Interviewing case-patients about where and what they ate in the days or weeks before they got sick is a critical component to hypothesis generation during an outbreak investigation. Interviews can also identify high-risk casepatients who could spread their infections to others (e.g., food handlers, day care workers or attendees, healthcare workers). During interviews, casepatients can also receive information about risky exposures and how to protect themselves and others. The FoodCORE Model Practice: Initial Case-patient Interviewing is intended to describe the basic practices and characteristics of conducting comprehensive interviews for all enteric disease case-patients upon initial identification or first contact, not just those identified as part of a local cluster or multistate cluster. The activities described would be applicable for various pathogens but are focused on those that are likely transmitted via food. Depending on jurisdictional resources, attempts should be made to interview all identified case -patients with enteric disease to ascertain an exposure history. This model practice describes successful triage and routing of case reporting and the process of attempting interviews with case-patients, recommends categories and elements identified as essential to ascertain during an initial enteric disease interview, and provides a checklist to determine alignment of initial interview practices with the FoodCORE model practice.# Timeliness, timing, and description of interview attempts:
Interviews should be attempted as soon as public health officials are notified of a case-patient. This may be before all subtyping is completed. Prompt interviewing is critical to improve exposure recall and increase the likelihood of identifying leftover products to collect for testing. Additionally, early interviewing provides an opportunity for prompt prevention education to limit additional transmission, especially if a case-patient is identified in a high-risk setting (i.e., foodhandlers, childcare, or health care setting).
At least three attempts should be made to contact a case-patient. Attempts should be made at different times of day, with at least one attempt during evening or weekend hours, if possible. During initial contact, interviewers can determine if the interview would be better conducted at a different time, confirm case-patient contact information, and (resource dependent) arrange for the interview to be conducted with an interpreter or other means of translation service, if necessary.
If a case-patient cannot be reached for interview via telephone, FoodCORE centers have used the following approaches to attempt to ascertain exposure history and/or conduct prevention education:
- Provide Case-patients with call back information, either a toll-free or direct line for reaching an interviewer.
- Provide a letter from the relevant public health agency with the reason for attempted contact and providing both contact information and educational materials about the enteric pathogen and prevention. See Appendix C for sample letters.
- Some centers are working on a novel approach to provide online questionnaires for exposure ascertainment. This method of exposure ascertainment is used as an alternative method for case-patients who cannot be reached or are unwilling to complete an interview over the phone but would like to provide their exposure history online. Online systems for self-reported data must be secure and allow for confidential data submission.

# Interview content:
FoodCORE initial case-patient interviews include elements from the following major categories: For all case-patients of enteric disease, data collected in categories 1-5 are needed to identify case-patients where public health officials can provide educational information to prevent additional illnesses and to identify any events or local trends that could indicate ongoing risk. FoodCORE center initial interviews include elements in categories 6 and 7 as part of a full exposure history. Depending on jurisdictional resources, interviews should collect sufficient detail to enable public health investigation in these categories. As resources allow, jurisdictions can evaluate including a detailed food exposure history as part of an initial interview. Other initiatives, including the Listeria Initiative, the STEC Standard Form, and the SNHGQ, have suggested food categories and elements to ascertain in a food history (e.g., Meat and Poultry; Fish and Seafood; Eggs, Dairy, and Cheese; Fruits and Vegetables; Frozen and Convenience Foods).
For successful interviews, interviewers should be familiar with the questionnaire and jurisdictional policies for education and intervention so the case-patient interaction is efficient and comfortable. The content and structure of the initial interview should be understandable, and sensitive to the personal nature of the questions. FoodCORE centers have implemented the following practices and considerations:
- The order in which elements are asked can influence how responsive a case-patient may be  More sensitive information should be collected after the case-patient is comfortable with the interviewer and the reason for being contacted
- If an interviewer determines that a case-patient is short on time, elements can be prioritized to ascertain the highest priority elements earlier in the interview  This could include risk of spreading infection to others or identifying additional case-patients for local clusters/events
- Interview elements can also be prioritized for pathogen-specific concerns to focus on highest priority elements for those specific interviews  This should include identifying persons who are at risk of spreading infection to others
- Since interviews may be conducted before case-patients are linked to a cluster of illness, interviewers may explain to case-patients that they may be re-contacted for additional details about their illness to keep other people from getting sick  Interviewers can verify contact information and preferred means of contact, the best times of day to reach a case-patient, and other preferences (as reasonable), such as preferred language
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