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MANUAL OF NAVAL PREVENTIVE MEDICINE
about: the person (name, rate/rank, social security number, residential
address or work/berthing as assignments, duty station, age, race, sex, and
telephone number); their illness, if any (specific symptoms and specific
times at which symptoms developed), and food history (when, where and what
was eaten, as precisely as possible).  The time at which food was eaten and
symptoms started must be recorded precisely, e.g.,"0100" or "1245."
Responsible persons should interview and complete a questionnaire for each
person.
(3) Establish a diagnosis etiologically if possible, otherwise
define cases clinically or epidemiologically.  Obtain clinical specimens
from patients, for laboratory analysis to isolate or identify the etiologic
agents.  Ideally, specimens should be collected during the acute phase of
the illness when the patient is first seen or when the initial interview is
conducted.  Convalescent specimens collected after the patient recovers may
be useful for comparison.  If the patient has diarrhea, obtain a stool
specimen or rectal swab.  If the person is vomiting, collect vomitus.
Blood specimens are used to detect antibodies, or isolate pathogens.  Blood
and/or urine specimens may also be useful in confirming diagnosis of
chemical food poisoning.  Contact the laboratory officer at the nearest
medical treatment facility or NAVENPVNTMEDU for guidance on collecting,
storing, and shipping samples for analysis.  If the demand for laboratory
analyses exceeds the capability of the MTF laboratory, contact the nearest
NAVENPVNTMEDU.  The units maintain a public health laboratory capability to
conduct analysis of clinical specimens from an outbreak investigation or
can assist in arranging for appropriate laboratory analysis.
(4) Collect food samples and/or containers.  If food items are
leftover from a suspect meal, or if a commercial product is suspected,
collect and preserve samples for laboratory analysis.  Remaining stocks of
suspect food should not be used until the investigation is complete.  Use
aseptic techniques and containers to collect samples; seal and label each
container. Collect a sample of each item weighing to 1 pound or measuring
to 1 pint, if less is available collect all of it.  Samples of perishable
foods should be chilled and held below 41F (4C) but should not be frozen.
Commercial foods in containers (e.g., jars or cans) should be kept in
those containers.  Empty containers of suspect commercial products should
also be collected and preserved.  Contact the nearest NAVENPVNTMEDU for
additional guidance on collecting, storing and shipping samples for
analysis.  NAVENPVNTMEDU laboratories can analyze food samples or can
assist in arranging for appropriate laboratory analyses.
d. Develop a case definition. A case definition allows exposed persons
to be classified as either cases or non-cases.  A case is usually defined
by symptoms, e.g., a person who was at risk and developed diarrhea (3 or
more watery stools within a 24-hour period), and a time frame.  Use the
data collected during the initial phase of the investigation to establish
the definition.  A case definition may be specific, e.g., diarrhea and
fever (temperature greater than 100.5F) or more general, (e.g., diarrhea,
nausea or vomiting with or without fever).  Cases can be categorized
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