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#FoodPoisoning: Using Social Media to Detect Outbreaks

Posted By Katelynn Devinney, Tuesday, February 7, 2017
Updated: Tuesday, February 7, 2017

Foodborne illness is not only an unpleasant experience, but also a major public health concern. Many individuals who acquire foodborne illnesses do not seek medical care and do not report their illness to health departments, which can make complete and timely outbreak detection nearly impossible. With the emergence of social media as a primary form of communication, many individuals do, however, complain to their friends and followers online about their illness, symptoms and possible causes. So, how can we harness the power of social media to stop foodborne outbreaks?

As a fellow with the Project SHINE Informatics Training in Place Program in the New York City Department of Health and Mental Hygiene (DOHMH) – with support from the Alfred P. Sloan Foundation and the National Science Foundation – I have been tasked with developing a system, using data from Twitter, to identify complaints of foodborne illness across the city. The DOHMH has a long history of applying innovative methods to improve foodborne disease surveillance. We utilize the citywide non-emergency information system, “311,” where anyone can submit a food poisoning complaint related to a New York City restaurant. Additionally, in 2011, after identifying reports of illness on the restaurant review website Yelp that were not reported to 311, DOHMH began collaborating with Yelp and Columbia University to obtain a daily feed of Yelp reviews and develop a machine learning program using text mining to identify reviews pertaining to foodborne illness. This project was supported by two former CSTE Applied Epidemiology fellows, Cassandra Harrison, MPH and Kenya Murray, MPH and resulted in the full integration of Yelp into our foodborne illness complaint system. Each year, approximately 4,000 restaurant-associated complaints are received via 311 and Yelp combined, which result in the detection of about 30 outbreaks.

Nevertheless, New York City is a large metropolitan area with more than 8.5 million residents, 78 percent of whom eat food purchased from the city’s approximately 24,000 restaurants and 15,000 food retailers at least once per week. There are ample opportunities for exposure to foodborne pathogens at New York City restaurants. Even with the integration of Yelp and 311, we remain concerned that we are not receiving all reports of restaurant-associated foodborne illness incidents in the city.

Working with Columbia University, we have developed a system very similar to that used for Yelp reviews, which pulls publicly available data from Twitter’s application program interface (API), and uses text mining and machine learning to identify tweets indicating foodborne illness. We have also developed a web-based application, which displays all Yelp reviews and tweets for epidemiologists to review and manually classify, and allows us to track follow up and conduct interviews with complainants.

Using this application, we can respond to Twitter users we believe to be tweeting about a potential food poisoning incident and ask them to complete a brief online survey. The survey asks about the restaurant name and location, date of their visit, details of the incident and contact information for follow-up. DOHMH staff attempt to interview all users who submit surveys to obtain more information about their symptoms, incubation period and a three-day food history.

The process of developing and launching the application was extensive; we encountered many roadblocks, such as accessing data through firewalls and obtaining secure public facing servers to allow survey data collection. We have only recently started tweeting and sending surveys; so far, the survey completion rate has been low (roughly two percent), but we have observed an overall positive reaction from the public to our tweets. We hope the response rate increases over time and the application is successful, so we can share our work and lessons learned with other health departments who want to incorporate social media into their surveillance and outbreak detection efforts.

Already, our project was recognized at the 2016 New York City Technology Forum as the Most Innovative Use of Social Media/Citizen Engagement. Since then, we’ve enhanced the application to allow us to automate processes and increase the sustainability of the project over time. We have also evaluated different data sources and aim to incorporate those that will increase both the timeliness and completeness of foodborne illness outbreak detection in New York City.



Pictured: New York City Social Media Foodborne Team accepting the award for
Most Innovative Use of Social Media/Citizen Engagement on November 14, 2016.

This project has been an incredible learning experience. I am very thankful to DOHMH, my mentors and Project SHINE for their continued support and guidance. None of this would have been possible without the work of Communicable Disease, Environmental Health and Information Technology staff at DOHMH, our partners at Columbia, our grant administrators at the Fund for Public Health New York and our funders. This collaboration provided me with an amazing opportunity to learn how to effectively communicate and coordinate between groups to promote innovation in informatics, which I will continue to apply throughout my public health career.
Katelynn Devinney, MPH, is an Informatics-Training in Place fellow at the New York City Department of Health and Mental Hygiene. She received her MPH from Columbia University Mailman School of Public Health. Ms. Devinney’s post is the fourth in a series of blogs by CSTE-sponsored fellows.

Tags:  cross cutting  epidemiology  fellowship  food safety  surveillance  workforce development 

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CIFOR Releases the Second Edition of the CIFOR Guidelines for Foodborne Disease Outbreak Response

Posted By Dhara Patel, Thursday, May 8, 2014
Untitled Document

The Council to Improve Foodborne Outbreak Response (CIFOR) is a multidisciplinary collaboration of national associations comprised of state and local agencies representatives and federal public health agencies whose goal is to improve methods at the local, state, and federal levels to detect, investigate, control, and prevent foodborne disease outbreaks. These CIFOR member organizations represent epidemiology, environmental health, public health laboratories, and regulatory agencies involved in foodborne disease surveillance and outbreak response. CIFOR identifies barriers to rapid detection and response to foodborne disease outbreaks and develops projects that address these barriers. CSTE co-chairs the CIFOR Council. More information about CIFOR can be found at www.cifor.us.

CIFOR released the second edition of the CIFOR Guidelines for Foodborne Disease Outbreak Response on April 25, 2014. The CIFOR Guidelines describe the overall approach to foodborne disease outbreaks, including preparation, detection, investigation, control and follow-up. These guidelines also describe the roles of all key organizations in foodborne disease outbreaks. The CIFOR Guidelines are targeted at local, state and federal agencies that are responsible for preventing and managing foodborne disease.

These guidelines incorporate many significant changes that have occurred in the foodborne disease surveillance and outbreak investigation framework since the first edition of the Guidelines was published in 2009. Examples of additions and changes include information about the Food Safety Modernization Act; new information about model practices in outbreak investigation and response; updated statistics, references and examples; and enhanced alignment between the Guidelines and the Toolkit.
While the publication serves as a comprehensive source of information for individuals and organizations involved in foodborne disease investigation and control, the Guidelines are not intended to replace existing procedure manuals. Instead, they are to be used as a reference document for comparison with existing procedures, for filling in gaps and updating agency-specific procedures, for creating new procedures where they do not exist, and for targeting training of program staff.
View and download the full Second Edition of the CIFOR Guidelines. If you and/or members of your organization/health department would like to request copies, please fill out this brief survey to request copies and provide an appropriate mailing address: https://www.research.net/s/89H5ZS6.
For more information on the CIFOR Guidelines, please contact Dhara Patel, MPH, at CSTE at (770) 458-3811or dpatel@cste.org.
Dhara Patel
Associate Research Analyst
The Council of State and Territorial Epidemiologists

Tags:  CIFOR  food safety  infectious disease  staff spotlight 

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Raw Milk Strikes Again

Posted By Sara Ramey, Wednesday, February 5, 2014
Updated: Wednesday, February 5, 2014

Tennessee recently experienced an outbreak of E. coli O157 associated with raw (unpasteurized) milk, in which 9 children became ill, 5 of whom were hospitalized, and 3 of whom developed hemolytic uremic syndrome (HUS). While the sale of unpasteurized milk is unlawful in Tennessee, it seems virtually impossible to entirely stop people intent on obtaining it. In this case, the affected families participated in a "cow share" program, in which they purchased a "share" of a cow (along with 20 or so others) from a farm which then distributes the raw milk from its herd to the "owners". This scheme skirts the issue of milk sales, as the consumers are purportedly drinking milk from their own animals

There is an almost endless list of concerning aspects to this outbreak. As is typically the case in these types of situations, the people who suffered the most harm were children, who are not the ones who made the decision about what they consumed. The implicated farm is not regulated by our Department of Agriculture, as it is not a commercial milk producer, and in the absence of a disease outbreak the Department of Health has no oversight of the facility. As soon as the outbreak was over, the farm reverted to the same situation, with no required testing or other regulatory oversight (though they did ask our department to declare them safe to reopen!).Overwhelming epidemiologic evidence and matching E. coli strains from the cows and farm environment were insufficient to convince many of this farm's consumers that the milk was the source of the outbreak (after all, we did not find it in batches of milk produced many days after the implicated lots were distributed).

Important lessons can be learned in any outbreak investigation. In this case, "social media" was a useful tool, as the farm's customers were active in a Facebook group, through which case finding and education could be done. While many consumers remained distrustful and resentful of government intervention, at least one distraught family of a very ill child subsequently agreed to videotape their story for public education about the risks of raw milk. In public health I think we are all too familiar with the seeming lack of response to presentations of data and scientific evidence, compared to the dramatic effect that a single compelling personal testimonial can have on people. When even one victim of such an event has the courage to share their story, we should do everything we can to help maximize the effect of that message to prevent future similar events.
It's extremely frustrating and sad to see outbreaks like this continue to occur, all over the country, despite widespread efforts to halt them. We will continue to fight to plug the regulatory gaps and try to stay a step ahead of creative attempts to circumvent our intention of protecting the public's health. In the meantime, vigorous investigation and intervention in outbreaks can continue to build our case, and hopefully help educate our communities (including those responsible for the health of vulnerable children).
 
Tim Jones, MD
State Epidemiologist
Tennessee Department of Health

Tags:  food safety  infectious disease  member spotlight  outbreak 

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