Enteric Diseases Toolkit

Enteric diseases are a substantial cause of morbidity and mortality in resource-limited communities. The capacity to prevent, detect, and respond to outbreaks caused by enteric pathogens is dependent on a public health system and a workforce equipped with specialized expertise and resources focused on epidemiology, environmental health, and laboratory science. CDC’s Division of Foodborne, Waterborne, and Environmental Diseases developed the Enteric Diseases Toolkit to help equip, build, and strengthen enteric disease-related capacity.

The Enteric Diseases Toolkit provides countries with a comprehensive package of needs assessments, training materials, and technical guidance to help monitor and evaluate outbreak prevention, surveillance, and response activities.

Toolkit Goals and Objectives

Build and Sustain:

  • Local and regional capacity around enteric disease outbreak prevention through the fields of epidemiology, environmental health, and laboratory science
  • Local and regional capacity around enteric disease outbreak detection, investigation, and response
  • Local and regional capacity to plan and manage food, water, and environmental health systems and infrastructure
  • An online platform to house continuing education training materials
  • A system to track training graduates and promote retention of graduates

Develop and Strengthen:

  • Enteric disease outbreak response training modules to build workforce capacity
  • National surveillance and monitoring of enteric disease pathogens

Facilitate:

  • Rapid and transparent reporting and sample sharing in the event of enteric disease outbreaks
  • The incorporation of monitoring and evaluation activities into routine enteric disease prevention, detection, and response programs
A young man hauls plastic containers in a wheelbarrow down an urban street

Taken during a site visit in Sierra Leone while conducting the BCR — DFWED photo contest winner (taken by Gouthami Rao)

A woman walks through a marketplace carrying a basket on her head full of plastic pouches that contain water

Captured as a group of epidemiologists and microbiologists visited Sierra Leone while training and piloting the BCR of DFWED's enteric diseases toolkit — DFWED photo contest winner (taken by Gouthami Rao)

A young girl looks at a waterway that runs through a densely populated neighborhood. The waterway contains a lot of debris.

Captured as a group of epidemiologists and microbiologists visited Sierra Leone’s Magazine Wharf. Here, a young girl gazes on Magazine Wharf’s populated waters — CDC-wide photo contest winner (taken by Gouthami Rao)

Baseline Capacity Review

The Baseline Capacity Review (BCR) is intended to assess country capacity to prevent, detect, and respond to enteric disease outbreaks. The purpose of the BCR is to identify gaps within a country’s public health system and workforce. GHU has developed a Water, Sanitation, and Hygiene (WASH) BCR and is currently developing a Foodborne BCR. As of 2021, the BCRs have been piloted in 11 countries.

After a BCR is completed, capacity scores are generated to highlight strengths and weaknesses across several areas.

The WASH BCR assesses competencies in the following areas:

  1. Pre-survey Background
  2. Existing WASH Framework
  3. WASH Emergency Preparedness and Readiness
  4. Real-Time Surveillance
  5. Environmental Sampling and Microbiology
  6. Clinical Sampling and Microbiology
  7. Workforce Development
  8. WASH-Related Disease Outbreak Response
  9. Cholera
  10. Shigella
  11. Typhoid
  12. Quality Management Systems

The responses captured in these sections are used to develop customized trainings that aim to address gaps and build capacity in disease surveillance, accurate data collection, timely and efficient outbreak investigations, and routine monitoring and evaluation of systems and progress. After the BCR is conducted, additional tools may be created to improve workforce development, resource management, laboratory efficiency, operational management of water and environmental systems, and standardization of national protocols and guidelines needed to promote good WASH practices and outbreak detection and response.

For more information on the Enteric Diseases Toolkit and the WASH BCR, please contact ghu@cdc.gov.

Case Studies

CDC has worked with global partners to prevent and stop the spread of enteric diseases by identifying and managing responses to foodborne and waterborne disease outbreaks. CDC DFWED developed case studies for cholera, Salmonella, and typhoid that are useful for training public health professionals. These interactive simulation opportunities can be adapted as train-the-trainer courses. For more information on available case studies, please contact ghu@cdc.gov.

Case Study Goals and Objectives

Goal: To simulate an enteric disease outbreak investigation

Learning objectives: After completing a case study, participants should be able to:

  • Discuss the steps of an outbreak investigation
  • Develop a case definition
  • Explain available interviewing tools and demonstrate good interviewing skills
  • Perform descriptive epidemiologic analyses and interpret the results
  • Develop hypotheses regarding source and/or vehicle using data and know which action(s) to take
  • Discuss control and prevention measures during an outbreak
  • Understand the role of the laboratory in outbreak investigation
  • Discuss key communication considerations during outbreak investigations
  • Identify public health actions that may result from outbreak investigations

Training E-Modules

The Enteric Diseases Toolkit Training Plan consists of three electronic training modules (E-modules):

  1. Foodborne Diseases
  2. Outbreak Investigation
  3. Water, Sanitation, and Hygiene (WASH)

The target audiences for the course are epidemiologists, laboratory scientists, and other public health professionals.  The self-paced training plan contains 15 hours of learning content. Each module may be completed independently. To receive a certificate, all three modules must be completed fully.

For access to the Enteric Diseases Toolkit Training, please create a profile in TRAIN.org.

The Enteric Diseases Toolkit Training Modules:

  • Foodborne Diseases Module: The four-part online training covers foodborne illnesses and pathogens, surveillance, and the burden of illness. It is designed to build and strengthen the capacity to detect, respond to, and prevent disease outbreaks.
  • Enteric Disease Outbreak Investigation Module: This four-part online training covers outbreak investigation using a 13-step approach. It includes case studies and interactive case investigations to teach the various aspects of an outbreak investigation.
  • WASH Introductory Training Module This four-part online training covers WASH and WASH-related diseases, routes and modes of transmission, principles of water quality, surveillance, and outbreak investigation. It is designed to build and strengthen the capacity to detect, respond to, and prevent WASH-related disease outbreaks.
Foodborne Illness Introductory Training may be accessed on TRAIN.org under The Enteric Disease Toolkit Training Plan. Each training provides ~5 hours of content

Steps of an Enteric Disease Outbreak Investigation may be accessed on TRAIN.org under The Enteric Disease Toolkit Training Plan. Each training provides ~5 hours of content

WASH Introductory Training may be accessed on TRAIN.org under The Enteric Disease Toolkit Training Plan. Each training provides ~5 hours of content