Disease Reporting

Investigating foodborne gastroenteritis outbreaks

• Authority
  • ORS 333-018-0015 authorizes local health departments to investigate foodborne and other common source outbreaks by requiring health care providers to report all such suspected outbreaks immediately. 
  • ORS 333-019-0010 imposes work restrictions on persons who work at food service facilities whilst in a communicable stage of any illness accompanied by diarrhea or vomiting.
  • ORS 6-24-080 authorizes local health departments to collect stool specimens from food handlers.

   

• Definition, suspect foodborne outbreak

  • > 2 non-householders who develop gastroenteritis (acute onset vomiting,diarrhea or both) at about the same time after eating food from the same source

   

• Investigation method
  • Collect preliminary data, specifically
    • are there > 2 non-householders with gastroenteritis?
    • what are the percentages of:
      • vomiting?
      • diarrhea?
      • severe abdominal cramps?
      • fever?
    • where did the > 2 non-householders eat?
    • when did they eat (date and time)?
    • when did they start vomiting or experiencing diarrhea (date and time)?
    • what did they eat?
    • with whom did they eat?
    • did they share other meals in the past week?

     

  • Call ACDP (971-673-1111) for referral, if indicated, to the ACDP Urgent Epidemiologic Response Team (UERT).
    • Conduct a conference call in accordance with the Outbreak Communication Agreement and following the Outbreak Conference Call Agenda if the outbreak is in Clackamas, Multnomah, or Washington counties.
    • Get patron information and menus from the restaurant using the Foodborne Outbreak Restaurant Checklist (which can and should be used for evaluating other food service establishments).
    • Expand the investigation with ACDP/UERT assistance and in accordance with Outbreak Investigation Expectations for Oregon (March 2004) and ACDP's Foodborne Outbreak Investigative Guidelines (draft) (May 2009).
    • Collect six stool specimens (by home pick-up, if necessary) from six outbreak-affected persons (more details below).

   

  • Specimens
    • Give outbreak-affected persons Instructions for Collecting Stools for Viral Culture and PCR
    • Use secure, leak-proof containers with screw tops, not flip tops, labeled with name, collection date, and outbreak number.
    • Collect specimens of walnut-size stool, 3 tbs of diarrheal stool (or vomitus) or 3-4 rectal swabs from six outbreak-affected persons up to four days after onset. Collecting >6 does not increase the chance of finding something.
    • Use proper containers for shipping stool and include OSPHL Virology/Immunology Request Form (pdf). Keep fresh stool specimens cold from the time they are produced until the time they reach OSPHL. (Instructions for Stool Collection.)
    • Also send OSPHL scoops of fecal matter plopped into Clair Blair transport media (for bacteriology testing if norovirus tests are negative and include the Microbiology Request Form (pdf).

   

  • Paperwork
    • Complete a Gastroenteritis Foodborne Outbreak Summary no later than 30 days after the onset of the last case.

   

  • Useful links
    • Compendium of Acute Foodborne Disease
    • Quick Reference Guide to the services of the Oregon State Public Health Laboratory (OSPHL). The Quick Reference Guide is arranged alphabetically by organism, and provides information about the types of tests available at OSPHL, specimen requirements, request forms, fees, and turn around times. Scroll down to "Food Outbreak" for information about testing food and clinical specimens for FBD agens, Remember to call the OHS epidemiologist assigned to work on the investigation befor submitting food or clinical specimens to OSPHL.
    • Instructions for Collecting Stools for Viral Culture and PCR
      • Mandatory Shipping Labels!!! (pdf)
      • Stool Collection Instructions 
    • Virology/Immunology Request (OSPHL Form 42)
    • General Microbiology Request (OSPHL Form 72)
    • Foodborne Information Fact Sheet (CDC)

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