OUTBREAK INVESTIGATION 1 OUTBREAK INVESTIGATION 2 Outbreak Investigation Introduction Epidemiology deals with the study of the determinants and distribution of disability or disease in the population groups (Szklo & Nieto, 2014). Epidemiology is one of the core areas in public health study and is essential for the evaluation of the efficacy of the new therapeutic and preventive modalities as well in the new organizational health care delivery patterns. I have for a long time developed a lot of interest in the area towards learning more on finding the causes of diseases and health outcomes in populations. Epidemiology views the individuals collectively, and the community is considered to be patient. The area of public health study is systematic, scientific, and data-driven in analyzing the pattern or frequency of the distributions and the risk factors or causes of specific diseases in the neighborhood, city, school, country, and global levels. Epidemiology handles various areas including environmental exposures, infectious diseases, injuries, non-infectious diseases, natural disasters and terrorism (Szklo & Nieto, 2014). Specifically, this paper explores epidemiology in addressing infectious disease, food-borne illness in the community. Also, the paper examines outbreak investigations as an intervention towards addressing the foodborne illness in the society. Further, an evaluation of the intervention and the expected results are discussed to examine or analyze the contributions of the intervention. Foodborne Illness Foodborne illness is any illness that results from food spoilage of the contaminated food. Food can be contaminated by the pathogenic bacteria, contaminated food, parasites, or viruses, as well as natural or chemical toxins including several species of beans, and poisonous mushrooms. In the United States, food-borne illness is estimated to impact negatively over 76 million people annually (Jones, McMillian, Scallan et al., 2007). This is translated to 5,2000 deaths, and 325,000 hospitalizations. However, the true incidence of food-borne illness is unknown. The majority of food-borne illness and most of the deaths are linked to “unknown agents” following the difficulties encountered in the diagnosis a foodborne disease. An estimated $7 billion is lost regarding productivity and medical expenses and is attributed to the most prevalent but diagnosable foodborne illnesses. Comment by Vetter-Smith, Molly J: Reference needed for this statement Comment by Vetter-Smith, Molly J: References needed for these statements The under diagnosis in foodborne illnesses is further contributed by the majority who has the symptoms and signs of the disease but totally fail to seek medical attention. This circumstance coupled with the global and national distribution of foo.

1. OUTBREAK INVESTIGATION
1
OUTBREAK INVESTIGATION
2
Outbreak Investigation
Introduction
Epidemiology deals with the study of the determinants and
distribution of disability or disease in the population groups
(Szklo & Nieto, 2014). Epidemiology is one of the core areas in
public health study and is essential for the evaluation of the
efficacy of the new therapeutic and preventive modalities as
well in the new organizational health care delivery patterns. I
have for a long time developed a lot of interest in the area
towards learning more on finding the causes of diseases and
health outcomes in populations. Epidemiology views the
individuals collectively, and the community is considered to be
patient. The area of public health study is systematic, scientific,
and data-driven in analyzing the pattern or frequency of the
distributions and the risk factors or causes of specific diseases
in the neighborhood, city, school, country, and global levels.
Epidemiology handles various areas including environmental
exposures, infectious diseases, injuries, non-infectious diseases,
natural disasters and terrorism (Szklo & Nieto, 2014).
Specifically, this paper explores epidemiology in addressing
infectious disease, food-borne illness in the community. Also,
the paper examines outbreak investigations as an intervention
towards addressing the foodborne illness in the society. Further,
an evaluation of the intervention and the expected results are
discussed to examine or analyze the contributions of the
intervention.
Foodborne Illness

2. Foodborne illness is any illness that results from food
spoilage of the contaminated food. Food can be contaminated by
the pathogenic bacteria, contaminated food, parasites, or
viruses, as well as natural or chemical toxins including several
species of beans, and poisonous mushrooms. In the United
States, food-borne illness is estimated to impact negatively over
76 million people annually (Jones, McMillian, Scallan et al.,
2007). This is translated to 5,2000 deaths, and 325,000
hospitalizations. However, the true incidence of food-borne
illness is unknown. The majority of food-borne illness and most
of the deaths are linked to “unknown agents” following the
difficulties encountered in the diagnosis a foodborne disease.
An estimated $7 billion is lost regarding productivity and
medical expenses and is attributed to the most prevalent but
diagnosable foodborne illnesses. Comment by Vetter-Smith,
Molly J: Reference needed for this statement Comment by
Vetter-Smith, Molly J: References needed for these statements
The under diagnosis in foodborne illnesses is further
contributed by the majority who has the symptoms and signs of
the disease but totally fail to seek medical attention. This
circumstance coupled with the global and national distribution
of food make it difficult or impossible to detect the large
foodborne outbreaks in good time towards limiting the impact
of the illness. In most of the situations, the foodborne outbreak
investigations are conducted late after the impact is felt
rendering the society to the dangers associated with the spread
of such diseases while offering little support. Comment by
Vetter-Smith, Molly J: References needed for statement in this
paragraph.
The illness is related to foodborne threats that expose the
community to different problems. New food production methods
and new types of food are introduced into the society more
often following the changing tastes and the varied cultural
traditions. Therefore, the foodborne diseases follow the
contaminated food supply with several toxins and microbes
present in the evolving challenges. New foodborne illness

3. emerges if previously unknown pathogens appear in reservoirs
related to the food suppliers or transmissions through new
foodborne pathways (Addis & Sisay, 2015). The appearance of
the new foodborne diseases is challenging regarding description
and detections subjecting the society in a lot of silent sufferings
and eventual deaths that the medical practitioners fail to
identify or categorize. The public health sector and the society
as a whole faces a challenge in conducting a diagnosis of the
new foodborne diseases as well as in their treatments. From
investigations, reservoirs, transmission pathways, to prevention
stratagems, foodborne illness have subjected the community and
the public health into a lot of challenges that have never been
fully solved. Foodborne diseases have a dynamic spectrum with
a range of threats (Rooney, Cramer, Mantha et al., 2004).
Comment by Vetter-Smith, Molly J: References needed.
Today, an array of viral, parasitic, and bacterial pathogens
that are known to cause the foodborne infections are recognized
challenges to the public health in the U.S. In the last 30 years,
some these pathogens have been associated with the foodborne
outbreaks. Some of the pathogens were identified as pathogens
that are currently creating the whole mess in the society and are
likely to represent evolving new combinations of the virulence
properties. For instance, the pathogen E. coli O157: H7 that was
only recognized later in 1982 became one of the major
foodborne diseases. The several phage-induced mutations must
have accelerated the evolution of the pathogen to the creation of
the large bovine reservoir found in many continents in the
1990s. Comment by Vetter-Smith, Molly J: References
needed for these statements.
The burden of foodborne diseases is estimated to include
the hospitalization and morbidity it causes, the mortality, and
the resulting medical care, among others (McLinden, Sargeant,
& Thomas et al., 2014). May children fall victims of the
foodborne diseases and die of the disease yearly. These are
potential young members of the society that are lost creating
gaps in the future labor supply and other areas of production.

4. The similar scenario is witnessed when the society loses its
members to foodborne illnesses. The society becomes short of
manpower in different productions lines while the individuals
and families incur losses whenever the disease attacks the bread
winner. To the government, a lot of funds have to be put in
place to help curb the outbreak of the diseases as well as take
care of the affected. This is expensive and the money used
could be diverted to other productive ventures in the community
such as the development programs. Comment by Vetter-Smith,
Molly J: Many? Comment by Vetter-Smith, Molly J:
References needed for statements in this paragraph
Outbreak Investigation To Prevent Emerging Foodborne Threats
The process of preventing the foodborne illness involves
multiple efforts by incorporating different actors along the
production chain, starting from the farms to the food service.
Many pathogens are involved, and none of these pathogens are
vaccine preventable when the effects are felt in the final
consumers. It is important to educate food handlers, consumers,
and producers, and consumers about their responsibilities in
preventing the foodborne diseases in the society. However,
educating the different parties on their roles is still not
sufficient. The food contamination can take place at several
points from the farms to the table. Therefore, what is critical in
preventing the foodborne outbreaks is understanding the various
points along the production chain that are likely to expose the
food to the dangerous pathogens and working towards getting
solutions to ensure safety in those areas. Understanding the
different mechanisms of food contamination involves
investigation of the contamination events. Specifically,
investigation of the foodborne outbreaks is critical in re-
engineering the various food policies and processes for safety.
However, the focus should be on a particular pathogen or food.
Comment by Vetter-Smith, Molly J: Reference?
Foodborne outbreak investigation can enhance the overall
food safety. Whenever there is an outbreak, the immediate
action should always to prevent the illness from spreading to

5. some other areas or other people by ensuring that the impacts
are controlled. This makes it easy to diagnose the illness
eventually and even find solutions. Also important is to conduct
research to find out more concerning the disease to determine
the needs for new regulations or processes. Outbreak
investigations go beyond the locally apparent and large
outbreaks and examine the foodborne illnesses that are rather
considered minor cases in the society. What people fail to
understand that is that even the pathogens that are today causing
the large outbreaks were once minor and of little impacts to the
public health. However, it is necessary to investigate all the
cases since the pathogens are subjects to evolution in which
they develop to become more dangerous in the long run
compared to the initial stages. Outbreak investigation takes into
consideration even the outbreak that involves an individual in a
single city or town taking a meal with a substantial rate of
attack. Rather than ignoring such cases that might appear of
little importance before many people, the intervention focuses
on such cases so that the potential threats of the outbreak are
handled effectively in the initial stages.
Outbreak investigation employs the use of the network
models and network theory that are today the most significant
tools for predicting and understanding the epidemics in general.
Here, the intervention focuses on the spatial disease systems
that are dynamic and the networks quantify facilitates the
quantification of the coupling transportation and strength fluxes
presented between the spatially distributed populations. Also,
the aim will be at forecasting and understand the future of the
foodborne illness depending on the connectivity of the different
underlying transmission pathways (transport networks). Apart
from the focus on the human-to-human transmissible diseases
and the spatial disease systems that are dynamic, the
intervention strategy involving the outbreak investigation will
contribute significantly to look at the inverse problem, which is
also known as ‘zero patient’ problem in epidemiology (Shah &
Zaman, n.d). Comment by Vetter-Smith, Molly J: Provide a

6. reference for the network model and network theory. Also,
provide a brief summary of your specific chosen model/theory.
Comment by Vetter-Smith, Molly J: Could you explain this
a little more?? Comment by Vetter-Smith, Molly J: Reference
this.
Universal source detections maximum likelihood estimates
are adopted to derive the theoretical thresholds about the
detection probabilities based on the assumption of the viral
spread. The relationship between the node centrality and source
estimation is of great significance in the intervention. The only
challenge here is that the one must understand the
comprehensive knowledge about transmission network. Many
people have not been in a position to successfully implement
the procedure due to its demands. In this case, however, there is
the option of adopting the network-geometric approach for the
reconstruction of the epicenter to food-borne diseases
(Brockmann & Helbing, 2013). The intervention takes the
approach in which the focus is on the introduction of effective
distance redefinition of the spatial separations. The method is
effective in analyzing the underlying food distribution networks
as well as the viewing of the contagious process with
consideration to specific nodes in the food distribution network.
The complex spreading patterns can thus be mapped onto
regular, simpler wave propagation patterns only in scenarios in
which the origin of the actual outbreak is the reference node.
Here, the underlying network will capture the underlying
transmission pathways used in to transport the contaminated
food and not the human mobility patterns. Comment by
Vetter-Smith, Molly J: Could you explain this more as well?
Comment by Vetter-Smith, Molly J: References needed for
these statements.
Evaluation Of The Intervention And The Expected Results

7. Adopting the outbreak investigation using the network
models and network theories is a sure way to prevent food-
borne threats compared to the standard public strategies or
procedures that use tracings along the food shipping chains and
case-control studies. These methods or interventions are biased
in data collection and time-consuming. The network in this
intervention program will capture the different transportation
routes or transmission pathways that are the major points along
the food production chain identified to result in food poisoning
(Meyers, Newman, Martin et al., 2003). We have learned in the
earlier sections that the best approach to preventing food-borne
illness is understanding the mechanisms of food poisoning and
developing strategies that can control such points along the
chain of production. The technique employed will only require
spatial information on the case reports that are regularly
collected by the public health institutions. Therefore, the self-
report survey will be analyzed in this case. Also important will
be the model used for the food distribution networks. The
approach that is based on the concept of replacing the
geographic distance (conventional) with effective distance
efficiently identifies the most probable epicenters that are the
origins of the food-borne illness outbreaks. Comment by
Vetter-Smith, Molly J: Again, you need to be more specific
about which model or theory you are employing for your
intervention. Comment by Vetter-Smith, Molly J: Explain this
in more detail of what you mean by spatial information
Comment by Vetter-Smith, Molly J: What type of
questions will be asked on this self-report survey?
Conclusion
Epidemiology still finds a lot of challenges in handling
infectious diseases such as the food-borne diseases. What makes

8. the matter worse is the fact that these diseases are primarily
caused by pathogens that evolve overtime into new generations
and thus making it difficult to establish a conventional vaccine
to prevent the outbreak of food-borne illness. While several
interventions have been brought forward to prevent the outbreak
of food-borne diseases, most of the approaches have not been
effective enough in identifying the outbreak origin and then
acting immediately to control any potential spread of the
disease. Also, most of the methods adopted have been time-
consuming. Adopting the outbreak investigation in the
prevention of food-borne disease outbreak is more efficient than
the other methods when there is a focus on the network models
and networks theory, especially the new network-geometric
approach that only require spatial information to identifying the
outbreak origin based on the effective distance method.
References Comment by Vetter-Smith, Molly J: Your
references are not in correct APA format. Review APA style.
Brockmann, D., & Helbing, D. (December 2013).The Hidden
Geometry of Complex, Network- Driven Contagion
Phenomena. Science;342(6164):1337-1342. [PubMed]
Shah D, Zaman T. Rumor centrality: A Universal Source
Detector. In: Proceedings of the ACM SIGMETRICS'12. 199-
210.
Jones TF, McMillian MB, Scallan E, Frenzen PD, Cronquist
AB, Thomas S, Angulo F.J. (Feb 2007). A population-based
estimate of the substantial burden of diarrhoeal disease in the
United States; FoodNet, 1996-2003. Epidemiol
Infect;135(2):293-301. PubMed PMID:17291364. [PMC free

9. article] [PubMed]
Addis, M., & Sisay, D. (2015). A Review on Major Food-Borne
Bacterial Illnesses. Journal of Tropical Diseases & Public
Health, 2015.
McLinden, T., Sargeant, J. M., Thomas, M. K., Papadopoulos,
A., & Fazil, A. (2014). Component Costs Of Foodborne
Illness: A Scoping Review. BMC public health, 14(1), 1.
Rooney, R. M., Cramer, E. H., Mantha, S., Nichols, G.,
Bartram, J. K., Farber, J. M., & Benembarek, P. K. (2004).
A Review Of Outbreaks Of Foodborne Disease Associated
With Passenger Ships: Evidence For Risk Management.
Public health reports, 119(4), 427.
Szklo, M., & Nieto, F. J. (2014). Epidemiology: Beyond the
Basics. Burlington, Mass: Jones & Bartlett Learning.
Meyers, L. A., Newman, M. E. J., Martin, M., & Schrag, S.
(2003). Applying Network Theory To Epidemics: Control
Measures For Mycoplasma Pneumonia Outbreaks. Emerging
infectious diseases, 9(2), 204-210.