Federal support for state public health surveillance significantly improves the detection and reporting of foodborne illness outbreaks, a new study demonstrates.

Through Epidemiology and Laboratory Capacity (ELC) cooperative agreements, the U.S. Centers for Disease Control and Prevention (CDC) funds three state-level programs focused on foodborne illness outbreak detection and response: the Foodborne Diseases Centers for Outbreak Response Enhancement (FoodCORE), the Integrated Food Safety Centers of Excellence (Food Safety CoE), and OutbreakNet Enhanced (OBNE). To assess the effect of these ELC-funded programs on state foodborne illness outbreak reporting, researchers analyzed data from CDC’s Foodborne Disease Outbreak Surveillance System (FDOSS) for 2009–2022, which resulted in a dataset of 714 total state-years. The researchers looked for states’ outbreak reporting rate (the number of single-state foodborne illness outbreaks reported per year per state per million population) for all causes, and specifically for outbreaks caused by three high-priority pathogens: Salmonella, Shiga toxin-producing Escherichia coli (STEC), and Listeria.

Analysis showed that, out of 714 total state-years, 210 (29 percent) were for states not enrolled in any programs, while 350 (49 percent) participated in OBNE, 84 (12 percent) in FoodCORE, and 70 (10 percent) in the Food Safety CoEs. The average annual reporting rate per state for all foodborne illness outbreaks was 2.5 outbreaks per million population.

Between 2009 and 2022, states with no programmatic funding had an average foodborne illness outbreak reporting rate of 1.54 per million population, which was lower than OBNE states (2.4 per million), FoodCORE (3.75 per million), and Food Safety CoE states (4.16 per million). For outbreaks associated with Salmonella, STEC, and Listeria, average reporting rates per million population were 0.37 for states not enrolled in any programs, 0.46 for OBNE states, 0.69 for FoodCORE states, and 0.67 for Food Safety CoE states.

Statistically, compared to states without program enrollment, Food Safety CoE states had a 2.69 higher average outbreak reporting rate, FoodCORE states had a 2.43 higher rate, and OBNE states had a 0.93 higher rate.

Average ELC funding per capita was significantly associated with increased outbreak reporting—a one dollar increase in average funding was associated with an estimated 0.88 reporting rate for all foodborne illness outbreaks, and a 0.14 increase in the reporting rate for outbreaks associated with Salmonella, STEC, and Listeria.

The researchers explain that the consistency of the findings between all foodborne illness outbreaks and the pathogen-specific outbreaks is important because, although most Salmonella, STEC, and Listeria outbreaks are detected through pathogen surveillance, the majority of foodborne illness outbreaks as a whole are caused by agents like norovirus and are detected through state and local complaint systems. Therefore, federal support for public health surveillance improves the detection and reporting of all causes of foodborne illness, which the researchers believe is due to the flexibility of ELC funding, as well as the promotion of evidence-based surveillance practices by FoodCORE and OBNE. Beyond ELC-funded support for specific programs that promote model surveillance practices, increased ELC funding provides states with flexible resources that can help provide surge capacity to respond to public health emergencies, including foodborne illness outbreaks.

Authors on the study are associated with the University of Minnesota School of Public Health, the Colorado School of Public Health, and the Washington State Department of Health. The study was funded in part by Minnesota and Colorado Integrated Food Safety Centers of Excellence, which are supported by the ELC for Infectious Disease Cooperative Agreement through CDC.