Instructions for Form CDPH8567 "Foodborne Disease Outbreak Report" - California

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Download Instructions for Form CDPH8567 "Foodborne Disease Outbreak Report" - California

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Guidelines for Completing the
California Department of Public Health
Foodborne Disease Outbreak Report (CDPH 8567)
(Adapted from NORS 52.13 Guidance Document for NORS Users
reporting foodborne, person-to-person, and animal contact)
Guidelines for Completing the
California Department of Public Health
Foodborne Disease Outbreak Report (CDPH 8567)
(Adapted from NORS 52.13 Guidance Document for NORS Users
reporting foodborne, person-to-person, and animal contact)
TABLE OF CONTENTS
L
ID N
.................................................................................................................................... 3
OCAL
UMBER
S
1: F
....................................................................................................................... 3
ECTION
OODHANDLER
S
2: I
M
....................................................................................................... 3
ECTION
NVESTIGATION
ETHODS
S
3: D
(P
C
O
) .............................................................................................. 4
ECTION
ATES
RIMARY
ASES
NLY
S
4: G
L
......................................................................................................... 4
ECTION
EOGRAPHIC
OCATION
S
5: P
C
(D
N
I
I
F
C
C
) ................. 5
ECTION
RIMARY
ASES
O
OT
NCLUDE
MPLICATED
OODHANDLERS IN
ASE
OUNTS
S
6: I
P
(P
C
O
) .......................................................................... 7
ECTION
NCUBATION
ERIOD
RIMARY
ASES
NLY
S
7: D
I
(A
R
P
C
O
) ....................................... 7
ECTION
URATION OF
LLNESS
MONG
ECOVERED
RIMARY
ASES
NLY
S
8: S
S
(P
C
O
) ........................................................................ 8
ECTION
IGNS OR
YMPTOMS
RIMARY
ASES
NLY
S
9: S
C
................................................................................................................ 8
ECTION
ECONDARY
ASES
S
10: T
......................................................................................................................... 9
ECTION
RACEBACK
S
11: T
– D
......................................................................................................... 9
ECTION
RACEBACK
ETAILS
S
12: R
C
M
....................................................................................... 9
ECTION
ECALL AND
ONTROL
EASURES
S
13: E
(P
C
O
) ...................................................................................... 9
ECTION
TIOLOGY
RIMARY
ASES
NLY
S
14.1
14.2: E
– D
(P
C
O
) ................................................ 10
ECTIONS
AND
TIOLOGY
ETAILS
RIMARY
ASES
NLY
S
15: I
........................................................................................................................... 11
ECTION
SOLATES
S
16: I
F
............................................................................................................ 11
ECTION
MPLICATED
OODS
S
17.1
17.2: I
F
– D
........................................................................ 12
ECTIONS
AND
MPLICATED
OODS
ETAILS
S
18: L
W
F
P
............................................................................ 15
ECTION
OCATION
HERE
OOD WAS
REPARED
S
19: L
E
(W
F
E
).......................................................... 16
ECTION
OCATION OF
XPOSURE
HERE
OOD WAS
ATEN
S
20: C
F
.................................................................................................... 16
ECTION
ONTRIBUTING
ACTORS
S
21: C
F
– D
.................................................................................... 17
ECTION
ONTRIBUTING
ACTORS
ETAILS
S
22: P
C
(C
S
) ..................................................... 18
ECTION
OINT OF
ONTAMINATION
ONFIRMED OR
USPECTED
S
23: S
............................................................................................................................. 18
ECTION
CHOOL
S
24: R
C
............................................................................................. 19
ECTION
EMARKS AND
ONCLUSIONS
S
25: R
A
O
K
I
........................................................ 19
ECTION
EPORTING
GENCY AND
THER
EY
NVESTIGATORS
S
26: PHEP – S
M
E
C
.................................................................. 19
ECTION
EVEN
INIMAL
LEMENTS
HECKLIST
S
27: S
U
O
............................................................................................................... 21
ECTION
TATE
SE
NLY
A
........................................................................................................................................ 21
TTACHMENTS
CDPH 8567 Guidelines (revised 1/13)
2
Please use the Foodborne Disease Outbreak Report (CDPH 8567) to report:
Two or more cases of similar illness from separate households resulting from the ingestion of a common food,
OR
Two or more cases of illness resulting from ingestion of food confirmed or suspected to be contaminated with
botulism, marine toxins, or other chemicals.
L
ID N
OCAL
UMBER
In the top right corner of the form, enter your local health department’s ID number for the outbreak. Also, indicate if
this is a preliminary or final report. If preliminary and final reports are both submitted, please use the same local ID
number.
S
1: F
ECTION
OODHANDLER
Was foodhandler implicated as the source of contamination? – Indicate if a foodhandler was implicated as the
source of the outbreak.
If Yes, specify what evidence was used to support this conclusion. The choice of “prior experience makes this
the likely source” is provided for situations when conclusive laboratory and epidemiologic evidence is absent,
but other factors may prompt the investigator to suspect the foodhandler(s). If a foodhandler is implicated in the
absence of laboratory and epidemiologic evidence, please explain in the Remarks and Conclusions section
(Section 24).
Note: The purpose of this report is to capture information about the actual outbreak itself. If a foodhandler was
implicated as the source of contamination, do NOT include the foodhandler’s information in any sections of this
report that ask about case information; that is, do NOT include the foodhandler in the case count, demographic
data, any date fields, etc. Additional information about an implicated foodhandler may be included in the Remarks
and Conclusions section (Section 24). If any foodhandlers are involved in the outbreak as cases (not the source),
they should be included in case information.
S
2: I
M
ECTION
NVESTIGATION
ETHODS
Investigation Methods – Select all methods that apply.
Interviews only of ill persons – Select if only ill persons were interviewed.
Case-control study – This is an epidemiological study to evaluate the relationship between an exposure
(e.g., eating contaminated food) and a particular outcome (e.g., illness). There are two categories of study
participants, people who have the outcome of interest (cases) and people who do not have the outcome of
interest (controls). Select this method if both ill persons and non-ill persons who may have had common
exposures were interviewed, and this investigation method was used. Please attach any reports or tables
associated with the case-control study.
Cohort study – This is an epidemiological study used to assess outcomes (e.g., the development of
gastrointestinal illness) in a group/cohort of people. Study participants are observed over time or counted to
determine how many people experience the outcome of interest, and when the outcome occurred.
Members in a cohort are defined according to their exposure profile (e.g., an exposed group and an
unexposed group). In outbreak investigations, a cohort is frequently defined by membership in an
organization (e.g., a boy scout troop attending a weeklong camp). Select this method if this investigation
method was used. Please attach any reports or tables associated with the cohort study.
CDPH 8567 Guidelines (revised 1/13)
3
Food preparation review – Select if a review of the preparation practices associated with the suspect food
was conducted.
Investigation at factory or production plant – Select if a factory or production plant was investigated
(e.g., poultry processing plant).
Investigation at original source – Select if the original source of implicated food was investigated (e.g.,
poultry farm, marine estuary, etc.).
Food product traceback – Select if a traceback of the implicated food was conducted.
Environment or food sample testing – Select if samples were taken from the environment or food for
testing.
Other – Select if investigation method is not listed above, and provide additional investigation methods in
the Comments field.
Comments – Please enter any additional information relevant to the investigation methods.
S
3: D
(P
C
O
)
ECTION
ATES
RIMARY
ASES
NLY
The following dates refer only to primary cases; exclude any foodhandlers implicated as source of outbreak and
any secondary cases.
Date First Case Became Ill (required field) – Indicate date first case became ill.
Date Last Case Became Ill – Indicate date last case became ill. If unknown, leave this field blank.
Date of Initial Exposure – Indicate date when first known exposure took place among primary cases. If unknown,
leave this field blank.
Date of Last Exposure – Indicate date last known exposure took place among primary cases. If unknown, leave
this field blank.
Date LHD or State First Notified of This Outbreak – Enter date when LHD or State first learned about the
outbreak (via telephone, e-mail, fax, etc.).
Time LHD or State First Notified of This Outbreak – If known, enter time when LHD or State first learned about
the outbreak (via telephone, e-mail, fax, etc.).
Date Investigation Initiated – Enter date when investigation of outbreak was initiated.
Time Investigation Initiated – If known, enter time when investigation of outbreak was initiated.
S
4: G
L
ECTION
EOGRAPHIC
OCATION
Reporting State (required field) – Indicate state reporting outbreak.
If Multiple States Involved – If multiple states involved in outbreak, select one option.
Exposure occurred in multiple states – Indicate if outbreak resulted from exposure that occurred in
multiple states. A multistate foodborne outbreak is defined as the occurrence of two or more cases of a
similar illness resulting from exposure to a common source, where exposure occurred in more than one
state (e.g., product from manufacturer X that was distributed to two or more states). States involved in a
multistate outbreak will create one NORS-foodborne outbreak report for their state. Please note: An
outbreak where the exposure occurred in multiple states and a common exposure was determined would
be considered a multistate outbreak and the reports would be consolidated by someone at CDC. However,
if the possible exposure occurred in multiple states but a common exposure was not identified (e.g., PFGE
CDPH 8567 Guidelines (revised 1/13)
4
cluster is reported and investigation does not yield a common food vehicle), the cluster would not
considered a multistate outbreak by CDC.
Exposure occurred in a single state, but cases resided in multiple states – Indicate if exposure
occurred in a single state, and ill persons were residents of multiple states. For example, residents from
California, New York, and Florida (multiple states) attended an event (convention) in California (single
state) and became ill from exposure at the event.
If Multiple States Involved, List Additional States – List other states involved in the outbreak.
Reporting Local Health Jurisdiction - Indicate local health jurisdiction reporting outbreak.
If Multiple Local Health Jurisdictions Involved – If multiple local health jurisdictions involved in outbreak, select
one option.
Exposure occurred in multiple jurisdictions – Indicate if outbreak resulted from exposure that occurred
in multiple local health jurisdictions in California.
Exposure occurred in a single jurisdiction, but cases resided in multiple jurisdictions – Indicate if
exposure occurred in a single jurisdiction, and ill persons were residents of multiple local health
jurisdictions. For example, residents from Los Angeles, Orange, and San Diego counties (multiple counties
of California) attended an event in Los Angeles (single jurisdiction) and became ill from an exposure at the
event.
If Multiple Local Health Jurisdictions Involved, List Additional Jurisdictions – List other local health
jursidictions involved in the outbreak.
Name of Facility Where Exposure Occurred – If outbreak was associated with only one facility, indicate name of
facility if it is publicly available.
City/Town of Exposure – If outbreak was associated with only one facility, indicate city or town of facility.
S
5: P
C
(D
N
I
I
F
C
C
)
ECTION
RIMARY
ASES
O
OT
NCLUDE
MPLICATED
OODHANDLERS IN
ASE
OUNTS
This section refers only to primary cases; exclude any foodhandlers implicated as the source of outbreak. Any
household contacts who became ill from person-to-person transmission would be secondary cases. Any cases that
can be clearly defined as secondary cases should be detailed in Secondary Cases section (Section 9). For
outbreaks where multiple modes of transmission or exposures are suspected but cannot be separated from one
another, classify all cases as primary cases.
Case Definition – Provide the criteria used to define a case for the outbreak, including person, place, and time.
Example 1: Point Source Cluster
Case Definition: Person who developed gastrointestinal illness within seven days of attending
wedding reception at Hotel X on February 14, 2011.
Example 2: PFGE-Defined Cluster
Case Definition: Person with: 1) Salmonella Typhimurium infection, 2) illness onset (or specimen
collection date, if onset date unknown) on February 27 – July 1, 2012, and 3) isolate matching
PFGE XbaI pattern JPXX01.2350.
Number of Primary Cases:
# Lab-confirmed Cases – Indicate number of primary cases in which a specimen was collected, and a
laboratory was able to confirm the pathogen(s) or agent(s) responsible for the illness. Marine toxin cases
CDPH 8567 Guidelines (revised 1/13)
5