1. CIFOR Council to Improve Foodborne Outbreak Response CIFOR Guidelines and CIFOR Toolkit Donald J. Sharp, MD, DTM&H Food Safety Office National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control, Atlanta

2. CIFOR: History and Structure 2005 – Organizational discussions 2006 – First full meeting and first projects identified Structure –Council (AFDO, APHL, ASTHO, CSTE, NACCHO, NASDA, NEHA, FSIS, FDA and CDC) –Workgroups for identified projects Co-Chaired by CSTE/NACCHO

3. CIFOR: Purpose To improve detection, investigation, control, reporting, and prevention of outbreaks of foodborne illnesses at the local, state, and federal levels

4. CIFOR: Process Systems approach used to identify and prioritize barriers in the foodborne outbreak detection, investigation, control, prevention system Workgroups are formed to develop projects that address the barriers Funding identified (CDC: projects, FDA: workgroup meetings)

5. CIFOR Guidelines for Foodborne Disease Outbreak Response Released July, 2009

6. Guidelines Development Experts from local, state and federal agencies Epidemiology, environmental health, laboratory science and communications Workgroup wrote major chapters Coordinated by technical advisors and lead author Key informant interviews, technical experts, external reviewers and a public comment

7. Guidelines Purpose Provides model recommendations Target local and state agencies, high or low capacity Cover preparation, detection, investigation, control and follow-up Provide all agencies a common foundation Describe the roles of all key organizations

8. Guidelines Chapters Overview Fundamental Concepts of Public Health Surveillance and Foodborne Disease Planning and Preparation Foodborne Disease Surveillance and Outbreak Detection Investigation of Clusters and Outbreaks Control Measures Special Considerations for Multijurisdictional Outbreaks Performance Indicators Legal Preparedness for Surveillance and Control

9. Chapter 4: “Foodborne Disease Surveillance and Outbreak Detection” Introduction Overview Pathogen-specific surveillance Notification/complaint systems Syndromic surveillance 20 pages in length

10. Guidelines Intended Usage Reference document that complements existing procedures to: –Fill gaps –Update agency-specific procedures –Create missing procedures –Target training of program staff Not intended to replace current procedure manuals. Released in electronic and in hard-copy formats Distributed to state and local health departments.

11. Guidelines Implementation Barriers A multitude of recommendations—198 pages Recommendations require different resources and have different levels of impact Recommendations include well-accepted activities seen as effective in most settings and “cutting edge” activities, evaluated only in limited settings. Implementation of any recommendation depends on careful consideration and a host of factors.

12. CIFOR Guidelines Toolkit Released Feb 4, 2011 TOOLKIT

13. CIFOR Toolkit Purpose Better understand their current foodborne disease outbreak response activities Assess their needs for improvement Identify appropriate recommendations from the CIFOR Guidelines Make plans to implement recommendations. A process (and supporting materials) to help agencies and jurisdictions:

14. CIFOR Toolkit - Target Audience Interdisciplinary groups that work together to respond to outbreaks Agency staff focused on specific elements of outbreak response Professional groups providing guidance or training to their members Individuals (“champions”) who can get the process started for an agency or jurisdiction.

15. CIFOR Toolkit - Components Instructions for toolkit process Worksheets to record findings and decisions Sample worksheet pages completed for a fictitious local health department Tips for facilitators A participant evaluation form

16. Response Activities Categorized “Tracks” and “Focus Areas” Smaller, bite-sized pieces of outbreak response Cover most critical aspects of outbreak investigation common to most jurisdictions and outbreaks Allow systematic examination of activities Focus on most important areas

17. Planning and preparation Surveillance and Outbreak Detection Investigation of Clusters and Outbreaks Control Measures Plus: Making changes Relationships Necessary resources Communication Notification/ complaint systems Pathogen-specific surveillance Initial steps Epidemiological investigation Environmental investigation Laboratory investigation Control of source Food recall Control of secondary spread Tracks and Focus Areas

18. Toolkit “Keys to Success” Help explain what is in each Focus Area Consist of critical activities, relationships, resources for each Focus Area If few Keys to Success are in place, should consider prioritizing that Focus Area

19. For each Focus Area: 1.Describe your current activities and procedures compared to the Keys to Success 2.Prioritize CIFOR recommendations to address needed improvements 3.Make plans to implement selected CIFOR recommendations Toolkit Steps and Worksheets

20. TRACK: SURVEILLANCE AND OUTBREAK DETECTION FOCUS AREA 5: PATHOGEN-SPECIFIC SURVEILLANCE FOCUS AREA GOAL: Agency receives reports from health-care providers and laboratories on all cases of disease when certain foodborne pathogens are identified and obtains case information in a way that allows for timely follow-up of patients and quick detection and investigation of possible outbreaks. Step 1: Describe your current activities and procedures in this focus area: Considering the keys to success on the previous page, describe your agency’s current activities and procedures in this focus area. Indicate which might need work to improve your agency’s response to foodborne disease outbreaks.

21. Step 2. Prioritize CIFOR recommendations to address needed improvements Having identified activities and procedures in need of improvement, review the CIFOR recommendations related to this Focus Area. Rate the priority for implementing each recommendation based on its likely impact on foodborne outbreak response at your agency and available resources. TRACK: SURVEILLANCE AND OUTBREAK DETECTION FOCUS AREA 5: PATHOGEN-SPECIFIC SURVEILLANCE

22. Step 3. Make plans to implement selected CIFOR recommendations For each CIFOR recommendation selected in the previous step, identify who might take the lead in implementing the recommendation and the timeframe for implementation. Consider other factors that might influence the implementation of a recommendation. TRACK: SURVEILLANCE AND OUTBREAK DETECTION FOCUS AREA 5: PATHOGEN-SPECIFIC SURVEILLANCE

23. Download hardcopies from the CIFOR website (www.cifor.us)www.cifor.us Users can pick and choose which documents to download Best to use online version with your team On line forms are “fill-able” Evaluation planned for next year Thank you!! CIFOR Guidelines and Toolkit