INPPAZ - PAHO - WHO
BIREME - PAHO - WHO

GuiaVETA
Guidelines of Surveillance System for Foodborne Diseases and Investigation of Outbreaks

ANNEX B

FBD Form 1 - Individual Case Report for Persons Linked to an FBD outbreak
FBD Form 2 - Registry of cases of foodborne diseases in consultation and laboratories
FBD Form 3 - Collective registry
FBD Form 4 - Samples and Speciemens Collected and Laboratory Results
FBD Form 5 - Health Status of Food Handlers Involved in an Outbreak
FBD Form 6 - Guidelines for Sanitary Inspection of Food Preparation Facilities
FBD Form 7 - Attack Rates for Food Served in a FBD Outbreak
FBD Form 8 - Combined Attack rates based on foods consumed
FBD Form 9 - Flowchart for Preparation of Meat and Potatoes
FBD Form 10 - Final Report on an FBD Outbreak
FBD Form 11 - Final Report of the FBD Outbreak
FBD Form 12 - Half-yearly Information to SIRVETA about FBD cases

FBD FORM 1

INDIVIDUAL CASE REPORT

INDIVIDUAL CASE REPORT FOR PERSONS LINKED TO AN FBD OUTBREAK

I. OBJECTIVE

To record data from exposed contacts, who are interviewed for the purpose of gathering information on the FBD outbreak, in an attempt to identify the food that transmitted the disease and the etiologic agent, by determining the behavior of different variables related to the outbreak - such as probable time of ingestion, incubation period, and epidemic curve - among individuals who consumed various foods at a common event, whether or not they became ill, and whether or not they consumed the suspected food. It also provides a chronology of the outbreak, data on specimens and samples collected, test results and their interpretation.

II PROCEDURE

Personnel responsible: The members of the team, both for filling out the form and for processing and interpreting the data.

Number of copies: Original.

When required: Whenever there is an FBD outbreak, and there is no hypothesis as to the vehicle.

Routing: After analysis, the form should remain on file at the Health Center that investigated the FBD outbreak. Preferably, Epi-info should be used to extract and process the data.

III. CONTENTS

A. IDENTIFICATION AND BACKGROUND DATA ON THE RESPONDENT

"1" Indicate the full name of the person being interviewed.

"2" to "4" Self-explanatory.

"5" Place an "X" in the appropriate bracket to show if the person was interviewed while hospitalized, during ambulatory treatment or at home.

"6" Place an "X" in the appropriate space to indicate if the respondent is a food handler or someone who ate the suspected food. If the relationship is ‘Other’, mark ‘Other’ and specify on the dotted line.

B. CLINICAL SYMPTOMS AND TREATMENT

"7" If the respondent has been apparently healthy during the 72 hours prior to the interview, place an "X" in the bracket marked "no symptoms present"; otherwise place an "X" in the appropriate space. If other symptoms are present, mark ‘Other’ and specify.

"8" Self-explanatory.

"9" Fill out both 9.1 and 9.2. (Self-explanatory in each case.)

C. FOOD INGESTED - DATE, TIME, AND PLACE OF INGESTION

"10" List the foods consumed.

"11" - "12" Self-explanatory.

D. CLINICAL SPECIMENS, FOOD SAMPLES, AND ENVIRONMENTAL SAMPLES COLLECTED AND LABORATORY RESULTS

"13" Fill in the information on the outbreak under investigation, indicating the origin of the samples, using the number of the form FBD 2 or FBD 3, which should also be part of the identification assigned to the samples, so as to avoid confusion.

"14" Fill in "14.1" and "14.2" Self-explanatory in each case.

"15" Use the same criteria as for "7;" the person responsible for shipping the sample should note the test required.

"16" "16.1" should be filled in by the person responsible for shipping the sample, specifying the type, such as: milk, swab from cutting board, etc.

"16.2" to "16.3" are provided so the test results can be noted by the person who carried out the tests.

"17" to "19" Self-explanatory, and are filled in before sending the sample(s) to the laboratory.

"20" Self-explanatory; filled in by the person who receives the sample, at the time of arrival.

"21" Self-explanatory; filled in by the person who carries out the laboratory test, at the time of its completion.

"22" Self-explanatory, on receipt of the results, by the person originating this activity.

"23" Self-explanatory

1. Date:_______________ 2. Week #:_______
3. Province or State:________________________
4. Center Name:________________________

18. Name of reporting person:_________________________________________

INSTRUCTIONS FORM VETA 2

REGISTRY OF CASES OF FOODBORNE DISEASES IN CONSULTATIONS AND LABORATORIES

I OBJECTIVE
To record a set of data based on cases of FBD

II OPERATIVE PROCEDURE

Responsible personnel: Staff from selected medical offices and laboratories
Number of copies: Original.
Periodicity: This form should be used every time a case of FBD is detected, particularly in the entities in which research was decided.
Destination: The model will go to the Statistics Department which will first make a tabulation and will then send it to the corresponding Surveillance Department for its processing, preferably through an Epi-info program.

III CONTENTS

A. IDENTIFICATION AND BACKGROUND DATA OF THE RESPONDENT

"1" Record the date the document is being prepared.
"2" Number of epidemiological week.
"3" Name of province or state where the informing unit is placed.
"4" Self-explanatory.
"5" The consecutive number of report will be indicated.
"6" Date in which first symptoms appeared.
"7" Self-explanatory.
"8" Address where the ill person can be found.
"9" Self-explanatory.
"10" Self-explanatory.
"11" Self-explanatory.
"12" Disease will be reported according to signs and symptoms and results of laboratory tests
"13" Record the probable causative agent of disease
"14" Write C when the agent has been confirmed and an S when the diagnosis is clinical/epidemiological.
"15" Indicate probable food, based on the patient's reference.
"16" Indicate place where the person says the suspected food was ingested.
"17" Write any comment considered important.
"18" Write the name of the reporting person.

COLLECTIVE REPORT

6. DATE: 7. Name of person filling out form:

COLLECTIVE REGISTRY

FBD FORM 2

I. OBJECTIVE

To record data from exposed contacts, who are interviewed for the purpose of gathering information on the FBD outbreak. FBD Form 2 collects similar information to FBD Form 1 but on a collective basis.

II PROCEDURE

Personnel responsible: Members of the research team, both for filling out the form and for its processing and interpretation.

Number of copies: Original.

When required: Whenever an FBD outbreak occurs and there is no hypothesis on the vehicle.

Routing: After analysis, the form should remain on file with the epidemiology personnel at the health service investigating the outbreak.

III CONTENTS

A. IDENTIFICATION AND BACKGROUND DATA ON THE RESPONDENT

"1" Identify the place where the outbreak occurred.

"2" List the names of healthy and sick persons who were exposed to the outbreak. Indicate age and sex, whether sick, whether or not treated.

Indicate the date and time when the suspected food was ingested.

"3" Specify if the person became ill or showed symptoms.

Indicate for each person the time (in hours and minutes) when the first symptoms were noticed.

Specify the incubation period (hours and days) taking the time elapsed between the appearance of the first symptoms and the ingestion of the implied food.

List the symptoms according to the characteristics of the disease

"4" Enter in the columns the foods that were consumed during the period under study.

"5" If specimens have been sent to the laboratory, indicate type and date.

NOTE: USE THE BACK OF THIS FORM FOR ANY ADDITIONAL OBSERVATIONS

FBD FORM 3

I. OBJECTIVE

To record the data for use in examining samples sent to the laboratory, both clinical specimens from contacts, as well food samples and samples collected from environmental surfaces (swab taken from utensils, cutting boards, food storage areas, etc.). The form is also used to record laboratory results and to keep track of the specimens and samples from the time they are collected until the results are received by the person who requested them.

II. PROCEDURE

Personnel responsible: Members of the research team should fill out this form to be submitted with all specimens and samples sent to the laboratory. Numbers "1" through "8.1" should be filled out in the case of human clinical samples; if food samples and/or samples from an environmental surface are sent, then lines "9" through "12.1" should be filled out. In all cases "13" and "14" should be completed. Number "17" is only completed when the laboratory results are received.

The laboratory personnel should fill out number "15" when the specimen or sample arrives, numbers 8.2, 8.3 and 8.4 and/or -depending on the type of specimen or sample - 12.2, 12.3, and 12.4, when the results are obtained, and number 16. Any explanatory observations may be added on the back of the form.

Number of copies: Original and copy.

When required: This form should be used whenever specimens or samples are sent to a laboratory in connection with an FBD outbreak.

Routing: Both the original and the copy should be sent to the laboratory together with the specimens or sample. The laboratory should return the original – showing the results obtained – to be placed on file with the epidemiology personnel; the copy should be remain on at the laboratory.

III. CONTENTS

A. IDENTIFICATION OF THE OUTBREAK

"1" Indicate the name and address the private home, school, hospital, hotel, restaurant, club, or other site where the food implicated in the FBD outbreak was consumed.

B. SAMPLE TO BE TESTED

"2" Place an "X" in the appropriate spaces to show the type(s) of specimen/sample(s) being sent to the laboratory.

C. CLINICAL SPECIMEN FROM CONTACT

"3" Self-explanatory.

"4" Copy data FBD FORM 1: "7."

"5" Fill in "5.1" and "5.2." Copy data FBD FORM 1, "9.1" and "9.2."

"6" and "7" The person responsible for shipping the sample should note the presumptive clinical diagnosis and the test requested, as an aid to the personnel who is carrying out the laboratory tests. This will save the laboratory valuable time and physical and human resources.

"8" "8.1" should be filled out by the person sending the specimen, specifying type, such as: stool, vomit, blood.

"8.2" to "8.4" are to be filled out by the personnel carrying out the tests.

D. FOOD SAMPLES AND SAMPLES FROM ENVIRONMENTAL SURFACES

"9" This line should be filled out using identifying information on the outbreak being investigated indicating the origin of the samples (using the number of the form FBD 2 or FBD 3,) which should also be part of the identification assigned to the samples, so as to avoid confusion.

"10" Fill "10.1" and "10.2." Both self-explanatory.

"11" Use the same criterion as at "7". The person sending the sample should specify the test required.

"12" "12.1" should be filled out by the person sending the sample, specifying type, (such as: milk, swab from cutting board, etc. )

"12.2" through "12.4" are to be filled out by the person carrying out the test.

"13" - "14" Self-explanatory. Should be filled out before sending the specimen/sample to the laboratory.

"15" Self-explanatory. Should be filled out by the person who receives the sample, on its arrival.

"16" Self-explanatory. Should be filled out by the person carrying out the laboratory test, on its completion.

"17" Self-explanatory. Should be filled out on receipt of the results, by the person that originated this activity.

FBD FORM 4 FORM. VETA 4

HEALTH STATUS OF FOOD HANDLERS INVOLVED IN AN FBD OUTBREAK

FBD FORM 4

I. OBJECTIVE

To record the health status of persons who participated in the preparation, processing, distribution, storage, or transportation of the suspected food in the FBD outbreak being investigated. It is very important to indicate whether the food handlers have skin lesions, such as pustules, boils, wounds, or infected burns, and their location. This activity is part of the investigation of an FBD outbreak. Whenever possible, specimens should be obtained from secretions of the oropharynx, nose, cutaneous lesions, or feces, depending on the hypothesis proposed for how the suspected food was contaminated.

II. OPERATIONAL PROCEDURE

Personnel responsible: Members of the team carrying out the investigation of FBD outbreak.

Number of copies: Original

When required: This form should be used whenever an FBD outbreak occurs, in order to help determine the possible source of contamination.

Destination: After analysis, the form should be placed on file with the epidemiology personnel at the health service investigating the FBD outbreak.

III. CONTENTS

A. DATA ON THE FBD OUTBREAK UNDER INVESTIGATION

"1" Write the name of the establishment where the investigation is being carried out, regardless of its size or number of handlers that it employs.

"2" indicate date on which the FBD outbreak started.

"3" Self-explanatory.

B. INFORMATION ON THE HEALTH STATUS OF HANDLERS OF THE SUSPECTED FOOD

NOTE: Use a separate line for each of the food handlers who work at the establishment being visited, whether or not they are present at the time of the visit. The manager or supervisor should be asked to provide a list of the people who handled the suspected food, whose full names should be recorded.

"4" Self-explanatory.

"5" Ask the person if he/she appeared to have been healthy during the 72 hours prior to the start of the outbreak being investigated. Place an "X" in the appropriate space.

"6" If the handler is currently working and has a disease that can be classified in one of the three columns, specify the disease in the appropriate column.

"7" Investigate the possibility of family members currently, or previously, presenting the same symptoms.

"8" Note information on habits of handling and personal hygiene of the handler.

"9" Indicate the type of sample sent to the laboratory.

"10" Place an "X" in the appropriate space: "NO" if handler has not missed any work and "YES" if he/she has, specifying the reason for absence in the appropriate space.

FBD FORM 5

GUIDELINES FOR SANITARY INSPECTION OF FOOD PREPARATION FACILITIES

(List of items to be inspected hygiene and food protection)

A. FOOD HANDLERS

1. Personal hygiene: Good appearance, body and hands clean, nails trimmed and without polish, no rings or bracelets, full uniform, light colored, clean and in good condition.

2. General hygiene: Thorough washing of hands before handling food and after using restroom. No coughing on food, no eating any food, smoking, touching money or performing any action that might result in food contamination.

3. Health status: Absence of skin diseases, wounds, lesions with pus, no symptoms of respiratory disease (cough), gastrointestinal disease (vomiting, diarrhea) or conjunctivitis, rhinitis, otitis, etc.

B. FOOD

4. Food and raw materials present normal organoleptic properties

5. Food and raw materials: Provided by authorized establishments, packaging, labels, statutory information on product, registered with the Ministry of Health and/or Ministry of Agriculture.

6. Protection from Contamination: Food free of dust, insects, and rodents. Hazardous substances such as insecticides, detergents, disinfectants, etc., adequately identified, stored and used in conditions that prevent the possibility of contaminating the food. Transportation that is appropriate and clean.

7. Protection from Change: Perishable food maintained at freezing temperature, under refrigeration, or above 70ºC (158ºF), according to the type of product. Hygienic Food storage, display, and maintenance.

8. Food Handling: Minimum and hygienic manual operations. Utensils are clean and well maintained.

9. Elimination and Disposal of Food Remains

C. EQUIPMENT

10. Machinery: For use with food, stainless steel. Surfaces coming in contact with the food, are washable and waterproof, clean, well maintained and in good working order.

11. Furniture: Sufficient tables and counters with adequate surface capacity, planned to allow easy cleaning, surfaces in contact with food are smooth, washable, and waterproof. Well maintained under good hygienic conditions.

12. Utensils: Smooth, of non-polluting material, of size and shape conducive to easy sterilization, well maintained under good hygienic conditions.

13. Equipment for Food Protection and Preservation: Refrigerators, freezers, cold-storage rooms, etc., adequate to the purpose, types of food and production and delivery capacity: surfaces, washable, and waterproof surfaces, well maintained, in good working order and hygienic.

D. ENVIRONMENT:

14. Location of the site and general construction factors.

15. Presence of Insects, Rodents, Others.

16. Disposal of liquid and solid wastes

FBD FORM 6

ATTACK RATES FOR FOODS SERVED IN AN FBD OUTBREAK

FBD FORM 6

ATTACK RATES FOR FOODS SERVED IN AN FBD OUTBREAK

I. OBJECTIVE

To record data needed to calculate the specific attack rates for each food served at a given event, based on the people who became ill and those who did not, and whether or not they ate the suspected food. With this information it is possible to estimate the risk attributable to each of the foods analyzed.

II. PROCEDURE

Personnel responsible: Epidemiology personnel: both for filling out the form and for processing and interpreting the data.

Number of copies: Original.

When required: Whenever an FBD occurs and there is no hypothesis as to the vehicle.

Destination: After processing the data, the attack rates and attributable risks should be calculated for each of the foods, and the results interpreted. The form should be placed on file with the epidemiology personnel at the health service that investigated the FBD outbreak.

INSTRUCTIONS FOR FILLING OUT FBD FORM 6

1. List all the food served at a given event.

2. In the appropriate columns, indicate the numbers of sick people and healthy people who ate and who did not eat each of the foods of the list.

3. Calculate the specific attack rate (as a percentage) for each of the foods, using the following formulas:

4. Calculate the risk attributable to each of the foods as follows:

(Specific attack rate                     -          (Specific attack rate among those who did
 among those who ate food "Y")                  not eat food "Y")

5. Complete the form by recording conclusions drawn with to the suspected food. The food responsible for the FBD outbreak is usually the one that has the highest attributable risk.

6. Use FBD FORM 7 to compare the attack rates for combinations of foods.

COMBINED ATTACK RATES BASED ON FOODS CONSUMED

Place and date:

Responsible Staff Member:

FBD FORM 8

I OBJECTIVE

To record the results of the Hazard Analysis Critical Control Point (HACCP) evaluations, which provide a systematic approach to identifying, assessing, and controlling risks, placing emphasis on the factors that directly affect food safety.

NOTE: All criteria selected for applying the HACCP should be duly documented and specified, with tolerances, where appropriate. Choice of control criteria depends on usefulness, cost, feasibility and whether it ensures a high level of security. This method can be used to control food safety both in the home and in food-processing plants or establishments where processed or semi-processed food is sold. It can also be applied to the production and harvesting of crops, raising of livestock and poultry, fishing, harvesting of shellfish, and the transportation, storage and marketing of foods, etc.

The HACCP approach is made up of the following components:

(a) Identification of hazards and evaluation of their severity.

(b) Determination of critical control points at which the identified hazards can be controlled.

(c) Specification of criteria that indicate whether an operation is under control at a particular critical control point.

(d) Establishment of procedures to monitor each critical control point in order to check that it is under control.

(e) Implementation of appropriate corrective action when monitoring indicates that criteria specified for a critical control point are not met.

(f) Verification to ensure that the system is functioning as planned.

II PROCEDURE

Personnel responsible: Personnel in charge of food control. The official agency to which such personnel are attached varies depending on the work site (e.g., processing plant, hospital, restaurant or street booth, etc.) and the legislation in each country.

Number of copies: Original and Copy.

When required: Whenever the HACCP approach is applied, regardless of the circumstances.

Routing: The original should remain with the person responsible for carrying out the recommendations indicating under section "A" with regard to controlling the critical points detected at the time the HACCP approach was applied.

After analyzing the information, the copy should be made part of the file with the personnel who carried out this activity.

This form should be kept for subsequent monitoring to determine if the remaining recommendations have been implemented. If the recommendations have been implemented, determine whether the critical points are under control. If not, take the appropriate corrective action.

III. CONTENTS

A. DATA ON THE FOOD BEING MONITORED

"1" Identify the FBD outbreak being investigated.

"2" Self-explanatory.

"3" Place an "X in the appropriate space. If the type of site is not listed, mark "other" and specify.

"4" through "7" Self-explanatory.

B. APPLICATION OF THE HACCP

"8" and "9" Indicate the date and time when each stage of the process being analyzed began and ended, e.g.: processing, transportation, distribution, storage, etc. with regard to the factor(s) being monitored.

"10" Specify the factor to be monitored; this may be physical, chemical, biological or sensory in nature.

The principal factors to be monitored may include: time and temperature for thermally-processed food; water activity of certain foods; pH of fermented foods; chlorine levels in water that is to be drunk fresh; humidity in storage areas for dry products; temperature during distribution of frozen products; depth of product in trays to be frozen; instructions on labels of finished products describing procedures for preparation and use by consumer.

"11" Record the results of HACCP evaluation, using conventional symbols to indicate possible existence or lack of critical control points. The column is divided in two so that the left side can be used to qualify the factor being monitored and the right to qualify the stage described in the next column.

"12" Describe each stage of the process being monitored (processing, transportation, distribution, storage, etc.), depending on the interest in identifying potential risks.

C. OBSERVATIONS OF EPIDEMIOLOGICAL INTEREST

Note any observation that might be useful in identifying potential hazards and critical control points.

D. RECOMMENDATIONS ON THE CONTROL OF CRITICAL POINTS

Make any pertinent recommendations, with regard to the critical points that should be controlled.

"13" and "14" Self-explanatory.

FLOW CHART

For illustrative purposes, a flow chart can be drawn on the back of the form to show the manufacturing or other processes that the food has gone through.

FBD SURVEILLANCE FORM 9

GUIDE FOR THE FINAL REPORT ON AN FBD OUTBREAK

DATE:........................................... Name of person filling out form: ......................................

FINAL REPORT ON AN FBD OUTBREAK

FBD FORM 9

I. OBJECTIVE:

To summarize the findings of the epidemiological studies for each outbreak and forward them to the various levels of the FBD surveillance system.

II. OPERATIONAL PROCEDURE:

Personnel responsible: The epidemiology personnel.

Number of copies: One copy for the files and other copies as necessary for reporting to the other levels of the FBD surveillance system.

Publishing: Upon completion of the investigation of any FBD.

Routing: As indicated in the flow chart (see Figure 1 in the main text)

III. CONTENTS

Enter data contained in FBD Forms 1 through 8.

FBD FORM 11

FINAL REPORT OF A FBD OUTBREAK
Regional Information System for Surveillance of Foodborne Diseases

1. Outbreak identification

2. Disease identification / agent

3. Food / ingredients

4. Place

5. Contributor factors

6. Affected persons

The instructive to fill out this form is distributed to the department of national level of the countries which report to Regional Information System for Surveillance of Food-borne Diseases (SIRVETA).

FBD Form 12

Half-yearly Information to SIRVETA about FBD cases

Country____________________ Half-yearly _____________ Year _______

Date of the report _____________________

⁽¹⁾ Others disease, describe

The instructive to fill out this formulary is distributed to the department of national level of the countries reporting to the Regional Information System for Surveillance of Food-borne Diseases (SIRVETA).