The Coun​​​cil to Improve Foodborne Outbreak Response (CIFOR) is a multidisciplinary collaboration of national associations and local, state and federal agencies representing epidemiology programs, environmental health programs, public health laboratories, and regulatory agencies. Since 2006, CIFOR has worked together to improve methods to detect, investigate, control, and prevent foodborne disease outbreaks. The food industry is represented on the CIFOR Industry Workgroup.

CIFOR identifies barriers to rapid detection and response to foodborne disease outbreaks and develops products that address these barriers. Some of the Council's products include:



The Laboratory Voice in CIFOR 

As a founding member of CIFOR, APHL works to identify barriers to rapid, accurate detection and investigation of foodborne disease outbreaks. APHL also proposes projects to address these barriers, notably those that impede laboratory response to foodborne illness.

The CIFOR products described below can assist public health laboratories and other agencies involved in response to foodborne outbreaks to:

  • Enhance collaboration among stakeholders

  • Identify model practices for foodborne disease investigations

  • Promote the value of molecular surveillance of foodborne illnesses

CIFOR Guidelines for Foodborne Disease Outbreak Response and companion Toolkit, Second Edition

The CIFOR Guidelines for Foodborne Disease Outbreak Response serve as a comprehensive source of information on foodborne disease outbreak investigation and control for state and local health agencies. The Guidelines describe the overall approach to addressing foodborne disease outbreaks, including preparation, detection, investigation, contr​ol and follow-up, and the roles of key organizations in foodborne disease outbreaks

Designed to aid in the implementation of the Guidelines, CIFOR cr​​eated a companion CIFOR Toolkit that contains a series of worksheets and "keys to success" (model program activities). The CIFOR Toolkit helps state and local health departments understand the contents of the Guidelines, furthers their ability to conduct self-assessments of their outbreak detection and investigation procedures, and facilitates implementation of appropriate recommendations from the nine chapters in the Guidelines.

CIFOR Outbreaks of Undetermined Etiology (OUE) Guidelines and OUE Agent List

The CIFOR OUE Gui​delines include recommendations on "universal" collection, shipment, testing and retention of foodborne outbreak specimens, even in the early stages of​ an investigation. Based on syndromes and specific outbreak profiles, the guidelines are designed to provide adequate specimens for second-tier testing and pathogen discovery should an etiology prove elusive.

The OUE Guidelines cover both infectious and non-infectious agents. A companion OUE Agent L​ist provides detailed information on each agent including incubation period, primary signs and symptoms, primary specimen(s) and key epidemiological information.

In collaboration with the CIFOR OUE Guidelines Work Group, the Oregon Department of Health developed an application-based, interactive version of the OUE Guidelines. The electronic tool provides guidance on recommended "universal" outbreak specimen collection, shipping information, recommended rule-out testing and long-term storage for negative specimens.

An Economic Evaluation of PulseNet

A 2016 economic evaluation of PulseNet activities from 1994 to 2009 shows the exceptional cost-effectiveness of this network. PulseNet costs public health agencies $7.3 million annually​. But it provides an economic benefit about 70 times greater than its cost by quickly identifying problems in the food supply that would not otherwise be recognized. This fast detection of problems leads to prompt actions to stop foodborne outbreaks, prevent additional people from getting sick, and save lives. Additionally, outbreaks detected by PulseNet have provided strong incentive for the food industry to make process improvements that reduce the risk of illness.

CIFOR Metrics Project

CIFOR developed standardized performance criteria and metrics promote a common understanding of the key elements of surveillance, outbreak investigation, and control activities. The CIFOR Metrics facilitate training of staff, allow for program evaluation, identify specific needs for improvement, and help agencies demonstrate their public health effectiveness.

In collaboration with the CIFOR and Food Safety Centers of Excellence Metrics Work Groups, APHL developed an interactive, web-based version of the CIFOR Metrics. The CIFOR Metrics Entry Tool (C-MET) is under revision and not available at this time.