute to foodborne disease outbreaks

10 The WHO Five Keys to Safer Food

• WHO guidelines for investigation and control of Foodborne Diseases outbreak
• Why is there a need for this guideline
• Target groups
• Focus
• Section 1 Practical guide
• Section 2 Planning and preparation
• Section 3 Surveillance to detect foodborne disease outbreaks
• Section 4 Investigation of foodborne disease outbreaks
• Slide 9
• Section 5 Control measures
• Section 6 Features of important foodborne diseases
• Annexes
• Slide 13
• Slide 14
• Slide 15

Section 4 Investigation of foodborne disease outbreaks

41 General

42 Epidemiological investigations

- preliminary assessment of the situation

- preliminary hypotheses and plan further action

- Descriptive epidemiological investigations ndash establish case definition identify case interview case collate data analyse data (include how to draw epidemic curve) calculate incubation period determine people at risk develop explanatory hypotheses analytical epidemiological (retrospective cohort and case control)

Section 4 Investigation of foodborne disease outbreaks

43 Environmental and food investigations

- Investigation of food establishments

- Investigation of a suspect food (interview food handlers draw flowchart of the operation conduct outbreak hazard analysis) food and environmental sampling

44 Laboratory investigations

- Microbiological analyses

- Chemical investigations

Section 5 Control measures

51 General

52 Control of source

- Closing food premises

- Removing implicated foods from the market (include communication with the public

- Modifying a food productionpreparation process

53 Control of transmission

- Public advice

- Exclusion of infected persons from work and school personal hygiene infection control protecting risk groups

54 End of outbreak - Review of outbreak outbreak report further studies

Section 6 Features of important foodborne diseases

61 Foodborne pathogens toxins and chemicals of public health importance

62 Major foodborne pathogens predominant clinical features

63 Major foodborne diseases epidemiology and methods of control and prevention

Annexes

1 Glossary

2 Outbreak control meeting draft agenda

minutes of last meeting outbreak update management of outbreak

3 Examples of outbreak investigation forms

Initial response form for disease outbreaks

Initial case report form

Line listing

4 Questionnaire design

5 Sample questionnaires

Annexes

6 Investigation report forms

Outline of outbreak investigation report

7 Statistics

calculating rates median statistical significance testing

8 Situations likely to contribute to foodborne disease outbreaks

9 Procedures and equipment for specimen collection

feces vomitus serum food and environmental specimens

10 The WHO Five Keys to Safer Food

8 Situations likely to contribute to foodborne disease outbreaks

10 The WHO Five Keys to Safer Food

• WHO guidelines for investigation and control of Foodborne Diseases outbreak
• Why is there a need for this guideline
• Target groups
• Focus
• Section 1 Practical guide
• Section 2 Planning and preparation
• Section 3 Surveillance to detect foodborne disease outbreaks
• Section 4 Investigation of foodborne disease outbreaks
• Slide 9
• Section 5 Control measures
• Section 6 Features of important foodborne diseases
• Annexes
• Slide 13
• Slide 14
• Slide 15

Section 4 Investigation of foodborne disease outbreaks

43 Environmental and food investigations

- Investigation of food establishments

- Investigation of a suspect food (interview food handlers draw flowchart of the operation conduct outbreak hazard analysis) food and environmental sampling

44 Laboratory investigations

- Microbiological analyses

- Chemical investigations

Section 5 Control measures

51 General

52 Control of source

- Closing food premises

- Removing implicated foods from the market (include communication with the public

- Modifying a food productionpreparation process

53 Control of transmission

- Public advice

- Exclusion of infected persons from work and school personal hygiene infection control protecting risk groups

54 End of outbreak - Review of outbreak outbreak report further studies

Section 6 Features of important foodborne diseases

61 Foodborne pathogens toxins and chemicals of public health importance

62 Major foodborne pathogens predominant clinical features

63 Major foodborne diseases epidemiology and methods of control and prevention

Annexes

1 Glossary

2 Outbreak control meeting draft agenda

minutes of last meeting outbreak update management of outbreak

3 Examples of outbreak investigation forms

Initial response form for disease outbreaks

Initial case report form

Line listing

4 Questionnaire design

5 Sample questionnaires

Annexes

6 Investigation report forms

Outline of outbreak investigation report

7 Statistics

calculating rates median statistical significance testing

8 Situations likely to contribute to foodborne disease outbreaks

9 Procedures and equipment for specimen collection

feces vomitus serum food and environmental specimens

10 The WHO Five Keys to Safer Food

8 Situations likely to contribute to foodborne disease outbreaks

10 The WHO Five Keys to Safer Food

• WHO guidelines for investigation and control of Foodborne Diseases outbreak
• Why is there a need for this guideline
• Target groups
• Focus
• Section 1 Practical guide
• Section 2 Planning and preparation
• Section 3 Surveillance to detect foodborne disease outbreaks
• Section 4 Investigation of foodborne disease outbreaks
• Slide 9
• Section 5 Control measures
• Section 6 Features of important foodborne diseases
• Annexes
• Slide 13
• Slide 14
• Slide 15

Section 5 Control measures

51 General

52 Control of source

- Closing food premises

- Removing implicated foods from the market (include communication with the public

- Modifying a food productionpreparation process

53 Control of transmission

- Public advice

- Exclusion of infected persons from work and school personal hygiene infection control protecting risk groups

54 End of outbreak - Review of outbreak outbreak report further studies

Section 6 Features of important foodborne diseases

61 Foodborne pathogens toxins and chemicals of public health importance

62 Major foodborne pathogens predominant clinical features

63 Major foodborne diseases epidemiology and methods of control and prevention

Annexes

1 Glossary

2 Outbreak control meeting draft agenda

minutes of last meeting outbreak update management of outbreak

3 Examples of outbreak investigation forms

Initial response form for disease outbreaks

Initial case report form

Line listing

4 Questionnaire design

5 Sample questionnaires

Annexes

6 Investigation report forms

Outline of outbreak investigation report

7 Statistics

calculating rates median statistical significance testing

8 Situations likely to contribute to foodborne disease outbreaks

9 Procedures and equipment for specimen collection

feces vomitus serum food and environmental specimens

10 The WHO Five Keys to Safer Food

8 Situations likely to contribute to foodborne disease outbreaks

10 The WHO Five Keys to Safer Food

• WHO guidelines for investigation and control of Foodborne Diseases outbreak
• Why is there a need for this guideline
• Target groups
• Focus
• Section 1 Practical guide
• Section 2 Planning and preparation
• Section 3 Surveillance to detect foodborne disease outbreaks
• Section 4 Investigation of foodborne disease outbreaks
• Slide 9
• Section 5 Control measures
• Section 6 Features of important foodborne diseases
• Annexes
• Slide 13
• Slide 14
• Slide 15

Section 6 Features of important foodborne diseases

61 Foodborne pathogens toxins and chemicals of public health importance

62 Major foodborne pathogens predominant clinical features

63 Major foodborne diseases epidemiology and methods of control and prevention

Annexes

1 Glossary

2 Outbreak control meeting draft agenda

minutes of last meeting outbreak update management of outbreak

3 Examples of outbreak investigation forms

Initial response form for disease outbreaks

Initial case report form

Line listing

4 Questionnaire design

5 Sample questionnaires

Annexes

6 Investigation report forms

Outline of outbreak investigation report

7 Statistics

calculating rates median statistical significance testing

8 Situations likely to contribute to foodborne disease outbreaks

9 Procedures and equipment for specimen collection

feces vomitus serum food and environmental specimens

10 The WHO Five Keys to Safer Food

8 Situations likely to contribute to foodborne disease outbreaks

10 The WHO Five Keys to Safer Food

• WHO guidelines for investigation and control of Foodborne Diseases outbreak
• Why is there a need for this guideline
• Target groups
• Focus
• Section 1 Practical guide
• Section 2 Planning and preparation
• Section 3 Surveillance to detect foodborne disease outbreaks
• Section 4 Investigation of foodborne disease outbreaks
• Slide 9
• Section 5 Control measures
• Section 6 Features of important foodborne diseases
• Annexes
• Slide 13
• Slide 14
• Slide 15

Annexes

1 Glossary

2 Outbreak control meeting draft agenda

minutes of last meeting outbreak update management of outbreak

3 Examples of outbreak investigation forms

Initial response form for disease outbreaks

Initial case report form

Line listing

4 Questionnaire design

5 Sample questionnaires

Annexes

6 Investigation report forms

Outline of outbreak investigation report

7 Statistics

calculating rates median statistical significance testing

8 Situations likely to contribute to foodborne disease outbreaks

9 Procedures and equipment for specimen collection

feces vomitus serum food and environmental specimens

10 The WHO Five Keys to Safer Food

8 Situations likely to contribute to foodborne disease outbreaks

10 The WHO Five Keys to Safer Food

• WHO guidelines for investigation and control of Foodborne Diseases outbreak
• Why is there a need for this guideline
• Target groups
• Focus
• Section 1 Practical guide
• Section 2 Planning and preparation
• Section 3 Surveillance to detect foodborne disease outbreaks
• Section 4 Investigation of foodborne disease outbreaks
• Slide 9
• Section 5 Control measures
• Section 6 Features of important foodborne diseases
• Annexes
• Slide 13
• Slide 14
• Slide 15

Annexes

6 Investigation report forms

Outline of outbreak investigation report

7 Statistics

calculating rates median statistical significance testing

8 Situations likely to contribute to foodborne disease outbreaks

9 Procedures and equipment for specimen collection

feces vomitus serum food and environmental specimens

10 The WHO Five Keys to Safer Food

8 Situations likely to contribute to foodborne disease outbreaks

10 The WHO Five Keys to Safer Food

• WHO guidelines for investigation and control of Foodborne Diseases outbreak
• Why is there a need for this guideline
• Target groups
• Focus
• Section 1 Practical guide
• Section 2 Planning and preparation
• Section 3 Surveillance to detect foodborne disease outbreaks
• Section 4 Investigation of foodborne disease outbreaks
• Slide 9
• Section 5 Control measures
• Section 6 Features of important foodborne diseases
• Annexes
• Slide 13
• Slide 14
• Slide 15

8 Situations likely to contribute to foodborne disease outbreaks

10 The WHO Five Keys to Safer Food

• WHO guidelines for investigation and control of Foodborne Diseases outbreak
• Why is there a need for this guideline
• Target groups
• Focus
• Section 1 Practical guide
• Section 2 Planning and preparation
• Section 3 Surveillance to detect foodborne disease outbreaks
• Section 4 Investigation of foodborne disease outbreaks
• Slide 9
• Section 5 Control measures
• Section 6 Features of important foodborne diseases
• Annexes
• Slide 13
• Slide 14
• Slide 15

10 The WHO Five Keys to Safer Food

• WHO guidelines for investigation and control of Foodborne Diseases outbreak
• Why is there a need for this guideline
• Target groups
• Focus
• Section 1 Practical guide
• Section 2 Planning and preparation
• Section 3 Surveillance to detect foodborne disease outbreaks
• Section 4 Investigation of foodborne disease outbreaks
• Slide 9
• Section 5 Control measures
• Section 6 Features of important foodborne diseases
• Annexes
• Slide 13
• Slide 14
• Slide 15