Abstract
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Objectives: Outbreak reports are essential for documenting the
spread of and responses to disease outbreaks. However, there is a lack of
standardized reporting guidelines that encompass broader perspectives on
outbreaks. We aimed to develop a universal reporting guideline applicable to
diverse outbreak reports and community epidemic interventions, the
“Guidelines for Community Outbreak Investigation Reporting
(G-CORE).”
Methods: G-CORE is designed to address the challenges in documenting
various outbreak scenarios, including infectious diseases and non-infectious
environmental hazards. The development of G-CORE involved a structured process,
including a comprehensive literature review of recent outbreak reports from
leading journals and an analysis of existing reporting guidelines. The process
also involved project registration with the EQUATOR Network and collaboration
with experts in various fields. Following the initial drafting, an internal
(team) review was conducted to evaluate the guidelines' robustness and
relevance. Subsequently, the guidelines underwent revision based on feedback
from external experts and potential users, including authors with experience in
outbreak reporting. The project also includes plans for widespread dissemination
and periodic revisions to adapt to developments and user feedback.
Results: G-CORE will provide a structured framework for reporting
outbreak investigations, comprising a detailed checklist and Explanation
& Elaboration documents.
Conclusion: G-CORE establishes a new standard in outbreak reporting,
facilitating comprehensive, clear, and actionable public health communications.
Its development marks a significant advance in the documentation and management
of public health outbreaks.
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Keywords: Outbreak report; Community intervention; Reporting guideline; Study protocol
Introduction
The 21st century has been marked by a series of significant infectious
disease outbreaks, including severe acute respiratory syndrome (SARS), Middle East
respiratory syndrome (MERS), swine flu, coronavirus disease 2019 (COVID-19), and
Mpox. In particular, the COVID-19 pandemic, along with its variants, has highlighted
the importance of outbreak reports in public health management. Outbreak reports
provide information on an outbreak's progression, the methodologies employed
in an investigation, key findings, and public health implications, which are crucial
for understanding and managing health crises. The reports elucidate the
investigation rationale, symptoms or agents involved, time and place of occurrence,
and affected individuals. Notably, outbreak reports are structured to present events
and interventions in a sequential, narrative format. During the COVID-19 pandemic,
these reports guided interventions at the community, national, and global levels,
influenced policy-making, and demonstrated the significant impact of prompt and
accurate information in controlling rapidly spreading infectious diseases.
The importance of outbreak reports is not limited to infectious diseases. They also
play a vital role in managing non-infectious outbreaks, such as those resulting from
environmental hazards or contaminated medical products. An example is an incident in
The Gambia during June-September 2022, where children’s medications
contaminated with diethylene glycol caused acute kidney injury in young patients
[
1].
Existing reporting guidelines, such as Outbreak Reports and Intervention Studies Of
Nosocomial Infection (ORION) [
2], often fail
to cover the full spectrum of public health emergencies. Reporting guidelines are
defined as checklists, flow diagrams, or structured texts that serve as a
comprehensive roadmap for authors to report specific types of research [
3]. They are crucial tools for various groups,
including peer reviewers, authors, and scientific journals. The last update to ORION
in 2007 and its subsequent lack of revision indicates a gap in current reporting
guidelines, underscoring the need for new, comprehensive reporting guidelines that
address public health emergencies beyond nosocomial infections.
In response, we aimed to develop a novel reporting guideline, referred to as
Guidelines for Community Outbreak Investigation Reporting (G-CORE). This guideline
will provide a comprehensive framework for reporting a wide range of outbreak types.
It extends beyond infections of nosocomial origin to include community-level
outbreaks and non-infectious environmental hazards. The guideline development
process involved an extensive literature review and expert consultations.
Methods
This project's methodology is aligned with the Enhancing the Quality and
Transparency of Health Research (EQUATOR) Network standards [
4]. The development of our reporting guideline has been
officially registered on the EQUATOR Network website [
5], ensuring adherence to their rigorous standards for health research
transparency and quality. It was first named ORIOCE (“Guidelines for
Transparent Reporting of Outbreak Reports and Intervention of Community
Epidemics”).
The research committee is a consortium of experts from diverse fields, each
chosen for their unique contributions to developing reporting guidelines. It
includes experts in preventive medicine, whose focus on disease prevention and
health promotion strategies is pivotal in shaping effective community-level
interventions. Epidemiologists who are experienced in the patterns, causes, and
effects of health conditions are included to provide a better understanding of
the dynamics of community outbreaks. Methodologists, with their expertise in
research design and data analysis, ensure that the guidelines are grounded in
scientifically robust principles. Family medicine practitioners offer a
practical perspective on managing community health issues, making the guidelines
pragmatic and applicable in real-world settings. Public health professionals
offer a broader viewpoint on the implications of these guidelines, aligning them
with comprehensive public health policies and practices. Lastly, the inclusion
of journal editors ensures that the reporting guidelines meet the highest
standards for clarity, transparency, and applicability. Through a synergistic
blend of workshops, consultations, and collaborative planning, these
professionals have integrated their diverse perspectives and expertise to
establish a novel reporting guideline.
The research committee discussed the development process and agreed upon the
following four steps: 1) literature review, 2) reviewing existing reporting
guidelines, 3) development, and 4) ongoing updates and revisions.
Literature review
The literature review is a critical component of our methodology. A team reviewed
manuscripts focused on outbreak reports published within the last 3 years in
internationally recognized journals. We chose Public Health Weekly
Report (PHWR), Morbidity and Mortality Weekly
Report (MMWR), and EuroSurveillance for their
significant contributions to the field, consistent publication of high-quality
outbreak reports, and rich history of publishing extensive and detailed accounts
of various outbreak investigations.
The manuscripts from these journals underwent a detailed examination to identify
specific characteristics, research designs, and content elements integral to
outbreak reporting. We cataloged and presented our findings in a structured
format for a comprehensive representation of the data to elucidate the current
trends and practices in outbreak reporting.
After the literature review, we held a meeting involving all team members to
consolidate findings, discuss the differences and similarities in reporting
styles across the selected journals, and identify any existing gaps in the
literature. These discussions shaped the new reporting guidelines to ensure that
they address the current needs and advance outbreak reporting standards in
health research.
Reviewing existing reporting guidelines
This phase of the project involved a detailed examination and categorization of
existing reporting guidelines, including a comprehensive analysis of the ORION
statement. The primary objective of this review was to assess these guidelines
for their relevance and applicability to outbreak reports, including in
non-nosocomial settings, particularly in publications in prominent scientific
journals.
The process involved evaluating each guideline to understand its structure,
specific elements, and overall reporting approach for outbreaks and related
health interventions. We focused on how these guidelines address the
complexities inherent in outbreak reporting, such as the delineation of
epidemiological methods, the presentation of results, and the discussion of
public health implications.
Developing new reporting guidelines
The expert committee planned the drafting of G-CORE. This draft was constructed
based on insights obtained from an extensive literature review and a detailed
analysis of existing reporting guidelines. This approach ensured that the G-CORE
guidelines are informed by current practices and standards and reflect the
latest understanding in the field. The inclusion of Explanation &
Elaboration (E&E) documents is important, as it provides a detailed
rationale for each guideline item. These documents, created through a systematic
item-by-item analysis and enriched with expert insight, offer clarity and
context, increasing the guidelines’ usability and applicability. The
committee's role was crucial in this phase. It was responsible for
systematically generating guideline items and ensuring that each item is
evidence-based and derived from the committee members’ collective
knowledge and the reviewed literature and existing guidelines. This
collaborative process covered all critical aspects of outbreak reporting,
prioritizing scientific accuracy, relevance, and practicality.
Subsequently, the initial draft of the guidelines, along with the E&E
documents, underwent a series of revisions. This iterative refinement involved
applying the draft guidelines and E&E documents to selected literature to
test their applicability and effectiveness. The resulting feedback was
critically analyzed, and the draft was modified accordingly. We also conducted
internal (team) and external peer reviews, including experienced authors in
outbreak reporting. The reviewer list included experts in infection,
epidemiology, outbreak reporting, and environmental exposures. This
collaborative approach ensured that G-CORE addresses real-world needs and
maintains scientific integrity. It will involve a scoring system (0−9)
enabling a quantitative evaluation of each component of the checklist,
E&E documents, and free-text comments. This structured feedback will
guide further revisions, ensuring the guidelines are both accurate and
user-friendly.
Next, we developed the finalized version of the checklist and an explanatory
manual. The checklist will provide a concise guide for researchers, while the
manual will offer detailed explanations and examples in various outbreak
scenarios. This methodical and evidence-based development approach ensures that
the final guidelines are comprehensive, current, and practical.
Ongoing updates and revisions
In light of the dynamic nature of public health and the fluidity of outbreak
scenarios, we are committed to regularly updating the G-CORE guidelines. This
ongoing process is crucial, as it ensures that the guidelines remain relevant
and effective in a field that constantly faces new challenges, scientific
advancements, and emerging best practices.
To facilitate these updates, we will consistently monitor and revise the G-CORE
guidelines to align with the latest public health and epidemiology developments.
First, we will regularly solicit and integrate feedback from a diverse range of
users, including researchers, public health practitioners, epidemiologists, and
policymakers. This feedback will identify areas for improvement and enhancement,
ensuring that the guidelines effectively meet the needs of users. In addition,
we will update the guidelines based on new research methodologies, technological
advancements, and evolving understandings of disease dynamics. As the field of
outbreak reporting progresses, we will update G-CORE to include these new
approaches. Lastly, recognizing that the user base of G-CORE may evolve, we will
adapt the guidelines to cover a wide range of contexts and applications. This
user-focused approach is vital to ensure that G-CORE remains practical and
applicable across various public health scenarios.
We will document and share these updates through the EQUATOR Network, ensuring
transparency and accessibility. G-CORE’s active presence on the EQUATOR
Network will result in a wider reach and more engagement with the global
research community.
Results
As of October 2023, the research team has made significant progress in developing a
comprehensive reporting guideline for outbreak investigations. This effort is a
direct result of the extensive literature review, including diverse outbreak reports
from PHWR, MMWR, and EuroSurveillance. The review showed various
approaches to documenting outbreaks of diseases such as COVID-19, tuberculosis,
Mpox, and salmonella. It highlighted the need for a standardized reporting format
that includes key elements such as pathogen identification, epidemiological methods,
outbreak curves, transmission paths, and public health responses. Meanwhile, the
team has been working on a detailed checklist and E&E documents. These tools
will guide authors in clearly and consistently reporting outbreak investigations.
The finalized versions of the checklist and E&E documents are expected to be
published by December 2024.
Discussion
The development of our comprehensive reporting guideline, G-CORE, marks significant
progress in addressing the challenges of outbreak reporting. This guideline will
fill a gap in current reporting practices for both infectious and non-infectious
public health emergencies.
The primary strength of G-CORE lies in its comprehensive nature. By encompassing a
broad spectrum of outbreak scenarios, including those involving environmental
hazards and medication-induced health conditions, it provides a versatile framework
applicable to a variety of public health challenges. The inclusion of specific
modules, such as seroepidemiology, molecular epidemiology, and environmental
epidemiology, will further strengthen its applicability and relevance. Our emphasis
on expert collaboration and literature review throughout the development process
will ensure the transparent reporting of outbreak reports and emerging knowledge in
the field.
The significance of reporting guidelines in the context of outbreak reports cannot be
overstated, as it will provide a future reference for outbreak investigations and
preventive or proactive measures. As a repository of vital information, these
guidelines are instrumental in guiding responses to future public health
emergencies. This is increasingly important as the frequency and diversity of
outbreaks are on the rise. In summary, well-structured outbreak reports, guided by
comprehensive guidelines, are crucial for improving public health.
However, this study has certain limitations. The rapid pace and unpredictable nature
of outbreaks can exceed the guideline's applicability, especially when
immediate action is prioritized over structured reporting. Moreover, the
standardization of reporting across diverse outbreak types remains complex. Future
updates to G-CORE will address these challenges. Regular revisions, informed by
feedback from users and changes in the public health landscape, will help to
maintain the guideline’s relevance and utility. This process will ensure that
G-CORE evolves with the ever-changing nature of public health emergencies.
Conclusions
G-CORE will increase the clarity, consistency, and comprehensiveness of outbreak
reporting. Its development underscores the need for continual adaptation and
improvement in public health reporting and highlights the collaborative effort
required to effectively manage public health crises. As we look toward its
publication in December 2024, we anticipate that G-CORE will play a crucial role
in outbreak reporting and public health strategies.
Authors' contributions
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Project administration: Jung W, Ryu S, Choi BY, Kim SY
Conceptualization: Ryu S, Ha M, Choi BY, Kim SY
Methodology & data curation: Ryu S, Ha M
Funding acquisition: Kim SY
Writing - original draft: Jung W, Ryu S
Writing - review & editing: Jung W, Ryu S, Ryu SY, Ha M, Choi BY, Kim
SY
Conflict of interest
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No potential conflict of interest relevant to this article was reported.
Funding
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This research was funded through the support of the Policy Research and
Development Service Project (202305210001) from the Korea Disease Control and
Prevention Agency.
Data availability
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Not applicable.
Acknowledgments
We extend our gratitude to Ms. JiHye Kwon for her invaluable administrative
assistance.
Supplementary materials
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Not applicable.
References
- 1. Bastani P, Jammeh A, Lamar F, Malenfant JH, Adewuyi P, Cavanaugh AM, et al. Acute kidney injury among children likely associated with
diethylene glycol-contaminated medications: the Gambia, June-September
2022. MMWR Morb Mortal Wkly Rep 2023;72(9):217-222.
- 2. Stone SP, Cooper BS, Kibbler CC, Cookson BD, Roberts JA, Medley GF, et al. The ORION statement: guidelines for transparent reporting of
outbreak reports and intervention studies of nosocomial
infection. Lancet Infect Dis 2007;7(4):282-288.
- 3. Kim SY. Reporting guidelines. Korean J Fam Med 2009;30(1):62
- 4. The EQUATOR Network. How to develop a reporting guideline [Internet] Oxford (UK), The EQUATOR Network. c2018;[cited 2023 Nov 11]. Available from https://www.equator-network.org/toolkits/developing-a-reporting-guideline/
- 5. The EQUATOR Network. ORIOCE: guidelines for transparent reporting of outbreak reports and
intervention of community epidemics [Internet] Oxford (UK), The EQUATOR Network. c2023;[cited 2023 Nov 11]. Available from https://www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-other-study-designs/#ORIOCE
