challenges, but there are themes across the outbreaks, including the use of environmental sampling to determine whether relationships exist between the pathogens found in ill individuals
and in the environment of the suspected source. Whole-genome
sequencing (WGS) has also become an essential tool in outbreak
investigations, assisting in determining how closely genetically
related pathogens are. This helps investigators determine the
likely source of an outbreak and whether cases appear to be
linked. Further, the federal government through the U.S. Centers
for Disease Control and Prevention (CDC) and the U.S. Food and
Drug Administration (FDA) assist with financial support for state
and local outbreak investigations through a variety of funding
instruments (see “Programs That Assist State and Local Governments in Outbreak Investigations,” p. 36).
“Essential Disciplines,” p. 30).
Each outbreak investigation
is different and may require
a different level of effort from
each discipline. Success-
fully investigating outbreaks
requires strong programs in
each of the three disciplines.
This article will focus on
outbreak investigations in
three states: Washington,
Tennessee, and New York.
Each investigation has its
own unique nuisances and