1. The PulseNet USA WebBoard – A Rapid Alert and Information Sharing System Peter Gerner-Smidt CDC, Atlanta, USA 5th Annual Meeting PulseNet America Latina, October 23, 2007

2. Communication Within PulseNet Submission of patterns to a PulseNet Server –By email to the database management –By uploading the patterns directly to the server Discussion forum –The WebBoard The PulseNet Web-site –www.cdc.gov/pulsenetwww.cdc.gov/pulsenet The PulseNet Newsletter Meetings – workshops – training courses Direct communication between participants

3. What is the WebBoard? The PulseNet ListservThe PulseNet Listserv –A closed non-moderated electronic discussion forum (password protected) –Available to PulseNet participants and foodborne epidemiologists –Rapid alert system for outbreaks of foodborne infection –Discussion and information sharing forum

4. PulseNet WebBoard All participants at the same time PulseNet participants get access to the WebBoard by sending an email to the PFGE mailbox (PFGE@cdc.gov)PFGE@cdc.gov – Must sign a non-disclosure agreement for access PulseNet participants approve access to the WebBoard of foodborne epidemiologists in their region –Foodborne epidemiologists must also sign a non- disclosure agreement for access

5. PulseNet WebBoard Entry Screen

6. PulseNet WebBoard Entry Screen - The alternate (blue) version A third version is under way and will be implemented in 2008

7. WebBoard Conferences Some of the conferences on the PulseNet USA WebBoard

8. Update Meeting 2006

9. General PulseNet Information

10. Important PulseNet Documents

11. PulseNet QA-QC Manual

12. Salmonella Cluster Alert

13. Cluster Detection 1.A cluster is detected –By PulseNet (state lab or CDC) –By epidemiologists (state or CDC) 2.Cluster is posted on WebBoard 3.CDC database manager verifies patterns and assigns outbreak code –Patterns that are not verified by CDC database team should only be reported as “possible matches” 4.CDC database manager posts results to WebBoard and notifies epi liaison at CDC 5.PulseNet labs respond to posting 6.CDC database manager updates as necessary

14. WebBoard Alert Protocol For initial postings for clusters or outbreaks –Submit information to the appropriate PulseNet database or –E-mail to the PulseNet database manager (PFGE@CDC.gov) and –Then submit information to the WebBoard Initial postings should contain this information: –State(s) included in cluster –Serotype and Shiga toxin type for E. coli (O157:H7 or other STEC) –TIFF must be included with lane identification (enzyme and standard lanes) indicate if second enzyme is pending –PulseNet bundle file (if available) –Identify lanes that contain cluster isolates –Additional information such as more isolates pending, isolation date, frequency of pattern and epi information

15. WebBoard Alert Protocol: Response Postings For response postings: number of “matches” to the cluster pattern within the past 60 days for E. coli, Salmonella, Shigella, Vibrio and Campylobacter or 120 days for Listeria Isolate numbers and/or TIFF name should also be provided in the response posting

16. E. coli O157:H7 in Vacuum-packed Steaks, 2003 WebBoard: Within 5 days there were 20 response postings.

17. Steak Outbreak-Associated E. coli O157:H7 Cases, 2003 1 1 8 1 1 1 1 1 2 1 1 1 1 1 1 8

18. USDA Investigation of Processing Plant Flavoring Injection and/or Needle- Tenderizing Transferred E. coli O157:H7 to the Interior of the Steaks. Recall occurred 12 days after WebBoard posting

19. PulseNet Outbreak Codes Basic code – –In some cases the basic code will include: “ml” to indicate multi-locational (multi-state) “c” to indicate that it is a cluster that has not yet been confirmed by epis as an outbreak “?” to indicate that the status is not firmly established PulseNet guidelines for naming outbreak codes/clusters is posted on the WebBoard under the conference “Important PulseNet Documents”

20. PulseNet Outbreak Codes Examples: –0406FL-1c is the first cluster that was discovered in Florida in June 2004 –If this cluster becomes an outbreak, the code will become 0406FL-1 –If this outbreak becomes multi-state, the code will become 0406FL-1ml –If another cluster appears in FL during the same month, the second cluster code will be 0406FL-2c

21. Pulling it all Together Recommendations Request WebBoard access via PulseNet lab Unsubscribe to mailing lists to avoid receiving hundreds of emails Check WebBoard daily if involved in an outbreak –make note of outbreak code How it works at CDC Database manager sends updated spreadsheets to PulseNet liaison and copies CDC epidemiologists CDC epidemiologists send updates to the PulseNet liaison and copies database manager

22. Comments on WebBoard We encourage PulseNet participants to use the WebBoard –Queries –Pattern comparisons –Troubleshooting assistance –Share unusual findings Remember: replies to the WebBoard will go to all WebBoard members on the conference--not just the message originator

23. PulseNet USA Web-Site www.CDC.gov/pulsenet

24. PulseNet USA Newsletter

25. Questions? Thank you!