FoodCORE Year Eleven Summary

January 1, 2021 to December 31, 2021


The Foodborne Diseases Centers for Outbreak Response Enhancement (FoodCORE) program addresses gaps in foodborne disease response through enhanced capacity in laboratory, epidemiology, and environmental health to improve timeliness and completeness of outbreak response activities. The FoodCORE centers during Year 11 (January 1, 2021–December 31, 2021) were Colorado, Connecticut, Minnesota, New York City, Ohio, Oregon, South Carolina, Tennessee, Utah, and Wisconsin.

Program Highlights

In 2021, public health agencies around the world continued their fight against the ongoing COVID-19 pandemic. While some staff slowly transitioned back to their regular duties, FoodCORE centers still had limited epidemiology, laboratory, and environmental health staff available to investigate outbreaks and conduct routine surveillance for foodborne and enteric diseases. Often, staff supported enteric disease work and the pandemic response concurrently. FoodCORE centers continued to identify innovative solutions, leverage their enhanced capacity, and adapt their workflows to maintain enteric work during the pandemic.

FoodCORE student teams provided significant support to health departments that had limited capacity to conduct enteric disease investigations. Compared with 2020, the volume of enteric disease cases increased in 2021. As enteric caseloads returned to pre-pandemic levels, students provided the capacity to complete follow-up on cases, assist with data entry, maintain enhanced surveillance activities, and carry out investigations.

During the pandemic, FoodCORE centers revised their enteric disease investigation protocols and systems to improve efficiency and function in a remote work environment. By 2021, centers permanently adopted successful practices that were beneficial in improving data quality and efficiency in surveillance activities. For example, more centers transitioned their paper interview forms to Research Electronic Data Capture (REDCap), a free and secure web application for building and managing online surveys and databases. REDCap helped streamline workflows and reduce reporting burden on staff.

Some FoodCORE activities were still paused during 2021, including the revision of model practices. To date, four FoodCORE model practices have been published that share the cumulative success of FoodCORE centers so that others can learn from their experiences.

Despite the strain that the COVID-19 pandemic placed on the public health workforce, FoodCORE centers, in collaboration with OutbreakNet Enhanced sites, published a success story to document how they leveraged their existing resources to maximize support for enteric disease investigations while simultaneously responding to the COVID-19 pandemic.

Each year, FoodCORE staff at CDC and in FoodCORE centers share progress and updates on their activities at national meetings and conferences, including the Council of State and Territorial Epidemiologists (CSTE) annual conference and the Integrated Foodborne Outbreak Response and Management (InFORM) regional meetings. In 2021, CSTE and InFORM regional meetings were among many meetings and conferences that were held virtually.

Program Performance

Centers report metrics once a year to document changes resulting from targeted FoodCORE resources. Metrics for Salmonella, Shiga toxin-producing Escherichia coli (STEC), and Listeria (SSL) have been collected since late 2010. Metrics for norovirus, other etiologies, and unknown etiology (NOU) investigations have been collected since 2012. The metrics collected by FoodCORE centers are revised as needed to best meet program goals.

While FoodCORE centers were able to maintain most of their core activities in 2021, some metrics capture the impacts of COVID-19 on enteric disease response and staff capacity.

Graphs for Selected Metrics – Year Eleven

After a decrease from Year 9 to Year 10, the average number of Salmonella, STEC, and Listeria primary isolates/isolate-yielding specimens submitted to or recovered at public health labs increased from Year 10 to Year 11.

Download and view chart data [XLS – 48 KB].

Bar chart: the avg. # of primary SSL isolates/isolate-yielding specimens submitted to/recovered at PHL in yrs. 9, 10, and 11.

Orange = Salmonella. Teal = STEC. Purple = Listeria.

The average number of laboratory-confirmed cases reported to epidemiology staff increased from Year 10 to Year 11. In Year 10, each center reported an average of 825 SSL cases (679, 131, and 15 cases for Salmonella, STEC, and Listeria, respectively) compared to an average of 902 SSL cases (712, 169, and 21 cases for Salmonella, STEC, and Listeria, respectively) in Year 11.

In Year 11, it took centers 2 days to attempt an interview and 3 days to complete an interview for confirmed, probable, and suspected SSL cases. This turnaround time* (TAT) is comparable to that for Year 10.

*Time in median days

Since Year 6, centers have reduced the TAT from receipt or recovery at the whole genome sequencing (WGS) laboratory to the sequence being shared with the national database. TAT slightly increased in Year 11 as centers had limited staff capacity available for enteric sequencing.

Download and view chart data [XLS – 48 KB].

Line graphs: turnaround time from SSL receipt/recovery at WGS lab to sequence being shared with the natl. database in Yrs. 6–11.

Orange = Salmonella. Teal = STEC. Purple = Listeria. Time in median days.

In Year 11, centers conducted 45 SSL and 101 NOU environmental health assessments as part of investigations where there was a link to a common location of exposures. Environmental health assessments provide information needed to recommend effective short- and long-term interventions that stop ongoing foodborne outbreaks and prevent them in the future.

Only foodborne and point-source investigations are reported for NOU metrics.

In Year 11, centers maintained a high proportion of primary Salmonella, STEC, and Listeria isolates with WGS results: 97%, 94%, and 98%, respectively.

From Year 10 to Year 11, the average proportion of confirmed Salmonella, STEC, and Listeria cases reported to epidemiology staff with WGS information increased.

Download and view chart data. [XLS – 48 KB]

Dumbbell plot shows the average proportion of confirmed SSL cases reported to epidemiology staff with WGS information in Years 10 and 11.

Brown = Year 10. Blue = Year 11.

During the COVID-19 pandemic, centers had fewer epidemiology, laboratory, and environmental health staff available to investigate foodborne outbreaks and conduct routine surveillance. In 2021, centers were able to maintain most of their core activities, but the Year 11 metrics capture some of the ongoing impacts of COVID-19 on staff capacity and enteric disease response activities.

Download a print version of the FoodCORE Year Eleven Summary [PDF – 2 pages].

FoodCORE Reporting Periods

FoodCORE reporting periods
Baseline (Y0) =
Oct 2010 – Mar 2011
Year 1 (Y1) =
Oct 2010 – Sept 2011
Year 2 (Y2) =
Oct 2011 – Dec 2012
Year 3 (Y3) =
Jan 2013 – Dec 2013
Year 4 (Y4) =
Jan 2014 – Dec 2014
Year 5 (Y5) =
Jan 2015 – Dec 2015
Year 6 (Y6) =
Jan 2016 – Dec 2016
Year 7 (Y7) =
Jan 2017 – Dec 2017
Year 8 (Y8) =
Jan 2018 – Dec 2018
Year 9 (Y9) =
Jan 2019 – Dec 2019
Year 10 (Y10) =
Jan 2020 – Dec 2020
Year 11 (Y11) =
Jan 2021 – Dec 2021