When the Coordinated Outbreak Response and Evaluation (CORE) Network was launched last summer, its teams were tested almost immediately, as was the Food and Drug Administration's new approach to outbreaks of foodborne illnesses.

It was August 2011 and reports were coming in of people suffering from Listeria monocytogenes. This outbreak—eventually tied to whole cantaloupes grown on a Colorado farm—proved to be the deadliest in decades in the United States, killing 30 people and making 146 sick in 28 states.

It was trial by fire for the new FDA team that had been more than a year in the making. By the end of its first year, CORE would also deal with major outbreaks involving frozen tuna used in sushi, sprouts, frozen oysters and Turkish pine nuts. It would also face human illnesses linked to the handling of contaminated pet food.

So what is CORE exactly?

It is a full-time staff dedicated to the investigation, control and prevention of outbreaks of illnesses caused when human food, animal food and cosmetic products are contaminated with bacteria, such as Salmonella, E. coli and Listeria. CORE closely coordinates its activities with FDA offices and staff in the field, as well as with state and local authorities and other federal agencies—making this a true network.

In the past, FDA would pull staff together on temporary assignment from all over the agency to respond to an outbreak. FDA Commissioner Margaret Hamburg, M.D., called for a new approach—a dedicated team that would not only streamline the response, but would constantly work to improve that response going forward.

For this new team, CORE recruited some of the veterans of outbreak response—including epidemiologists, veterinarians, public and environmental health specialists, consumer safety officers and policy analysts. New additions came from all over the agency to staff the permanent team that would not only respond to outbreaks, but would detect them earlier, and prepare the lessons learned for the future.

"We intentionally brought in people from multiple disciplines, with multiple perspectives," says Roberta Hammond, Ph.D., CORE's response manager. "Each person has different talents, skills and levels of expertise. We wanted to bring a fresh perspective to all outbreak-related activities at FDA."

"In this era, the whole point is to be one step ahead," says Kathleen Gensheimer, M.D., MPH, CORE'S chief medical officer. "It's not just about putting out the fire. It's trying to figure out what started the fire, and then prevent it from happening again."

Teamwork is Key

There are several teams in CORE:

• Signals and Surveillance: This team continuously monitors trends and data from a wide range of sources in search of signs that an outbreak is emerging.
• Response: There are three separate teams to facilitate rapid response to multiple outbreaks. Their work is to stop the outbreak, working closely with FDA district offices, and with their partners in local, state and federal agencies.
• Post-response: This team works to prevent the next outbreak by putting together the lessons learned and using them to help update or improve FDA policies, processes and the guidelines that are provided to the food industry.

Because communication with the public throughout the outbreak is key, there is a three-member communications staff involved from the beginning with each of the response teams. The communications team provides all information that will be shared with the media and with consumers about outbreaks.

"We're very organized," says Hammond. "Our structure enables us to handle multiple outbreaks."

The First Year

Hammond says CORE has dealt with both small and large outbreaks this year, sometimes being confronted by pathogens (disease-causing organisms) that the teams hadn’t seen before. She said the major efforts were associated with:

• Listeria monocytogenes in cantaloupes: This was the first documented case of Listeria in whole cantaloupe. FDA ultimately identified factors that likely contributed to the outbreak, including failure to follow safe food handling practices in the facility where the cantaloupes were stored and packed. There was also improper cleaning and use of equipment.
• Salmonella Bareilly in frozen scrape tuna: A raw, frozen yellowfin tuna product (called "scrape") used to make sushi made more than 400 people sick in 27 states and the District of Columbia. CORE worked with colleagues from across FDA within the agency's Emergency Operations Center to manage the response to this outbreak, which was eventually tied to an imported frozen tuna product from a processing facility in India.
• Salmonella Infantis in dry pet food: Twenty-two people in 13 states became ill from exposure to dry pet food—either by handling the food or touching an infected animal—manufactured by Diamond Pet Foods. The company recalled more than 16 brands of dry dog and cat foods.

"We've learned a good deal and we're continually evolving," says Gensheimer. "I am proud of what we've accomplished so far. And I think that the CORE Network will only get better in the coming months and years."

This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.

August 6, 2012