Investigation of Enteric Disease Outbreaks

Abstract

This chapter talks about acute gastroenteritis and other foodborne diseases that can be caused by bacteria, viruses, protozoa, fungi, helminths, prions, and biological or environmental toxins. Many foodborne and waterborne diseases are self-limited and characterized by gastrointestinal symptoms such as vomiting and diarrhea. In a few situations, such as mushroom poisoning, ciguatera fish poisoning, or other chemical intoxications, it is sufficient to document the clinical syndrome among affected persons. Staphylococcus can also be problematic because the organism may not be viable in stool or food samples, and most laboratories cannot test for enterotoxin. Enteric disease surveillance is generally the province of public health agencies. Surveillance includes the collection and analysis of information about disease occurrence and leads to taking considered action based upon those data. Disease surveillance often is based on mandatory reporting laws, whereby diagnostic laboratories or clinicians are required to notify public health agencies about individuals with specified conditions, e.g., salmonellosis or hepatitis A, as well as unusual clusters of illness. In recent years, however, public health officials and the public have become increasingly concerned that the food supply system is a potential target of intentional acts of contamination, sabotage, or terrorism. Summary information about foodborne and waterborne outbreak investigations is typically reported to the CDC, which periodically summarizes these data. It should be emphasized that the quality of these data is highly variable, which complicates one's ability to summarize them meaningfully.