Common Issues When Investigating Outbreaks

Key takeaways

Outbreak investigators should conduct activities that are more likely to lead to finding outbreak contributing factors.

Investigators should visit restaurants early in investigations. Workers may be more likely to cooperate in the early stages.

Education programs may help restaurant customers learn about foodborne illness.

Doctors could learn more about foodborne illness diagnosis and investigation. The Centers for Disease Control and Prevention primer on foodborne illness could be a helpful tool.

The role of environmental health in outbreak investigations should be defined. This is needed before an outbreak so that epidemiology and environmental health programs can effectively work together. This could also help with problems posed by public health agencies (for example, lack of support from management).

Why this is important

Knowing the contributing factorsA to foodborne illness outbreaks is critical to stopping them. Environmental health specialists find contributing factors by investigating how and why outbreaks happened.

But these investigations often do not give enough information. This may be the result of ineffective investigation practices and problems faced during investigations. Thus, it is important to collect data that will describe investigation practices and problems.

What we learned

Environmental health specialists dealt with the following problems during foodborne illness outbreak investigations:

• Organizational problems such as lack of management support and training
• Uncooperative restaurant workers
• Uncooperative restaurant customers

Investigation practices

Some specialists said they did routine inspectionsB during outbreak investigations. But many said their visits to restaurants during outbreaks were different from their routine inspections. During an outbreak, they focused more on four activities. These activities are recommended by the Food and Drug Administration:

• Finding the food linked to the outbreak
• Learning how the food linked to the outbreak was handled
• Learning how foods linked with foodborne illness in general are handled
• Talking to workers to find those who might be ill

Many said they worked with epidemiologyC staff. How they worked together varied.

Finding contributing factors

Finding contributing factors was hard. Specialists were often not able to find them.

Many specialists said they focused more on learning the germs that caused the outbreak than on finding contributing factors.

Finding contributing factors often depended on finding the food and/or germ linked to the outbreak.

The germ, food, and contributing factors were found by:

• Looking at illness symptoms
• Carrying out epidemiologic analyses
• Doing restaurant investigations

Three things made it hard to find contributing factors:

• Turnover of restaurant workers
• Restaurant workers who did not cooperate
• Time lags between outbreaks and investigations

Problems during investigations

Specialists talked about 12 problems of investigations. Problems fell into four groups:

• Restaurant workers who did not cooperate.
• Restaurant customers:
  • Trouble contacting them to ask them about their illness and what they ate.
  • Lack of cooperation. Some did not want to talk about symptoms or give stool samples.D
  • Trouble finding out what they ate. Some could not remember.
  • Lack of knowledge about foodborne illness. Specialists had to teach customers before their questions could be answered.

• Public health agency:
  • Lack of epidemiologic help or a team approach.
  • Lack of training and experience investigating outbreaks.
  • Lack of support from management.
  • Lack of teamwork between state and local agencies.
  • Lack of staff to conduct investigations.
• Other:
  • Lack of cooperation from doctors. They did not always test patients with illness symptoms when asked.
  • Delay in investigations because sick people were slow to tell agencies about illnesses.

More information

Journal article this plain language summary is based on

More practice summaries and investigation summaries in plain language