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Improving Response to Foodborne Disease Outbreaks in the United States: Findings of the Foodborne Disease Centers for Outbreak Response Enhancement (FoodCORE), 2010-2012

Biggerstaff, Gwen Kathryn MSPHfor the FoodCORE Team

Journal of Public Health Management and Practice: July/August 2015 - Volume 21 - Issue 4 - p E18–E26
doi: 10.1097/PHH.0000000000000115
Original Articles

Context: Each year foodborne diseases (FBD) affect approximately 1 in 6 Americans, resulting in 128 000 hospitalizations and 3000 deaths. Decreasing resources impact the ability of public health officials to identify, respond to, and control FBD outbreaks. Geographically dispersed outbreaks necessitate multijurisdictional coordination across all levels of the public health system. Rapid response depends on rapid detection.

Objective: Targeted resources were provided to state and local health departments to improve completeness and timeliness of laboratory, epidemiology, and environmental health (EH) activities for FBD surveillance and outbreak response.

Design: Foodborne Disease Centers for Outbreak Response Enhancement (FoodCORE) centers, selected through competitive award, implemented work plans designed to make outbreak response more complete and faster in their jurisdiction. Performance metrics were developed and used to evaluate the impact and effectiveness of activities.

Participants: Departments of Health in Connecticut, New York City, Ohio, South Carolina, Tennessee, Utah, and Wisconsin.

Results: From the first year (Y1) of the program in October 2010 to the end of the second year (Y2) in December 2012, the centers completed molecular subtyping for a higher proportion of Salmonella, Shiga toxin-producing Escherichia coli, and Listeria (SSL) isolates (86% vs 98%) and reduced the average time to complete testing from a median of 8 to 4 days. The centers attempted epidemiologic interviews with more SSL case-patients (93% vs 99%), and the average time to attempt interviews was reduced from a median of 4 to 2 days. During Y2, nearly 200 EH assessments were conducted. FoodCORE centers began documenting model practices such as streamlining and standardizing case-patient interviewing.

Conclusion: Centers used targeted resources and process evaluation to implement and document practices that improve the completeness and timeliness of FBD surveillance and outbreak response activities in several public health settings. FoodCORE strategies and model practices could be replicated in other jurisdictions to improve FBD response.

Supplemental Digital Content is Available in the Text.The aim of this study was to improve foodborne disease outbreak response through FoodCORE.

Outbreak Response and Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.

Correspondence: Gwen Kathryn Biggerstaff, MSPH, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333 (

The author acknowledges the following individuals and partners for their invaluable participation in and contributions to the FoodCORE Team: Ian Williams, Sharon Balter, Rana Barakat, Karen Baransi, Diane Barden, Lyndsay Bottichio, Eric Brandt, Cindy Burnett, Rebekah Carman, Ludwin Chicaiza, Kenneth Davis, Traci DeSalvo, Melissa Dimond, John R. Dunn, Alycia Esliger, Gabrielle Farhadi, Katie N. Garman, Tanya Geiz, Julia Hall, Heather Hanson, Sharon Hurd, Porche Jackson, Larry King, Stacey Kinney, Rachel Klos, Justin Kohl, Laura Kornstein, Lillian Lee, Meghan Maloney, Laurn Mank, Tracy Middleton, Susan Miller, Jennifer Mitchell, Tim Monson, Jade Mowery, Christina Nishimura, Scott Nowicki, Marilee O'Connor, Keoni Omura, Holly Oxley, Kara Paul, Jacob Paternostro, Quyen Phan, Keisha Peters-Belleran, Kim Quinn, Terry Rabatsky-Ehr, Mike Rauch, Vasudha Reddy, Sheri Roberts, Kristina Russell, Julie Schlegel, Jared Shelerud, Katie Stilwell, Bun Tha, Jenni Wagner, HaeNa Waechter, Dave Warshauer, Lai Ming Woo, Amy M. Woron, David Young, Diana Zaato, The Connecticut Student Team, The New York City Team Salmonella, The Tennessee FoodCORE Interview Team (FIT), and The Wisconsin Surveillance and Outbreak Support Team.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The author declares no conflicts of interest.

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