www'ReportFoodPoisoning'com

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www.ReportFoodPoisoning.com
History Philosophical Underpinnings Prof Paul
Bartlett Holly Wethington, MS Michigan State
University
Program Description and Usage Lisa Hainstock,
RS MDA Sally Bidol, MPH MDCH
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AGENCIES NVOLVED
The Collaborators Working Under the National
Food Safety and Toxicology Center Umbrella
SUPPORT

• National Food Safety Tox Ctr at Michigan State
  University
• Michigan Dept of Agriculture
• Michigan Dept of Community Health
• Ingham County Health Dept
• USDA APHIS VS
• U of M - Dept. of Epidemiology

• Michigan Life Sciences Corridor

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The R D Pipeline From the
WWW.ReportFoodPoisoning.com
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Public Health Impact of Foodborne Disease

• Estimated 76 million cases of foodborne diseases
  every year in the US
• 5,000-9,000 related deaths annually
• The very young, elderly, and immunocompromised at
  highest risk

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Starting Out - 1999

• What were the problems with foodborne disease
  surveillance?
• What could we do to make improvements?

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Current Foodborne Disease Surveillance -
Negative Features

• 1 Problem - Poor participation
• Less than 1 of the 76 million cases were
  currently being reported.
• About the same as today.
• We mostly had a laboratory-based reporting
  system.
• Frequently only cultured cases are reported.
• But most gastroenteritis was never cultured.
• And therefore never reported.
• If cultured - Not all labs looked for the rare or
  hard-to-diagnose etiologies

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The Current Laboratory-based Surveillance Pyramid
Most of these dont contact their LHD
100
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With a 1 rate of reporting, what is the meaning
of the reports that we do have?
Or Tip of an Iceberg?
Isolated Snow Flake?
Source John Tilden
One of many isolated sporadic cases
Or does it represent 99 other cases that were
part of the same outbreak?
Or maybe the report is just from an isolated
flake?
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• 2 Problem The Reporting System is to slow
• Investigation usually done after the outbreak is
  over
• When control opportunities no longer exist
• Fading memories and interest make it difficult to
  obtain data regarding food history food
• Clinical specimens no longer available
• Food samples no longer available

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Are We Sufficiently Speedy? Multistate Outbreak
of Listeriosis, USA, 1998-1999

Why did this go on for so long before being
discovered?
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Fatal
Recall
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Usual listerosis
Non-fatal
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incubation period
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Number of Patients
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Plant Construction
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5
4
3
2
1
0
6/27
8/2
9/6
10/11
11/15
12/20
1/24
2/27
4/3
Date
Date of Onset
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PBB in Michigan - 1973

• Flame retardant accidentally mixed into animal
  feed.
• Took 1 year to recognize.
• By then, gt97 of human population of Michigan had
  incorporated PBBs into their bodies.
• How fast would we recognize if someone had done
  this on purpose?

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Total reliance on laboratory confirmation can
cause considerable reliance on delays.

• Melinda Wilkins (MDCH) Survey (2000).
• 91.3 (263/288) response rate
• Mean 12.3 days (specimen collection to
  serotyping)
• Mean 35 days - interval between symptom onset and
  completion of the case investigation form

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Current System for Foodborne Disease - Negative
features -

• 3 problem Sole dependence on a
  laboratory-bases system may miss the unexpected.
• Anthrax in the mail?

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It is doubtful that terrorists will feel
compelled to select their biological agents from
the list NIAID provides them.Our defenses must
therefore be flexible and prepared for the
unexpected.
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Round up the usual suspects
Casablanca
Laboratories can only find agents for which they
look, and they only look for what they expect to
find. A serious problem for total reliance on
laboratory based systems.
Casablanca
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Syndromic Surveillance is not anti-laboratory It
is pre-laboratory.
We need to identify time-space clusters that can
be investigated with good laboratory support.
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Current System for Foodborne Disease - Negative
features -

• 4 problem - Low surge capacity at the LHD and
  state level.
• Large outbreaks overwhelm a telephone-based
  reporting system.
• When the phone lines are full, do you have
• 30 cases?
• 300 cases?
• 3 million cases?

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Current System for Foodborne Disease - Negative
features -

• 5 problem Lack of Analytical Tools
• Stone age epidemiology
• Hasnt changed much in 24 years
• Most complaints are just filed away and
  forgotten.

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The Unspoken Truth about Foodborne Disease
Complaints

• Managing (non-laboratory confirmed) foodborne
  complaints is like mining low-grade ore. It must
  be done efficiently.
• We needed an efficient way to find the occasional
  nugget of information that can be of critical
  importance.

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For These Reasons We Started the RUsick2 Forum.
2002-2004

• Sought to encourage more reporting by providing
  immediate feedback to the public.
• Allowed reporting citizens to search for
  associations and share their data with each other
  
• LHDs had full access to all data fields and a
  variety of cluster-identifying reports.
• Brought in about 6,500 disease reports.

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Strengths of RUsick2

• More complete food history than on telephone.
• Number of food items mentioned
• RUsick2 Mean 8.8 (SD7.4, n5536)
• Telephone reports mean 4.4 n87
• Mean number of food sources
• RUsick2 Mean 1.7 (SD1.16, n5536)
• Telephone reports mean 1.65 n87
• Available 24 hours a day, 7 days a week
• High surge capacity for large outbreaks or
  intentional contamination.

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Strengths of RUsick2

• Accurate spelling of addresses, cities, names of
  restaurants and stores.
• When people can put their own fingers on the
  keyboard
• No need for B as in Boy, R as in Roger,
  etc.
• Important for geocoding (for GPS maps)
• Saved time for health dept personnel
• Less time on phone while people remember food
  history.
• Major head start on data collection if outbreak
  related.

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Weaknesses of RUsick2

• Relied too much on public to find common risk
  factors
• but they rarely looked at output provided to
  them.
• Probably because of scarcity of other reports
  from their locality.
• Confidentiality issues for food sources led to a
  complicated coding system.

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Weaknesses - continued

• Questionnaire too complex for the average
  citizen.
• Insufficient participation to detect even
  medium-sized clusters
• If everyone had started using the RUsick2 Forum,
  it would have detected more clusters and obtained
  more publicity.
• Leading to more usage,
• leading to more clusters, etc.
• But the critical mass was not attained.

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So . . .

• As all good R D outfits do
• We regrouped.
• We copied what we had done well
• and changed what needed improvement.
• To come up with a new approach.

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The Next Generation . . . .
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www.ReportFoodPoisoning.com

• Helps prepare and submit foodborne disease
  reports/complaints to LHD
• Helps local health departments find disease
  clusters
• Developed by MDCH, MDA, and university
  epidemiologists
• Operated by National Food Safety and Toxicology
  Center (NFSTC) at MSU

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Why www.ReportFoodPoisoning.com is better

• Quicker, less complex
• More streamlined questionnaire
• No abbreviations, complicated coding
• No confidentiality issues
• Travel history easily obtained when the visitor
  enters their food sources
• Citizens from non-participating jurisdictions are
  directed to health dept.
• No consumer advocacy groups

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Relation to IAMFES Form C1

• Collects most info to establish commonalities
  that define a cluster
• Collects all C1 data EXCEPT
• Physician name and address
• Laboratory results
• Medications, known allergies
• Ethnicity
• Place of work
• Exact time of consumption of food items

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You get a big head start on the hardest
questions. You may need to collect additional
data from reporting citizens. Probably a very
short phone call or Email
All the data you need
Data collected from website
Collected over the web site
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Confidentiality

• Website visitor uses password to access and
  modify their own data
• Excellent legal protection, part of MSU research
  and development project
• Should be safe from anything short of a court
  order. (MSU has never had such a court order).
• - MSU told that the data has better legal
  protection than data collected by health
  departments.

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Advantages

• Testing with gt 6,500 reports has shown more
  complete food history than when given in a report
  over the telephone.
• Identifying names and locations are recorded much
  more accurately
• Important for identifiers such as the persons
  name, addresses, phone numbers, email addresses,
  restaurant names and grocery names.

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Advantages (continued)

• Computer doesn't mind waiting
• Keeps on-track and saves you TIME.
• Gives techniques for recalling food history
• Surge Capacity Thousands of reports
• The website is always open
• FREE to you and the public!

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The Communicable Disease or Environmental Health
Specialist

• When data is entered from anyone claiming to be
  from your county
• You receive E-mail notification at 12 minutes
  after the next hour (can use multiple email
  addresses)
• Use your LHD password to view all data from your
  county

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MI Counties (19) participating in RUsick2 Forum
Allegan Bay Clinton Eaton Genesee Grand
Traverse Ingham Ionia Kent Lenawee Livingston Luce
-Mackinac-Alger- Schoolcraft Muskegon Ottawa
Saginaw Shiawassee Wayne
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Regions

• Each local health department can choose to be
  part of a region
• Counties can agree to view each others data
• contact the Program Manager.
• Each local health department can be in more than
  one region (i.e. Washtenaw can be in a region
  with Detroit Oakland AND in another region with
  Jackson Lenawee)
• Each region will have its own regional password
  (i.e. in example above, Washtenaw would have 2
  passwords)

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Identifying Time-Space Clusters

• Comparison Report can help LHDs identify people
  with similar symptoms who ate
• the Same Thing
• from the Same Place
• at about the Same Time.
• Shows each risk factor (symptom, food item, etc.)
  reported by at least two cases
• Two adjustable time periods to compare recent
  activity with baseline

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Noise

• Fraudulent Reports
• Malicious
• Angry employees or customers
• Competitors
• Pranks
• Clusters due to fraudulent reports are quickly
  recognized
• RUsick2 had lt 3 in 6,500 entries
• Suspicious reports can be flagged
• To be ignored by data retrieval options

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Comparison Report from the LHD Monitor Option
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How to Select Records for the Case Report or Line
Listing
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Getting Registered and Getting your LHD Password

• RUsick2 Forum passwords will work.
• Passwords can be assigned to new LHDs
• Contact the project manager for password (517)
  432-3100 x128 or ffmod_at_cvm.msu.edu.
• When people from your jurisdiction enter data,
  the computer will notify you via Email at the
  Email address(s) you provide.

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How does it work for non-participating counties
that do not have their LHD password?

• If the citizen indicates they are from a county
  that is not participating (screen 3)
• They are told that this website helps them
  prepare their report, but they must deliver it
  themselves to their LHD via fax, Email or phone.
• We provide them web links to help find their LHD.

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Publicizing the Website

• Put a link on your health department's homepage.
• Your newsletter or other promotional materials.
• Have your telephone receptionists direct calls to
  the website.

Click here to report your suspected food
poisoning.
Click here to report your food poisoning at
www.ReportFoodPoisoning.com
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TEST IT OUT!

• Enter a test case.
• Go to http//35.10.112.88/foedsproject
• Select Testing Only as your state.
• There are two counties
• One for residents from counties where the LHD
  does not participate
• One for residents from counties where the LHD has
  their password and receives Email notices from us
  when data is entered from their jurisdiction.

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Questions?

• If you have any questions about the Report Food
  Poisoning Program, contact
• Paul Bartlett
• Holly Wethington
• 165 Food Safety Tox Bldg
• National Food Safety Toxicology Center
• Michigan State University
• East Lansing, MI 48824
• P 517-432-3100 x128
• Email ffmod_at_cvm.msu.edu

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Remember www.ReportFoodPoisoning.com Not
www.RFP.com
People with food poisoning are usually looking
for a different kind of pot.