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 (pdf) and following the Outbreak Conference Call Agenda (pdf) 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 (pdf)  and ACDP's Foodborne Outbreak Investigative Guidelines (pdf)(more details below).
• Specimens
  • Give outbreak-affected persons Instructions for Collecting Stools for Viral Culture and PCR (pdf)
  • 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. Keep fresh stool specimens cold from the time they are produced until the time they reach OSPHL. (Instructions for Stool Collection. (pdf))
  • 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.

Paperwork

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

Useful links

• Compendium of Acute Foodborne Disease (pdf)
• Submitting samples to the Oregon State Public Health Laboratory (OSPHL). 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 (pdf)
• Virology/Immunology Request
• General Microbiology Request
• Foodborne Information Fact Sheet (CDC)