Content Information
Introduction
The final step in an outbreak investigation is to provide written documentation of the events that occurred and the results of the investigation. Throughout the investigation, all participants should take careful and detailed notes, perhaps keeping a log. These notes will make the process of creating the written report much easier.
Purpose
Useful lessons from the outbreak can be learned if the documentation is complete and the data is statistically analyzed. Complete documentation is important for many reasons.
Disease Prevention and Control
The main purposes of an investigation are to prevent further disease and identify future actions that can be taken. Usually as a result of the outbreak, public health has identified areas that can be monitored or improved to reduce contamination by foodborne pathogens. The report can be used to disseminate these recommendations to prevent future outbreaks. By analyzing several years of data on foodborne disease outbreaks, public health can monitor trends in the prevalence of outbreaks caused by specific etiologic agents, food, and common errors in food handling. This information provides the basis for education to prevent disease.
Potential Legal Issues
Lawsuits are always a possibility when a foodborne outbreak occurs. It is important to have unbiased, accurate documentation of events.
A Record of Performance
The final report is an official documentation of the outbreak. It should sequentially and accurately document events and processes in the investigation. It may be used as a tool to aid public health in future outbreak investigations.
Report Creation and Distribution
The written report will follow a standard scientific format and includes an introduction, background, methods, results, conclusions, and recommendations section. An outbreak report template is included in this chapter with a detailed explanation of what each section should include. The Iowa Department of Public Health (IDPH) recommends following this format even when an investigation piece may be missing or incomplete. In each section follow the template directions and enter the information that is known or a short explanation why this section is incomplete.
It is also recommended that two final outbreak reports be created, one containing identifiable information and one in which all proper names have been removed. Proper names may include names of persons or information that may identify them, names of businesses or other such entities, county names, etc. The report containing identifiers is a legal document that should be kept internally and not released to the public without a subpoena. The report that has been stripped of identifying information can be released to anyone in the public or private domain who requests a copy. However, if a report is requested by name, i.e. “I want a report of the Smith outbreak”, the report cannot be released. Reports must be asked for in such a way that the outbreak is not identifiable. Contact the Attorney General office for more information.
Along with the final reports, the Center for Disease Control and Prevention’s (CDC) Investigation of a Foodborne Outbreak form, often referred to as the “fork and spoon” form, will need to be filled out. The preliminary “fork and spoon” form should be started at the beginning of the outbreak, and then finalized as part of the final report process. It is used by all states to report foodborne outbreaks to the CDC. Its information is entered into the CDC’s Electronic Foodborne Outbreak Reporting System (EFORS) by IDPH Center for Acute Disease Epidemiology (CADE) staff. The form is included in this chapter.
Authors
It is the responsibility of the principal investigator to integrate the three written investigation pieces (epidemiology, environmental, and laboratory) to produce the final outbreak investigation report. The principal investigator collaborates with the three primary investigation leads (epidemiology, environmental, and laboratory) within their areas of expertise. The leads should be responsible for writing their sections in the final report. The principal investigator may or may not be responsible for a specific piece (epidemiology, environmental, or laboratory), but should take part in managing the process, editing, and assembling of the final report. Anyone involved in the investigation may be asked to contribute to the final report writing.
It is important to remember that CADE epidemiological staff is available to provide assistance throughout the investigation process. CADE staff can address questions or problems with data analysis, help complete a fork and spoon reporting form, as well as to help with the final written report.
Deadlines
The final reports, along with the CDC Investigation of a Foodborne Outbreak form (“fork and spoon”) should be submitted to the IDPH Center for Acute Disease Epidemiology within 30 days of the date the outbreak occurred. This deadline is important because CADE is required to report in a timely fashion all foodborne outbreaks to the CDC through the Electronic Foodborne Outbreak Reporting System (EFORS). It is also beneficial to start the report as soon as possible because with time, recall of specific events begins to diminish and could affect the results and conclusions of the investigation.
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[sample template]
[sample reports]