Using indicator-and event- based surveillance to detect foodborne events Stage One Booklet Strengthening surveillance of and response to foodborne diseases Strengthening surveillance of and response to foodborne diseases Stage One Booklet Using indicator- and event-based surveillance to detect foodborne events Strengthening surveillance of and response to foodborne diseases: a practical manual. Stage 1. Using indicator- and event-based surveillance to detect foodborne events ISBN 978-92-4-151324-1 © World Health Organization 2017 Some rights reserved. This work is available under the Creative Commons Attribution- NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non- commercial purposes, provided the work is appropriately cited, as indicated below. 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The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Printed in Geneva Table of Contents Acronyms used in this module vi 1. How to use this module 1 2. Introduction to Stage One 3 Minimum Requirements 5 Objectives of the surveillance and response system 5 Vision for the surveillance and response system 6 3. Indicator-based surveillance: strengthening surveillance of notifiable diseases 8 Identifying diseases and syndromes already under surveillance that might indicate a foodborne disease 10 Database 11 Conducting regular analysis and using thresholds to detect foodborne disease clusters 12 Publishing national surveillance data in a regular bulletin 18 Surveillance protocol 19 Options for strengthening notifiable disease surveillance 20 4. Event-based surveillance: strengthening the ability to detect foodborne events 23 Designate a focal point 26 Managing data about foodborne events 26 Reporters 29 Summary of options for strengthening EBS 30 5. Rapid risk assessment of foodborne events 32 Rapid risk assessment team 33 Protocols for rapid risk assessment 34 Summary of options for strengthening rapid risk assessment 40 iii 6. Response 42 Gathering epidemiological evidence during a response 43 Gathering laboratory evidence during a response 53 7. Multisectoral collaboration 58 Focal points 60 Mechanism for rapid information exchange 60 8. Monitoring and evaluation 64 Monitoring 66 Evaluation 66 9. Managing implementation 70 Decision-trees 71 Identifying priority capacities for implementation 71 Strategic plans 72 Annex 1: Foodborne disease agents 73 Annex 2: Identifying priorities in stage 1 79 Annex 3: Minimum data requirements for notifiable disease surveillance in stage 1 85 Annex 4: Example of a data dictionary for the notifiable disease surveillance database 87 Annex 5: Example of a surveillance log 90 Annex 6: Examples of data analysis 92 Annex 7: Example of an event report form 97 iv Annex 8: Minimum data requirements for a database of foodborne events 100 Annex 9: Examples of information sources that can be used in rapid risk assessment of a foodborne event 104 Annex 10: Example of risk characterization of a foodborne event 107 Annex 11: Mapping agents, specimens and laboratories 111 Annex 12: Examples of monitoring indicators for foodborne diseases 113 Annex 13: Managing implementation in stage 1 116 References 124 v Acronyms used in this module CDC Centers for Disease Control and Prevention (of the United States of America) EBS event-based surveillance ECDC European Centre for Disease Prevention and Control FETP Field Epidemiology Training Programme FOSCOLLAB Global platform for food safety data and information GuiaVETA Guidelines for surveillance system for foodborne disease and outbreak investigation HCW health care worker HUS haemolytic uraemicsyndrome IBS indicator-based surveillance IHR International Health Regulations INFOSAN International Food Safety Authorities Network ORT outbreak response team STEC Shiga-toxin-producing Escherichia coli STEEEP social, technical, economic, environmental, ethical and political considerations WHO World Health Organization vi 1. How to use this module 1 Stage one This module is intended for countries that are in stage 1 of strengthening their surveillance and response system for foodborne diseases, and contains specific guidance on strengthening indicator- and event-based surveillance. Users of this module are encouraged to read first the introductory module of this manual, which sets the context for the guidance contained here and defines the scope and target audience. A glossary of terms contained at the end of the introductory module explains some of the technical terms used in the manual. It also discusses the different risk-related terms used in the various disciplines involved in the prevention and control of foodborne diseases. The present module contains specific advice on: indicator-based surveillance (IBS) (notifiable disease surveillance); event-based surveillance (EBS); rapid risk assessment of foodborne events; response to foodborne events; multisectoral collaboration; monitoring and evaluation; managing implementation. Most sections contain decision-trees, which display a step-by-step pathway for developing capacities for surveillance and response for foodborne diseases. The section on managing implementation contains a tool that countries can use to document the capacities that have already been met and the steps that need to be taken to further strengthen the system. 2 2. Introduction to Stage 1 3 Stage one A country in stage 1 of strengthening its surveillance and response system for foodborne diseases is building on its existing system to meet the minimum core capacity requirements under the International Health Regulations (IHR) (WHO, 2008a), which include foodborne diseases.This module describes options for: strengthening the surveillance system to: monitor trends in priority syndromes through indictor-based surveillance; detect foodborne outbreaks through indicator-based surveillance; detect acute foodborne events through event-based surveillance. strengthening the response system to: assess the risk posed by foodborne disease events; ensure that foodborne disease outbreaks are investigated; identify the sources of foodborne disease outbreaks; ensure that timely control measures are undertaken; capture information from investigations to guide future long-term interventions. 4 Stage one Minimum requirements Minimum requirements Before the surveillance and response system for foodborne diseases can be strengthened in this way, the following should be in place: • an IBS and an EBS system that collect data from the local level and collate the data at national level; • a team at the national level that can assess and respond to acute public health events. Objectives of the surveillance and response system All data collection should be based on well defined objectives