The investigation and control of foodborne disease outbreaks are multi-disciplinary tasks requiring skills in the areas of clinical medicine, epidemiology, laboratory medicine, food microbiology and chemistry, food safety and food control, and risk communication and management.

Many outbreaks of foodborne disease are poorly investigated, if at all, because these skills are unavailable or because a field investigator is expected to master them all single-handedly without having been trained.

These guidelines have been written for public health practitioners, food and health inspectors, district and national medical officers, laboratory personnel and others who may undertake or participate in the investigation and control of foodborne disease outbreaks.

While the book focuses on practical aspects of outbreak investigation and control, it also provides generic guidance that can be adapted to individual countries and local requirements. At the field level it will be valuable in initial epidemiological, environmental and laboratory investigations, in implementation of appropriate control measures, and in alerting investigators to the need to seek assistance for more complex situations.

At national and regional levels, the guidelines will assist decision-makers in identifying and coordinating resources and in creating an environment appropriate for the successful management of foodborne disease outbreaks.

The guidelines are divided into six main sections. Section 1 is a practical guide, outlining the steps of outbreak investigation and control. More detailed information about these steps and related activities is provided in the subsequent sections, which deal with planning and preparation, detection of foodborne disease outbreaks, investigations, control measures, and clinical features of foodborne disease pathogens.

The annexes contain background technical information, sample forms for data collection and analysis, questionnaires and other tools that may be useful during an investigation. Despite a clear focus on foodborne diseases, much of the material in these guidelines is also applicable to the investigation of outbreaks of other communicable and noncommunicable diseases.

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CONTENTS
Acknowledgements iii
Foreword v
Introduction 1
Section 1. Practical guide 2
Section 2. Planning and preparation 4
2.1 General 4
2.2 Outbreak control team 4
2.3 Record keeping 6
2.4 Communication 6
Section 3. Surveillance to detect foodborne disease outbreaks 9
3.1 Introduction 9
3.2 Definitions 9
3.3 Data sources 9
3.4 Interpreting data sources 12
Section 4. Investigation of foodborne disease outbreaks 14
4.1 General 14
4.2 Epidemiological investigations 14
4.3 Environmental and food investigations 36
4.4 Laboratory investigations 43
Section 5. Control measures 47
5.1 General 47
5.2 Control of source 47
5.3 Control of transmission 50
5.4 End of outbreak 52
Section 6. Features of important foodborne diseases 54
6.1 Foodborne pathogens, toxins and chemicals of public health importance 54
6.2 Major foodborne pathogens: predominant clinical features 56
6.3 Major foodborne diseases: epidemiology and methods of control and
prevention 61
References 94

FOREWARD
Acute diarrhoeal illness is very common worldwide and estimated to account for 1.8 million childhood deaths annually, predominantly in developing countries (World Health Organization, 2005). The burden of diarrhoeal illness is substantial in developed countries as well (Scallan et al., 2005).

Estimates of the burden of foodborne diseases are complicated by a number of factors: different definitions of acute diarrhoeal illness are used in various studies, most diarrhoeal illness is not reported to public health authorities, and few illnesses can be definitively linked to food. While not all gastroenteritis is foodborne, and not all foodborne diseases cause gastroenteritis, food does represent an important vehicle for pathogens of substantial public health significance.

A number of studies are under way that aim to provide a better understanding of the global public health burden of gastroenteritis and foodborne diseases (Flint et al., 2005).

There are many reasons for foodborne disease remaining a global public health challenge. As some diseases are controlled, others emerge as new threats. The proportions of the population who are elderly, immunosuppressed or otherwise disproportionately susceptible to severe outcomes from foodborne diseases are growing in many countries. Globalization of the food supply has led to the rapid and widespread international distribution of foods. ...

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