Key factors in successful outbreak management: lessons learned in the United Kingdom (50m Lecture)

Vero cytotoxin-producing E. coli (VTEC) are a group of bacteria which cause illness in humans. The most important VTEC strain to cause illness in the UK is E. coli O157. Symptoms can range from mild gastroenteritis to severe bloody diarrhea, mostly without fever, through to serious conditions such as hemolytic uremic syndrome (HUS). In recent years two major outbreaks of E. coli O157 have been subject to independent review in the United Kingdom.

The first outbreak occurred in Wales during the autumn of 2005, with 157 cases, of which 118 were confirmed microbiologically as E. coli O157, and 31 people were admitted to hospital. Tragically, a five-year old boy died. The Outbreak was caused by cooked meats that had been contaminated with E. coli O157 because of food hygiene failures at the premises of a catering butcher business, who supplied schools across South Wales. A Public Inquiry was established, which reported in March 2009.
The second outbreak occurred in Surrey in August 2009, and is the largest outbreak of E. coli O157 linked to an Open Farm to have occurred in the UK. There were 93 people affected, of whom 76 were under 10 years of age. 27 were admitted to hospital and 17 children were diagnosed with HUS. Epidemiological, environmental and microbiological investigations pointed to the main animal petting barn at the farm as the source of the outbreak. An Independent Investigation was commissioned, which reported in 2010.

This session will highlight the lessons learned from these reviews, focusing on the factors influencing the management of the outbreak investigations and the operation of the Outbreak Control Teams. A summary of the course of each outbreak investigation will be provided, followed by the comments of the independent review in relation to the management of the outbreak. The session will then synthesize these findings to identify those factors most crucial in successful investigation and control of a major outbreak, enabling delegates to reflect on their own experiences and practice to identify the practical steps required to ensure successful outbreak investigations in the context of their own jurisdiction and organizational arrangements.