From:  Investigating foodborne pathogen outbreaks: an integrated framework for tracing, detection, and risk assessment in food systems

 Three-tiered adaptive implementation model: investigation stages, methods, and enabling conditions.

Investigation stageTier 1: foundational (all settings)Tier 2: intermediate (moderate-resource)Tier 3: advanced (high-resource)Enabling conditions required
Outbreak detectionPassive clinical reporting; basic food inspectionActive sentinel surveillance; food monitoring programsIntegrated molecular surveillance (PulseNet-equivalent); AI-assisted signal detectionT1: Basic lab + reporting. T2: Trained inspectors, national surveillance. T3: Genomic database, IT infrastructure
Pathogen detectionISO/AOAC culture methods; biochemical confirmationCulture + PCR/qPCR; ELISA-based rapid assaysWGS (Illumina/Nanopore); metagenomics; proteomicsT1: BSL-2 lab. T2: PCR platform + reagents. T3: Next-gen sequencer, bioinformatics pipeline
Source attributionCase-control interviews; trace-back of suspect food vehiclesPFGE/MLST typing; trace-forward supply chain mappingSNP phylogenomics; metagenomics source tracking; GIS-supply chain overlayT1: Trained epidemiologist. T2: Molecular typing capability. T3: WGS platform + GIS software
Risk assessmentSemi-quantitative risk ranking; HACCP reviewSimplified QMRA using published dose-response dataDynamic QMRA with real-time omics data inputs; stochastic modellingT1: HACCP competency. T2: QMRA training + software. T3: Biostatistician + MCRA/R integration
Communication & decisionNational authority notification; product recall protocolMulti-agency coordination; stakeholder briefingsReal-time dashboards; GIS risk visualization; AI-assisted decision supportT1: Legal framework. T2: Inter-agency protocols. T3: Data visualization platforms

AI: artificial intelligence; GIS: geographic information systems; MLST: multilocus sequence typing; PCR: polymerase chain reaction; PFGE: pulsed-field gel electrophoresis; QMRA: quantitative microbial risk assessment; qPCR: quantitative polymerase chain reaction; SNP: single-nucleotide polymorphism; WGS: whole-genome sequencing.