The Case of the Hidden Cheese: Cultural Competency and Interagency Collaboration in Outbreak Investigations
Abstract
BACKGROUND: In June 2024, Gwinnett, Newton, and Rockdale (GNR) Public Health identified a Brucella melitensis cluster among Hispanic individuals in Rockdale County. A joint investigation between GNR, Georgia Departments of Public Health (DPH) and Agriculture (GDA), and the Centers for Disease Control and Prevention (CDC) sough to identify exposures and limit further illness, but encountered challenges due to sociocultural factors.
METHODS: GNR initiated standard investigation protocols to determine exposures and a potential common source. Difficulties arose due to case-patients’ hesitancy to share information with public health. Communication was improved through a relative who helped disseminate information and establish trust. Spanish-speaking staff were assigned and culturally competent talking points and information, including a questionnaire and qualitative survey, were developed. Field visits were utilized. Linkage to medical evaluation, serologic testing, treatment, and post-exposure prophylaxis were provided to minimize barriers to accessing care.
RESULTS: Whole genome sequencing (WGS) identified a 100% match to Brucella melitensis sourced from Mexico on six isolates in three family groups. Through the investigation, a likely source of imported unpasteurized cheese was identified. Ongoing efforts to work with the families with respect to their cultural norms resulted in testing, prophylaxis administered to 8 individuals, and treatment of 6 cases without further hospitalizations or significant medical consequences to date.
CONCLUSION: Qualitative data obtained through interviews and questionnaires, Brucella speciation, and WGS suggest that unpasteurized cheese imported from Mexico was the source in the B. melitensis cluster. GNR and DPH continue to conduct case finding. Efforts are ongoing to improve compliance and trust between Hispanic communities and GNR during outbreak investigations.
KEYWORDS: Outbreak, Epidemiology, Brucella, Hispanic, cultural competency
Keywords
Outbreak, Epidemiology, Brucella, Hispanic, cultural competency
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The Case of the Hidden Cheese: Cultural Competency and Interagency Collaboration in Outbreak Investigations
BACKGROUND: In June 2024, Gwinnett, Newton, and Rockdale (GNR) Public Health identified a Brucella melitensis cluster among Hispanic individuals in Rockdale County. A joint investigation between GNR, Georgia Departments of Public Health (DPH) and Agriculture (GDA), and the Centers for Disease Control and Prevention (CDC) sough to identify exposures and limit further illness, but encountered challenges due to sociocultural factors.
METHODS: GNR initiated standard investigation protocols to determine exposures and a potential common source. Difficulties arose due to case-patients’ hesitancy to share information with public health. Communication was improved through a relative who helped disseminate information and establish trust. Spanish-speaking staff were assigned and culturally competent talking points and information, including a questionnaire and qualitative survey, were developed. Field visits were utilized. Linkage to medical evaluation, serologic testing, treatment, and post-exposure prophylaxis were provided to minimize barriers to accessing care.
RESULTS: Whole genome sequencing (WGS) identified a 100% match to Brucella melitensis sourced from Mexico on six isolates in three family groups. Through the investigation, a likely source of imported unpasteurized cheese was identified. Ongoing efforts to work with the families with respect to their cultural norms resulted in testing, prophylaxis administered to 8 individuals, and treatment of 6 cases without further hospitalizations or significant medical consequences to date.
CONCLUSION: Qualitative data obtained through interviews and questionnaires, Brucella speciation, and WGS suggest that unpasteurized cheese imported from Mexico was the source in the B. melitensis cluster. GNR and DPH continue to conduct case finding. Efforts are ongoing to improve compliance and trust between Hispanic communities and GNR during outbreak investigations.
KEYWORDS: Outbreak, Epidemiology, Brucella, Hispanic, cultural competency
