The investigation of and response to multi-jurisdictional food-borne illness outbreaks in Canada may involve several organizations at multiple levels of government with complementary responsibilities. The Food-borne Illness Outbreak Response Protocol (FIORP) was collectively developed by the Public Health Agency of Canada (PHAC), Health Canada (HC), and the Canadian Food Inspection Agency (CFIA), in consultation with provincial and territorial stakeholders, to enhance the collaboration and overall effectiveness of response during multi-jurisdictional food-borne illness outbreaks.
The first edition of the FIORP was developed in 1999 by HC and the CFIA, in consultation with the provinces and territories (P/Ts). In 2002, the former Federal/Provincial/Territorial Committee on Food Safety Policy (FPTCFSP) recognized the FIORP as a key procedural document in national emergency preparedness, and identified a need to review this document and seek senior management endorsement. The FIORP was endorsed by the FPTCFSP, the Council of Chief Medical Officers of Health (CCMOH), and the Federal-Provincial-Territorial (F/P/T) Deputy Ministers of Health in 2004. In 2006, the document was further revised to reflect the role of PHAC. The current version was developed after consultation with F/P/T stakeholders throughout 2009 and received endorsement by the F/P/T Deputy Ministers of Health and Agriculture and Agri-Food, along with their respective supportive committees such as the F/P/T Food Safety Committee, the CCMOH and others.
The contributions of all the individuals who participated in the revision and consultation process are gratefully appreciated.
For more information on or to receive a copy of the FIORP please contact the Centre for Food-borne, Environmental and Zoonotic Infectious Diseases (CFEZID) at PHAC by e-mail: email@example.com or by calling (519) 826-2243.
The following definitions are provided to ensure a common understanding of the terms in this document.
Centralized Integrated Analysis: When multiple agencies are involved, centralized collation and analysis of data by the Outbreak Investigation Coordinating Committee (OICC) lead agency is required to inform decision-making and draw conclusions based on all available data.
Cluster: An unusual aggregation of similar health events, generally grouped together as they appear over a particular time period or geographical area. A cluster may be seen as the occurrence of cases of disease (human illnesses) in excess of what is usually expected for a given period of time. A cluster may or may not reach the status of an “outbreak.” The use of the term is particularly common in describing the results of subtype-based surveillance, which may detect a cluster of infections caused by similar microbial strains.
Emergency Operations Centre (EOC): The physical location where an organization comes together during an emergency to coordinate response and recovery actions, and resources. These centres may alternatively be called command centres, situation rooms, war rooms, crisis management centres, or other similar terms. Regardless of the term, this is where the coordination of information and resources takes place. The EOC is not an incident command post; rather, it is the operations centre where coordination and management decisions are facilitated.
Epidemiological investigation: Investigation made to determine the existence of an outbreak; to characterize it over a specific time period, geographical area and describe personal characteristics of cases; and to develop and test a hypothesis explaining the specific exposure that caused disease. The investigation may result in recommendations towards the implementation of appropriate prevention and mitigation measures.
Epidemiological evidence: The demonstration of an association between a food and human illness through an increase in cases in a population, place, or time frame with exposure to the same food product, or a statistically significant association between illness and food.
Evidence: That which demonstrates or shows an association between events. Evidence of an association between a consumed food and human illness may be epidemiological and/or based on the results of food safety investigations or laboratory analysis.
FIORP duty officer: Each partner will appoint a primary representative (by named position within its respective organization) who will be responsible for briefing senior officials within his or her organization and ensuring that the respective jurisdiction leads or participates in an OICC as required. FIORP duty officers will be notified by the OICC lead when an OICC is to be established with participation by their organization and will be responsible for notifying and providing regular updates to their senior officials. Contact information for the FIORP duty officers will be maintained as part of the FIORP contact list.
Food: Includes any article manufactured, sold or represented for use as food or drink for human beings, chewing gum, and any ingredient that may be mixed with food for any purpose whatsoever.
Food-borne hazard: A biological, chemical, or physical agent in, or a condition of, food that has the potential to cause an adverse health effect.
Food-borne illness: A human illness, with evidence indicating a food was the source of exposure to the contaminant causing illness. Food-borne illness occurs when a person consumes food contaminated with bacteria, viruses, parasites, or toxins.
Food safety investigation: Inspection and related activities undertaken by regulatory officials to verify whether or not a food hazard that could cause human illness exists and to determine the nature and extent of the problem.
Health Risk Assessment (HRA): A scientifically based process to determine the likelihood that a specific adverse health effect will occur in an individual or a population following exposure to a hazardous agent. The following steps are used in the development of a health risk assessment: 1) hazard identification, 2) hazard characterization, 3) exposure assessment, and 4) risk characterization.
Incident Command System (ICS): A standardized organizational structure used to command, control, and coordinate the use of resources and personnel that have responded to the scene of an emergency. The concepts and principles for ICS include common terminology, modular organization, integrated communication, a unified command structure, a consolidated action plan, a manageable span of control, designated incident facilities, and comprehensive resource management.
Laboratory evidence: Evidence shown by the isolation/identification of the same pathogen, toxin, or contaminant from cases of human illness and the suspect food.
Multi-jurisdictional food-borne illness outbreak: A food-borne illness outbreak that occurs in more than one province or territory (P/T) or occurs in Canada and involves another country or countries and requires the resources of more than one F/P/T public health and/or food regulatory organization to investigate or control it.
Outbreak: An incident in which two or more persons experience similar illness after a common source exposure. An outbreak is identified through laboratory surveillance or an increase in illness that is unusual in terms of time or geography. An outbreak is confirmed through laboratory and/or epidemiological evidence.
Partner: Any agency with a responsibility to investigate or respond to food-borne illness outbreaks in Canada, including F/P/T health and agriculture and agri-food agencies that share food safety and public health responsibilities.
Ready-to-eat food: Foods not requiring any further preparation before consumption, except perhaps washing/rinsing, thawing, or warming.
Recall: The removal from sale, use, or correction, of a marketed product that poses a risk and/or contravenes a statute.
Response: In the context of food-borne illness outbreaks, response includes activities related to the determination, investigation, mitigation, and containment of such outbreaks, as well as related communication activities.
Food-borne illness results from the natural, accidental, or malicious contamination of foods by microbiological or chemical substances. The impacts of food-borne illness may include morbidity and mortality, increased health care costs, loss of consumer confidence, economic losses, and lost productivity to industry.
Changes in food distribution networks and the increased globalization of trade in food have resulted in larger volumes of raw and processed products moving across domestic and international boundaries. Consequently, food-borne illness outbreaks associated with widely distributed foods result in human illnesses that cross local, provincial/territorial and international boundaries. Regulatory bodies responsible for human health and food safety respond to these events through the development of enhanced food-borne illness surveillance networks, including the use of molecular subtyping and other laboratory technology, to enable cluster detection and the linkage of seemingly unrelated cases to initiate outbreak investigation. Increased concern and public awareness of food safety has heightened the demand for swift resolution of food safety issues at a time when they are becoming increasingly complex, reinforcing the need for collaboration in multi-jurisdictional outbreak investigations and the active participation of all partners in centrally led efforts to mitigate risk and prevent further illness.
Food safety and public health are responsibilities shared by the Government of Canada and the P/Ts (the partners). Collaboration among these partners and across jurisdictions is of utmost importance to effectively manage multi-jurisdictional food-borne illness outbreaks. The partners recognize that formalized approaches will facilitate such collaboration and cooperation, thereby protecting the health of Canadians.
The principal framework document that guides multi-jurisdictional collaboration in response to food-borne illness outbreaks in Canada is the Food-borne Illness Outbreak Response Protocol (FIORP). This document has been in use since 1999 and is periodically reviewed and shared with partners and other implicated public health professionals for their endorsement.
The purpose of the FIORP is to set out the key guiding principles and operating procedures for the identification and response to multi-jurisdictional food-borne illness outbreaks in order to enhance collaboration and coordination among partners, establish clear lines of communication, and improve the efficiency and effectiveness of response, thereby protecting the health of Canadians.
It is designed to be used in response to illness outbreaks with a suspected or confirmed link to food consumed in Canada when more than one P/T or another country or countries and multiple agencies are involved.
It can serve as a model for individual P/Ts to develop their own food-borne illness outbreak response protocol when multiple jurisdictions/agencies within a single P/T are engaged in the investigation and response.
The FIORP is not intended to provide detailed instructions on how to conduct investigation and response. Rather, it serves to guide the collaboration of the partners in the identification and response to multi-jurisdictional outbreaks. This includes guidance for notification of partners, communication, and information sharing.
4.1 The FIORP describes activities beginning with the determination of a potential for multi-jurisdictional food-borne illness outbreak and ending with either the containment of the risk that triggered the outbreak or resolution of the outbreak. It also includes the post-outbreak review process.
4.2 The FIORP is intended to be used for outbreaks that affect, or have the potential to affect, more than one P/T or affect Canada and another country or countries. Where more than one country is affected, the FIORP is intended to guide activities within Canada only.
4.3 Where an individual P/T has a food-borne illness outbreak response protocol, it will guide outbreak investigations within that P/T. The FIORP may also be used by a P/T to guide investigation and response if the outbreak is limited to a single P/T, where a food-borne illness outbreak response protocol does not exist.
4.4 The FIORP addresses potential food-borne illness outbreaks resulting from the natural, accidental, or intentional contamination of foods by microbiological, chemical, or other hazardous substances (e.g. radio nuclear hazards).
4.5 The principles outlined in the FIORP may also serve as a guide when human enteric illnesses are caused by non-food sources (e.g. contaminated pet treats, petting zoo animals, pets, etc.) or when other food hazards cause widespread human injuries requiring prompt collaboration and coordination (e.g. inert physical hazards).
4.6 The FIORP operating procedures focus primarily on developing a coordinated response that is needed to mitigate food-borne illness outbreaks. While the FIORP does not specifically address the broader risk assessment process that contributes to policy development and standard-setting to reduce the risk of future outbreaks (occurrences), the opportunity to raise the need for future policy development to manage risk is provided for during the outbreak debrief/review (Section 7.11).
The principles underlying the FIORP are intended to guide the collaboration of the partners to maximize their effectiveness and efficiency during the investigation and response to multi-jurisdictional food-borne illness outbreaks. These guiding principles are listed below.
Responsibilities for responding to food-borne illness outbreaks may be shared between F/P/T and local/regional jurisdictions. The response to such situations involves collaboration and cooperation among all those involved. Annex 13 describes the legislative authorities within each of the F/P/T governments and provides more detailed roles and responsibilities of all the partners.
Local/regional health officials in individual P/Ts generally have the mandate to investigate human illness outbreaks that occur within their boundaries, with local/regional medical officers of health taking a leadership role. Additionally, they have the responsibility to report food-borne pathogens to provincial/territorial health officials under disease control legislation. However, in certain P/Ts, other departments (including Agriculture and Agri-Food) may also have a role in food-borne illness investigations.
P/Ts have food safety legislation and may also carry out inspection and education activities to reduce risks related to food. Provincial/territorial health officials conduct surveillance for enteric illnesses. Some P/Ts have their own individual food-borne outbreak response protocols to guide the collaborative response within the P/T and identify the lead should an outbreak span regional/local boundaries. Should an outbreak span regional boundaries or have serious human health implications, a leadership role in investigation may be assumed by the provincial/territorial Chief Medical Officer of Health. The provincial/territorial food regulatory officials are often called to participate and may lead the response under some provincial/territorial protocols. During their investigations, the various provincial/territorial or local/regional authorities may take steps to control potential causes of food-borne illness. In addition, the territories have responsibilities for the investigation of food-borne illness outbreaks that occur in First Nations communities north of 60 degrees.
Local/regional or provincial/territorial officials may also, in some cases, request the assistance of HC, PHAC, or the CFIA in the response to a potential food-borne illness outbreak. The P/Ts provide the case-level information required for the centralized collation and analysis of data by the OICC lead agency in order to inform decision-making and draw conclusions based on all available evidence during a multi-jurisdictional food-borne illness outbreak.
At the federal level, PHAC, HC, and the CFIA have legislated responsibilities for responding to food-borne illness-related events. The interaction between HC and the CFIA are detailed in the June 1999 Memorandum of Understanding between Health Canada and the Canadian Food Inspection Agency and its corresponding framework document entitled Roles and Responsibilities Framework For Federal Food Safety and Inspection Activities (June 1999). In 2008, a trilateral Memorandum of Understanding between Health Canada, the Public Health Agency and The Canadian Food Inspection Agency was finalized. The trilateral MOU specifies the roles and responsibilities of the CFIA, HC, and PHAC as they relate to the common issues that directly or indirectly have an impact on human health, including food safety and nutrition, infectious disease outbreak management, and emerging zoonotic diseases. These MOUs and corresponding roles and responsibilities frameworks reference the FIORP as a key guidance document. The following is a summary of the respective federal responsibilities regarding food-borne illness outbreak response.
Under the leadership of the Chief Public Health Officer, PHAC delivers on the Government of Canada’s commitment to promote and protect the health and safety of all Canadians. Among its activities is responding to multi-jurisdictional infectious disease outbreaks and acting as the National IHR (2005) focal point, that is, the national centre designated to communicate with the World Health Organization (WHO) IHR Contact Points under the regulations.
Within the Government of Canada, the usual first point of contact for notification by the partners of issues related to actual or potential food-borne illness outbreaks and requests for content expertise/support for food-borne outbreak investigation is the Centre for Food-borne, Environmental and Zoonotic Infectious Diseases (CFEZID), within the Infectious Disease Prevention and Control (IDPC) Branch of PHAC. The Centre plays the following role:
The National Microbiology Laboratory (NML) provides reference services for strain identification and characterization, national laboratory-based surveillance, and dissemination of information through PulseNet Canada and the National Enteric Surveillance Program (NESP) (described in Annex 9). The NML, through PulseNet Canada, is the usual first point of contact for P/Ts sharing strain identification data and the detection of clusters of strains that are occurring in more than one P/T, indicating the potential for multi-jurisdictional food-borne outbreaks.
PHAC has public health capacity and resources that can be mobilized to assist in the investigation of food-borne illness outbreaks. Programs include the Canadian Field Epidemiology Program (CFEP) and the Canadian Public Health Service (CPHS).
The CFEP, in the Office of Public Health Practice (OPHP), provides specialized training for health professionals in the practice of applied epidemiology. Field epidemiologists are deployed to assist in field investigations of food-borne illness outbreaks within the jurisdiction of their placement and are mobilized as an EPI-AID to local and provincial/territorial public health authorities. Field epidemiologists may also assist in international outbreak investigations.
The CPHS is a program to recruit and deploy qualified staff in consultation with interested health jurisdictions, and to provide these staff with ongoing field experience and training in order to build public health capacity across the country. The CPHS provides public health support to provincial, territorial or local health jurisdictions and to public-health-oriented NGOs and may be involved in enhancing routine surveillance and epidemiological work. The CPHS is also prepared to deal with broader public health issues as well as outbreak or pandemic duties as these needs may emerge.
Health Canada (HC) is the federal department responsible for helping Canadians maintain and improve their health. Its food safety responsibilities include
HC also has food safety responsibilities with respect to First Nations communities south of 60 degrees parallel, and food served on common carriers.
HC may be involved or assist with investigations of food-borne illness outbreaks as follows:
The Canadian Food Inspection Agency (CFIA) delivers all federal inspection and enforcement services related to food under the authority of 13 federal acts that address all stages of the food continuum. Not only does the CFIA inspect foods, but also the seed, livestock feed, fertilizers, plants, and animals on which a safe food supply depends. The CFIA’s contribution to the investigation and control of food-borne illness outbreaks includes its food safety investigation, testing and recall activities, as well as its regulatory compliance and enforcement activities.
The CFIA’s role in food safety investigations includes tracing foods from the retail level through distribution to production or processing facilities to pinpoint a suspected source of the problem. Information obtained throughout the food safety investigation provides the basis for the assessment of risk and the development of appropriate risk management strategies to control affected products. The food industry carries out most recalls voluntarily. However, if a company is not available or willing to conduct the recall voluntarily, the Minister of Agriculture and Agri-Food can, under the Canadian Food Inspection Agency Act, order a company to recall a product where the Minister believes that it poses a risk to public, animal, or plant health. In the case of voluntary recalls, the CFIA officials will verify that the recalling firm has recalled the product effectively.
When a potentially contaminated food that could pose a risk to the public has been identified in Canada, the CFIA launches a food safety investigation to
This work is done collaboratively with provincial/territorial partners guided by MOUs.
There are three groups within the CFIA that play key roles in the food safety response to food-borne illness outbreak situations:
Expertise from other F/P/T or international agencies may be sought to provide advice in the control of outbreaks caused by unusual pathogens or toxic substances in foods.
If an outbreak is suspected to be related to criminal activity (e.g. tampering and terrorism), law enforcement agencies (local police or the Royal Canadian Mounted Police (RCMP)) assume responsibility for the law enforcement response and the criminal investigation (Section 7.8.1).
The following sections outline the general operating procedures for coordinating the response to a potential multi-jurisdictional food-borne illness outbreak. Annex 3 provides a contact point for the current FIORP contact list.
Figure 1 provides a schematic representation of how the FIORP operates.
Notification refers to the initial contact between partners to identify an issue with the potential to become a multi-jurisdictional food-borne illness outbreak.
The general pathways for notification used to guide the sharing of information when such an issue is identified are described in Figure 2. Annex 4 provides a description of Public Health Alerts, which is an effective communication tool used for early notification of possible or confirmed outbreaks with the potential to be multi-jurisdictional among local/regional and F/P/T health officials (some F/P/T agricultural authorities also have access).
The following criteria are indicative of issues that have the potential to become multi-jurisdictional food-borne outbreaks. Officials at any level (local, provincial/territorial, or federal) should notify their appropriate partners when these criteria are identified for a more complete assessment of available information and the identification of a potential multi-jurisdictional food-borne illness outbreak:
The notification of international partners may also be required. The responsible federal partner will act as a liaison with foreign countries. In international food-borne illness outbreak situations, PHAC (CFEZID) will act as the main liaison with international public health counterparts. The CFIA will act as the main liaison with international food safety counterparts for international food safety related issues.
* Tool for early notification of possible or confirmed outbreaks with the potential to be multi-jurisdictional used by F/P/T health officials (some agricultural authorities also have access). It is an additional means of communication and does not replace normal notification as described above.
A potential multi-jurisdictional food-borne illness outbreak may come to the attention of public health or food regulatory agencies through the following means: notification from partners as described in Section 7.1; reports of human illness (surveillance); identification of a food-borne hazard during a routine inspection with the potential to cause human illness; or a food safety investigation. Examination of surveillance data and the determination of cases in more than one jurisdiction should prompt further investigation and notification of investigative partners.
Human health surveillance activities occur at the local/regional, F/P/T, and international levels. Increased or unusual cases of human illness will trigger investigations to determine a common source. Identification of human illnesses that may potentially be linked to food may originate from the following sources:
Food safety investigations may be triggered by the following situations:
Once a potential multi-jurisdictional food-borne illness outbreak has come to the attention of public health or food regulatory agencies, there is a requirement to examine the current available information and determine if it is sufficient to indicate the presence of a potential multi-jurisdictional food-borne illness outbreak that requires a collaborative and coordinated investigation and the activation of an OICC (described in Section 7.4).
A teleconference call will be held among affected partners (those with cases of human illness or having relevant food-borne hazard information) to review the available information and assess whether or not an OICC is required and should be activated.
The FIORP OICC should be activated when the investigation and response to the identified potential multi-jurisdictional food-borne illness outbreak involves or may involve cases occurring in multiple P/Ts or occurring in Canada and another country or countries and meets any of the following criteria:
An identified food-borne hazard in the absence of human illness or widespread injury would not trigger OICC activation. When a potentially contaminated food has been identified in Canada that could pose a risk to the public, the CFIA will launch a food safety investigation (Section 6.2.3).
The severity and scope of the identified potential multi-jurisdictional food-borne illness outbreak may further support the requirement for and activation of an OICC if, for example, any of the following exist:
When the initial assessment and review of available information indicates that an OICC is required and should be activated, the FIORP duty officers (Section 7.4.5) will be notified by the OICC lead (Section 7.4.3) and asked to inform their senior officials.
The OICC lead will initiate a teleconference call with the affected partners’ identified representatives to activate the OICC and begin the coordination of the investigation.
Any partner involved in an epidemiological or food safety investigation where evidence exists to show a food product is the cause, or has the potential to be the cause, of a multi-jurisdictional outbreak can request that the OICC be established under the leadership described below. Where conflicts arise over the need for the OICC to be established, these should be discussed with the FIORP duty officers representing the affected partners so that guidance from senior officials can be sought.
Identifying the source of a multi-jurisdictional food-borne illness outbreak represents a collaborative effort between local, provincial/territorial and federal agencies where sharing of information between public health and food regulatory agencies is critical to the investigation’s effectiveness in removing the source of risk to the public.
A central element of the FIORP is the establishment of an OICC, with representation from the partners who are actively involved in a specific outbreak, to coordinate a multi-agency response to a food-borne illness outbreak in Canada.
The purpose of the OICC is to allow the partners to use the FIORP as a guide to share information and to formulate and coordinate the outbreak investigation and response strategies in order to mitigate or contain the effects of multi-jurisdictional food-borne illness outbreaks in a timely and effective manner, thereby protecting the health of Canadians.
The OICC’s primary objectives are to
The purpose of the OICC is to effectively respond to multi-jurisdictional food-borne illness outbreaks by coordinating a unified response to the health risk. This requires the OICC to make consensus-based decisions to develop coordinated strategies. While the OICC will strive to reach consensus to guide response actions, the OICC partners recognize that each partner has unique legal obligations, policies, and mandates that must be respected. Any decisions made by one of the partners pursuant to its obligations, but related to the purpose of the OICC, should be communicated to all OICC members.
The OICC will attempt to resolve all differences of opinion during the course of an outbreak. However, when consensus cannot be reached, the partners should seek guidance from senior officials in their respective agencies through their identified FIORP duty officer (Section 7.4.5). Any decision made by senior officials in resolving the issue should be communicated to all OICC partners.
OICC collaboration includes the following:
Section 7.5: Coordinated Investigations
Section 7.6: Centralized Integrated Analysis
Section 7.7: Health Risk Assessment
Section 7.8: Public Health and Food Safety Actions
Section 7.9: Communication with the Public
Section 7.10: Outbreak Conclusion
Section 7.11: Outbreak Debrief/Review
An OICC will be comprised of representatives designated to act on behalf of the partners involved in the food-borne illness outbreak investigation. It is the responsibility of each of the partners to determine its own appropriate representation on the OICC. The partners should strive to limit representation on the OICC to the responsible parties required for investigation and response to the multi-jurisdictional food-borne illness outbreak.
The composition of the OICC will depend on the nature of the outbreak, and it may evolve as knowledge related to the source of the outbreak is generated during the outbreak. At varying times, it should have representatives that provide epidemiological, food safety, laboratory, and communication expertise from the different levels of government required.
Members may include the following:
The lead organization responsible for coordinating an OICC (OICC lead) is identified using these guidelines:
Any partner may request that an OICC be activated under the leadership described above.
Where an individual P/T has a food-borne illness outbreak response protocol, it will guide outbreak investigation within that P/T. The FIORP may also be used by a P/T to guide investigation and response if the outbreak is limited to a single P/T, where a food-borne illness outbreak response protocol does not exist.
If the FIORP is used by a P/T to guide investigation and response to a food-borne illness outbreak and the outbreak is contained within the single P/T, the affected P/T would be considered the OICC lead.
The OICC lead will be responsible for contacting all the FIORP duty officers (Section 7.4.5) of participating organizations to inform them that an OICC has been established and for ensuring that these representatives receive summaries of OICC activities and actions. The FIORP duty officers will be responsible for sharing these with senior officials within their respective organizations.
Responsibilities of the OICC lead will also include centrally collating and analyzing data, managing meetings, recording and distributing discussion summaries and action items, and maintaining documentation of the response effort.
The OICC teleconference calls/meetings are chaired by an individual identified by the OICC lead. The chair may change as the outbreak evolves.
The OICC will be dismantled once the outbreak is declared to be resolved. It is the responsibility of the OICC lead organization to advise other representatives that the OICC has been dismantled.
Each partner will appoint a primary designated representative, a FIORP duty officer, (by named position within its respective organization). FIORP duty officers are responsible for briefing senior officials within their organization and ensuring that their respective jurisdiction leads or participates in an OICC as required. The FIORP duty officers will be notified by the OICC lead when an OICC is established with participation by their organization and will be responsible for notifying and providing regular updates to their senior officials. Contact information for the FIORP duty officers will be maintained as part of the FIORP contact list.
To facilitate epidemiological investigations of multi-jurisdictional food-borne illness outbreaks, the OICC will assess what information is required and determine which partner is best able to gather the identified information. Every effort will be made to standardize the collected information. Data analysis will occur within each jurisdiction and agency as per standard protocol. However, when multiple partners are involved, the overall collation and analysis of epidemiological data will take place within the identified OICC lead. This analysis will support the examination of findings from all aspects of the outbreak investigation. This information will be shared as described in the Guiding Principle V (Section 5).
When human illness is recorded in more than one P/T with a potential link to a food source, or there is exposure to a common food distributed to more than one P/T, the OICC lead will coordinate the epidemiological investigation. This investigation will be conducted in collaboration with the affected partners. In international food-borne illness outbreak situations, PHAC (CFEZID) will act as the main liaison with international public health counterparts.
When the source of an outbreak is suspected to be a food, a food safety investigation will be conducted to determine whether the food may be responsible for the outbreak and to strive to identify the root cause of the contamination in the affected food.
If the food is imported or shipped interprovincially or manufactured in an establishment under the CFIA's jurisdiction, the CFIA will conduct the food safety investigation.
When a food product is produced or manufactured in a facility that received a licence or registration from a provincial/territorial or regional/local authority, or where the CFIA has signed an MOU with a P/T concerning shared responsibilities for inspection, the appropriate regulatory officials will conduct the food safety investigation and may request assistance from other regulatory partners.
Should the food safety investigation expand to include issues of employee health, where employee records of illness and/or employee test results are required, the responsible regulatory officials should request the assistance of the appropriate public health authority in the jurisdiction of the investigated facility.
Both epidemiological and food safety investigations usually involve laboratory testing. Each of the partners is responsible for conducting the appropriate laboratory analyses as part of its respective investigations and mandates. If an OICC is in place, it will coordinate laboratory analyses in order to avoid overlap and duplication, permit discussion of issues, and share results.
In some cases the lead partner may not have the necessary capacity or expertise to perform the necessary test(s). It should then contact supporting laboratories (refer to Annex 10 for detailed guidance on laboratory capability and instructions for access) in order to send the samples to a laboratory that has the required expertise and capacity.
The use of PulseNet or other existing laboratory networks should facilitate communication among F/P/T laboratories.
If Clostridium botulinum is suspected, clinical, food, and environmental samples should be sent directly to the Botulism Reference Service as per the instructions outlined in Annex 5, unless botulism testing is available within the P/T.
If Listeria monocytogenes is suspected, clinical, food, and environmental samples should be sent directly to the Listeria Reference Service as per instructions outlined in Annex 6, unless Listeria testing is available within the P/T.
When multiple partners are involved, centralized collation and analysis of data by the OICC lead agency is required to inform decision-making and draw conclusions based on all available data. Findings from the epidemiological, laboratory, and food safety investigations will be shared with the partner members of the OICC and integrated to identify the potential cause and source of the outbreak and areas for further investigation.
HC and the CFIA have federal responsibility for food safety. An appendix to the Memorandum of Understanding (MOU) between HC and the CFIA on Food Safety Emergency Response (dated May 2000) describes the roles and responsibilities of each party with respect to the management of the federal food safety system. Where no standard, or guideline exists, or where the standard, policy, or guideline does not provide an indication of the appropriate control expected to have adequate health protection relative to the identified health concern, HC is responsible for conducting a health risk assessment (HRA), upon request, for the CFIA or other stakeholders (e.g. provincial governments).
HC science-based health risk assessments are completed in a rapid and timely manner in order to ensure that appropriate risk management decisions are taken to prevent contaminated food from reaching the consumer. Data gathered through the centralized integrated analysis is considered in the HRA for the determination of the level of risk posed by a food. The HC HRA process follows the guidelines developed by the FAO/WHO Codex Alimentarius Commission 14, which is responsible for developing international food standards and guidelines. Decisions and rationales are conveyed to the requesting inspection authorities who depend on such assessments, and are also shared with the OICC to facilitate its coordination role. HC representation on the OICC ensures that the necessary background and information is provided to support the health risk assessment process.
Actions undertaken during a food-borne illness outbreak to address the source of the outbreak and prevent further cases of human illness may include a wide range of activities by one or more of the partners. Examples include
Each partner will conduct the necessary mitigation actions under its respective mandate. The OICC coordinates information sharing related to these actions. The OICC will also facilitate discussions concerning the timing of actions by multiple partners.
In the event that a multi-jurisdictional food-borne illness outbreak investigation identifies or suspects the intentional contamination of a food product, the appropriate local/regional law enforcement agency must be immediately notified. Regardless of police jurisdiction, the RCMP National Operations Centre must also be contacted at 613-993-4460.
Following notification of the appropriate authorities, the food safety and epidemiological investigations will continue to be carried out in collaboration with law enforcement authorities, who may conduct a criminal investigation. The partners involved in the food-borne illness epidemiological and food safety investigations would continue to collaborate while informing their respective law enforcement officials.
a) Exchange of Information with Industry
During an investigation, all implicated companies will be kept informed of developments by the responsible inspection authority.
The CFIA is the responsible inspection authority and primary contact, with processors and importers operating under federal jurisdiction. However, for processors operating under provincial/territorial jurisdiction or where the CFIA has signed an MOU with a P/T concerning shared responsibilities for inspections, the appropriate provincial/territorial officials would be the primary industry contact.
Some outbreaks may require communication with industry representatives beyond the implicated facility. In this case, the OICC will identify the lead communicator, according to the partners' mandates and jurisdictions.
b) Exchange of Industry Information between OICC Partners
The responsible inspection authority will share relevant information stemming from its investigation with other investigating organizations through the OICC, as appropriate. The exchange of information among government agencies will be conducted according to applicable provincial/territorial and/or federal access to information and privacy legislation, and existing information-sharing agreements. Confidential business information provided by industry will be treated accordingly.
Each of the partners has the responsibility to communicate with the general public, including those at greater risk, within its respective jurisdiction and to designate a spokesperson (see Annex 11).
Due to the nature of food-borne illness outbreaks, all involved partners have a responsibility to ensure that communications activities are coordinated in a consistent and timely way.
Communications staff develop products with input from content experts. Further details about responsibilities are provided in Annex 11, Guidelines for Communicating with the Public and Those at Greater Risk. The chart in the Annex defines which organization leads certain communication activities during food-borne illness outbreaks that are restricted to a single P/T, span more than one P/T, are occurring in Canada and another country or countries, or occurring on common carriers (e.g. cruise ships, aircraft, passenger ferries and passenger trains) and international vessels (i.e. cargo vessels) entering Canada.
Communication to health professionals may also be required as part of the response to a multi-jurisdictional food-borne outbreak. This communication will be coordinated as part of the OICC investigation and response activities. Distribution of the communication products to health care professionals remains the responsibility of the P/Ts.
Public communications activities and content in the event of a food-borne illness outbreak will be guided by several key objectives:
The Communications Directorate of PHAC will provide an evaluation of communications activities to assess effectiveness.
Annex 11, Guidelines for Communicating with the Public and Those at Greater Risk, provides a framework for public communications activities of the involved partners.
The OICC will evaluate all available evidence describing the progression of the outbreak in order to determine when response efforts can be concluded. The OICC lead should continue to monitor for ongoing cases that may need to be investigated for a period of time following the dissolution of the OICC to determine if they can be attributed to a particular source.
After reviewing the status of the food-borne illness outbreak, the OICC lead, in consultation with the OICC, will declare the outbreak investigation closed. The OICC will then be dismantled and the participating agencies may demobilize resources. OICC members will also collectively inform stakeholders of the conclusion of the OICC.
The OICC lead, with the assistance of agencies represented on the OICC, may prepare and circulate an outbreak summary or final report to chronicle key events and findings from the outbreak investigation.
Post outbreak reviews may be conducted at the request of the OICC lead or any of the partners involved in the response. For a large outbreak involving multiple partners, a formal debriefing meeting is recommended and should be chaired by the OICC lead.
The goals of the post-outbreak review should include, but are not limited to
The outbreak debrief/reviews should be conducted in a timely manner after the resolution of the outbreak in order to benefit from the lessons learned. Unless otherwise agreed upon by the partners, the OICC lead will chair the outbreak debrief/review. It is the chair’s responsibility to provide a summary report to all other partners. The partners may also further distribute the report to other officials within their organizations who would benefit from the information.
Annex 12 provides a list of questions to be addressed during the outbreak debrief/review process.
PHAC will be the custodian of the FIORP. Under PHAC’s leadership, the FIORP will be reviewed regularly to ensure the accuracy of organizational names, roles and responsibilities, and to assess the recommendations received through the post outbreak reviews. Smaller-scale revisions will occur as necessary to address these identified issues and to maintain up-to-date information regarding MOUs and information-sharing agreements as they are developed.
PHAC will also update the contact list quarterly, based on input from those on the list, and any changes provided by the partners will be made upon receipt.
A more formal review process will occur every five years to ensure the document is up to date and will be created with F/P/T input. An F/P/T body will be identified to perform this task.
Most multi-jurisdictional food-borne illness outbreak investigations do not require the use of an incident command system (ICS) and activation of emergency operations centres (EOCs).
However, agencies may consider using such an approach for some public health emergencies, including food-borne illness outbreaks, to help coordinate the response. Agencies that are implementing an ICS will determine the types of events or outbreaks that will trigger the use of such a system.
If an ICS is to be used, it should be incorporated into the agency's food-borne illness outbreak response protocol. In relation to food-borne illness events, all the partners are responsible for notifying other partners of their intent to utilize an ICS and activate their respective EOC(s).