Roles & Responsibilities

Table of Contents

Understanding Roles and Responsibilities

  1. Describing roles and responsibilities of agencies involved in a foodborne outbreak investigation
  2. Providing contact information for agencies involved in a foodborne outbreak investigation

Introduction

In Iowa, investigation of an outbreak of foodborne illness is a multi-departmental team effort.  Each department plays an essential role in the control and prevention of foodborne illness.  A crucial step in conducting a complete investigation includes the collaboration of epidemiologists, environmental health officials, and laboratorians. All three disciplines should be involved in a foodborne outbreak investigation. In addition each discipline should have an understanding of others’ roles and responsibilities.

Due to the number of partners that may be involved in a foodborne outbreak investigation, ongoing communication is critical to keep everyone informed and organized. The nature, scope, and cause of the outbreak will help determine the need for, and extent of, communication.  Numerous agencies, including those at the federal, state, and local level, may be involved.  If an outbreak is widespread or severe, the state agencies (i.e., Iowa Department of Public Health (IDPH)) will notify the federal (i.e., Centers for Disease Control and Prevention (CDC)) as well as other appropriate state health agencies. The roles of the food worker, food-establishment licensee, and the healthcare provider should also be considered, as they can contribute to the cause, prevention, or the detection of an outbreak.

See below for more details concerning several local and state agency roles. It is important to remember that many area experts, not included, may be able to provide technical expertise and could be called to assist (i.e. state toxicologist, state medical examiner, or an infectious disease physician). 

Investigation Roles

Epidemiological Investigator Lead

  • The role of the principal investigator should be filled by an experienced epidemiologist.

  • Coordinates overall epidemiological processes, including the identification of team members, regular team communications, development of the investigation steps, statistical analysis, and the steps needed to move the outbreak investigation to conclusion.

  • Provides outbreak management expertise to the investigation.

  • Establishes expectations of each discipline (epidemiological, laboratory, environmental) to each discipline lead.

  • Establishes and maintains communication with contacts for each discipline.

  • Ensures the development and implementation of prevention and control measures.

  • Manages media messages with appropriate PIO assistance.

  • Conducts meetings/discussions to establish sequence of events leading to the illness, reviews findings of each investigation discipline, and discuss further investigation steps.

  • Requests written submissions from each discipline to produce the outbreak report.
  • Provides editorial functions to produce the preliminary and final reports, and ensures a collective agreement to the contents and recommendations of the report prior to finalizing and submission to IDPH as a permanent record of the outbreak.
  • Collects, enters and performs statistical analyses of collected data.
  • Develops a de-identified version of the outbreak report.
  • Completes Investigation of a Foodborne Outbreak (Fork and Spoon) form.
  • Submits outbreak report, de-identified version, and Investigation of a Foodborne Outbreak to IDPH CADE.

Environmental Investigation Lead

  • The environmental health specialist responsible for areas such as the food and water inspections within the affected jurisdiction should fill the role of the environmental investigation lead.
  • Coordinates and/or conducts environmental investigation including but not limited to the standard facility inspection process.
  • Communicates with the principal investigator to coordinate the environmental investigation, report findings, and to inform of any prevention and control measures implemented.

  • Participates in meetings and/or discussions to establish the sequence of events leading to the illness, reviews findings of each investigation discipline, and implements any additional steps needed to finalize the environmental investigation.

  • Prepares and submits an environmental investigation report to the principal investigator in a timely manner for development of the outbreak report.

  • Reviews the complete outbreak report for accuracy and agrees to the content prior to finalizing the report and submission to IDPH CADE as a permanent record.

Laboratory Investigation Lead

  • A representative of the University of Iowa Hygienic Laboratory should fill the role of the laboratory investigation lead.

  • Coordinates and/or conducts the laboratory investigation including steps to ensure that all necessary lab samples (human, environmental, water and food samples) are collected quickly and appropriately.
  • Communicates with the principal investigator to coordinate the laboratory investigation.
  • Establishes and maintains communications with the principal investigator.
  • Participates in meetings/discussions to establish the sequence of events leading to the illness and review the findings of each investigation discipline.
  • Prepares and submits the laboratory investigation report to the principal investigator in a timely manner for development of the outbreak report. Reviews the outbreak report for accuracy and agrees to the content prior to submission to IDPH CADE.

Local Agency Roles

Local Public Health

In most instances, the local public health communicable disease practitioner and environmental health specialist partner with IPDH epidemiological staff in a foodborne outbreak investigation.  In an investigation local public health typically:    

  • Receives and assesses foodborne illness complaints.

  • Participates in the team processes that identifies the cause of the outbreak, collects data, and formulates and tests hypotheses. 
  • Interviews and assesses cases on possible exposures, sources, symptoms, and personal hygiene practices. 
  • Educates the community on disease processes, treatment, modes of transmission, means of prevention, and ensures implementation of control measures.
  • Delivers environmental inspections, including food safety inspections.
  • Manages local media, coordinating the message with investigation team members.
  • Collects and submits food, water, environmental and human samples for testing.
  • Participates in the final report writing.
  • Conducts interviews.  

State Agency Roles

Iowa Department of Public Health – Center for Acute Disease Epidemiology

  • Conducts passive surveillance for some enteric pathogens of foodborne disease and provides epidemiological leadership for foodborne-outbreak investigations.
  • Provides ongoing assessment processes to identify a foodborne outbreak.
  • Contacts and establishes a team to implement an epidemiologic investigation.
  • Provides outbreak management expertise.
  • Manages local media, coordinating the message with investigation team members, including local public health officials.
  • Works in conjunction with team members to define the framework for the epidemiological investigation process.
  • Ensures all three disciplines coordinate the steps to investigate foodborne outbreaks. 
  • Consults on disease processes, treatments, modes of transmission, and prevention and control measures.
  • Develops processes to statistically analyze data and factors involved in outbreaks.
  • Ensures that outbreaks are brought to conclusion.
  • Develops and distributes final reports, maintains a permanent record of the outbreak, reports statistics to the CDC, and responds to legal processes.

Iowa Department of Public Health – Division of Health Protection and Environmental Health

  • Does not take an active role in most foodborne-illness investigations.

  • Provides division updates on information and reports as appropriate on an informational basis only. 

  • Forwards information to local environmental health contacts in counties not directly involved in the investigation or follow-up, if needed. 

  • Acts as the primary contact for local environmental health officials (sanitarians) on non-foodborne issues. 

University Hygienic Laboratory

  • Conducts diagnostic testing and laboratory surveillance on patient specimens and foods for pathogens causing foodborne diseases.

  • Analyzes food specimens to detect, identify, and quantify toxic contaminants (e.g., pesticide residues, heavy metals, and volatile organic compounds).

  • Performs molecular strain typing of pathogens to assist in the epidemiologic investigation.

  • Provides information and educational steps for local public health and laboratory officials

  • Provides expert advice.

Iowa Department of Inspection and Appeals - Food and Consumer Safety Bureau

  • Administers and enforces the state's food code (Iowa Code Chapter 137F) by conducting inspections of food establishments (grocery stores, restaurants, convenience stores, mobile food units, vending machines, and temporary food stands), food processing plants and egg handlers. The code’s purpose is to "safeguard the public health and provide to consumers food that is safe, unadulterated and honestly presented."

  • Regulates food establishments and performs environmental investigations of establishments implicated in foodborne outbreaks. (Cities and county have the power to regulate and local ordinances may present)

  • Monitors and enforces code compliance.

  • As part of Iowa’s joint state and local inspection program, the department's 13 environmental specialists, who are state employees, cover 20 counties for retail inspections, and conduct food processing and egg handler inspections statewide. Inspectors from 30 local health agencies conduct retail food-safety inspections in 80 counties and five municipalities.

Iowa Department of Natural Resources (DNR) – Water Quality Bureau

  • Assesses, investigates, and problem solves in any water-related incident involving a public water supply.

  • Assists the epidemiological efforts of state and federal public health agencies through information sharing and cooperative investigations.

  • When DNR identifies an acute Maximum Contaminant Level (MCL) violation in a public water supply, they notify IDPH, Division of Health Protection and Environmental Health which then notifies local environmental/public health officials.

Iowa Department of Agriculture and Land Stewardship (IDALS)

  • Regulates meat, eggs, and dairy products.

  • Participates with federal and state inspection partners.

  • Assists the epidemiological efforts of state and federal public health agencies through information sharing and cooperative investigations.

  • IDALS has different roles based on where products are distributed, what the federal regulations are, and if is an interstate or foreign export. 

IDALS - Meat and Poultry Bureau

  • Assists the epidemiological efforts of state and federal public health agencies through information sharing and cooperative investigations.

  • Has statutory authority to investigate and initiate a detention of alleged adulterated/misbranded meat or poultry products in commerce.

  • May seek a court-authorized seizure and/or destruction of unsafe meat or poultry products and may request a voluntary company recall.

IDALS - Dairy Products Control Bureau

If the dairy foodborne outbreak was caused by a product produced in Iowa and distributed only in Iowa, the Diary Products Control Bureau:

  • Issues a stop-sale of the product, and notifies IDPH and the Food & Drug Administration (FDA).

  • Investigates the plant or dairy farm, collects samples of the product, and sends or delivers them to the appropriate laboratory for analysis.

  • Recalls the product and coordinates with the Iowa Department of Natural Resources on its proper disposition.

  • Assists the epidemiological efforts of state and federal public health agencies through information sharing and cooperative investigations

If the dairy-product outbreak was caused by a product involved in interstate commerce that was produced in Iowa, the Dairy Products Control Bureau:

  • Issues a stop-sale of the product and notifies IDPH and the FDA.

  • Investigates the plant or dairy farm, collects samples of the product, and sends or delivers them to the appropriate laboratory for analysis.

  • Uses the industry distribution channels, meaning the product would be recalled and the FDA would notify other state dairy regulatory agencies of its recall. The FDA would advise on the product’s proper disposition.

Federal Agency Roles

When an outbreak has been linked to a specific source or food item, the range of partners involved in controlling or distributing across state lines may expands to include other state and federal partners.  If an outbreak is caused by an imported food, the state departments work with the Food and Drug Administration (FDA) and/or the United States Department of Agriculture (USDA) to investigate and conduct product tracebacks. See below for more details on each federal agency’s role.  If the outbreak is linked to an act of bioterrorism or tampering, state law-enforcement agencies and the Federal Bureau of Investigation (FBI) are contacted. More on intentional contamination can be found in Appendix B.  

Centers for Disease Control and Prevention

  • Assumes the primary responsibility for outbreak management in a multi-state or international outbreak, most of the time.  This includes forming a multi-state team that works with state health departments and laboratories to identify and investigate the cause of the illness.   
  • Maintains a nationwide system of foodborne-disease surveillance, through the creation of an electronic system for such infections.
  • Works with other federal and state agencies to monitor rates and trends in foodborne-disease outbreaks. 
  • Develops state-of-the-art techniques for rapid identification of foodborne pathogens at the state and local levels.
  • Provides expert consultation to states.
  • Develops and maintains educational tools.
  • Develops year-to-year national statistical summaries.
  • Conducts research to help prevent foodborne illness.
  • Trains local and state food-safety personnel.

Protection of the nation's food supply is shared among the Food and Drug Administration (FDA), the Food Safety and Inspection Service of the U.S. Department of Agriculture (USDA) and the Environmental Protection Agency (EPA).

Food and Drug Administration (FDA)

  • Has primary jurisdiction over most foods sold in interstate commerce, with the exception of meat, poultry, and pasteurized processed egg products, which are regulated by the USDA.
  • Becomes involved in an outbreak investigation when surveillance identifies disease clusters or outbreaks and an FDA-regulated product is implicated.
  • Verifies the association of illness with a regulated product, aids in the identification of the source of the product and its extent of distribution, prevents any further exposure, and initiates regulatory action, if the outbreak investigation warrants.  
  • Coordinates a voluntary recall of FDA-regulated products that are linked to an outbreak, if needed.  
  • Develops model codes and ordinances, guidelines and interpretations and works with states to implement them in regulating milk and shellfish and retail food establishments, such as restaurants and grocery stores.

Food Safety and Inspection Service (FSIS) of the U.S. Department of Agriculture (USDA)

  • Has primary jurisdiction over meat, poultry, and pasteurized processed egg products. 
  • Has regulatory authority to coordinate a voluntary recall of meat, poultry and pasteurized processed egg products linked to outbreaks.
  • Assists local, state, and other federal agencies in investigations.
  • Assists in tracing the origin and distribution of meat, poultry, and pasteurized processed egg products.
  • Provides laboratory assistance to identify the contaminants in an implicated product.

U.S. Environmental Protection Agency

  • Oversees drinking water and maintains the capability to respond to drinking-water disease outbreaks.
  • Establishes safe drinking-water standards.
  • Regulates toxic substances and wastes to prevent their entry into the environment and food chain. 
  • Assists states in monitoring drinking water quality and finds ways to prevent contamination of drinking water.

Other Roles

Food worker

  • Maintains good personal hygiene, including frequent and thorough hand washing as outlined in the Iowa Food Code.
  • Practices proper food handling.
  • Notifies employers of illness as outlined in the Iowa Food Code.
  • Complies with restrictions or exclusions when ill to prevent foodborne illness as outlined in the Iowa Food Code.
  • Cooperates with local and state agencies in investigations of foodborne illness.

Food establishment licensee/person in charge of food establishment

  • Demonstrates to the Iowa Department of Inspection and Appeals knowledge of foodborne-disease prevention, application of the Hazard Analysis Critical Control Point principles, and requirements of the Iowa Food Code. 
  • Demonstrates knowledge through compliance with the Iowa Food Code, being a certified food-protection manager, or by responding correctly to the inspector’s questions on a specific food operation.
  • Ensures that employees are effectively cleaning their hands by routinely monitoring their hand washing and by providing adequate hand-washing facilities.
  • Trains employees and management on proper food handling and hand washing.
  • Excludes employees with apparent gastrointestinal illness or exposed skin lesions from work.
  • Avoids practices that punish or discourage employees from reporting illness.
  • Cooperates with local and state agencies during investigations of foodborne illness.

Health-care Providers

  • Reports to local and state public health departments by telephone upon recognition of a suspected foodborne outbreak or reportable illness.
  • Cooperates with public health in the investigation and control of an outbreak.
  • Collects clinical specimens.

Wise Person Group

  • Forms for a multi-state foodborne outbreak investigation, by the CDC, to provide consultation.
  • Consists of epidemiologists from unaffected states to provide an unbiased opinion to ensure the right actions are taken. 

References

http://www.astho.org/pubs/FS_Written_Analysis.pdf

“Multi-state Foodborne Outbreak Investigations,” national Food Safety System Project, Outbreak Coordination and Investigation Workgroup, February 2001.  http://www.fda.gov/ora/fed_state/NFSS/Outbreak_Coordination.pdf