Tag Archives: Going Public

44 sick in Kentucky Salmonella outbreak

Posted on by
Reply

Why is this just being made public now?

Maybe it has been public and slipped my mind.

WSAZ reports that nine cases of Salmonella have been confirmed in Olive Hill, Ky., and at least four are part of a statewide outbreak sickening at least 44 people.

People apparently started getting sick about July 11, and there have been no new cases of Salmonella reported since July 31.

Two weeks later and the outbreak becomes public.

A statewide investigation is underway to try to find the source of the cases. 

Going public: there may be some rules but FDA says they’re a secret

Posted on by
Reply

The same agencies that tout a science-based approach to foodborne illness aren’t so good at one of the 3 legs of the risk analysis stool – risk communication.

It gets lots of pandering, but almost all government agencies and industry groups, regardless of geography, are really bad at risk communication when performance is stacked up against what has been proven to work (not very much).

When to go public about health warnings – like potential outbreaks of foodborne disease – remains contentious. And no one is willing to come clean about it and say, this is when we go public and why. Or at least write it down. Bureaucrat 101 – write it down, have to do it; so don’t write it down.

I understand the flexibility public health types require to do their jobs effectively, but much of the public outrage surrounding various outbreaks – salmonella in tomatoes/jalapenos, 2008, listeria in Maple Leaf deli meats, 2008, the various leafy green recalls and outbreaks of 2010, 2011, 2012, the 1996 outbreak of cyclospora linked to Guatemalan raspberries, and the delay in clamping down on Iowa eggs – can be traced to screw ups in going public.

It’s long been a tenet of risk communication that it is better to go early with public information rather than later. People can handle all kinds of information, especially when they are informed in an honest and forthright manner.

So it’s of no surprise that the U.S. Government Accountability Office (GAO) couldn’t find anyone within the Food and Drug Administration (FDA) to say, this is how we decide when to go public.

“FDA has interim internal procedures describing the steps it will take to order a food recall, but these procedures have not been made public, and the agency has not provided information on when they will be. Federal internal control standards call for federal agencies to clearly document
policies, procedures, techniques, and mechanisms for implementing management directives and to make that documentation readily available for examination.”

“Similarly, FDA officials told us that they have not decided whether they will issue regulations or industry guidance to clarify for the public FDA’s procedures for ordering food recalls and that FSMA has no requirement to do so. Federal internal control standards direct federal agencies to
ensure adequate means of communicating with and obtaining information from external stakeholders who may have a significant impact on the agency achieving its goals.

“About a week-and-a-half before our closing meeting, FDA officials provided us interim internal procedures for ordering recalls of food. These interim procedures include detailed information on such topics as which officials are to be involved in an ordered food recall decision and what methods and timelines FDA officials will use to communicate with companies involved in such a recall. The interim procedures also state that FDA is to incorporate procedures into the
agency’s publicly available Regulatory Procedures Manual and other FDA documents. FDA officials have not, however, provided timelines on when they expect to make procedures publicly available."

And it goes on like that for 61 pages.

GAO recommends, among other things, that FDA issue regulations or industry guidance to clarify its ordered food recall process and implement recommendations from others to address FDA communication challenges in advising the public about food recalls and outbreaks. The agency neither agreed nor disagreed with GAO’s recommendations but cited ongoing agency actions that are to address most recommendations.

To strengthen FDA’s process for ordering recalls, the Secretary of Health and Human Services should direct the Commissioner of FDA to document FDA’s process for ordering food recalls in regulations or industry guidance to include information on how the agency will weigh evidence on whether a recall is necessary.

To address FDA’s communication challenges in advising the public about food recalls and outbreaks, the Secretary of Health and Human Services should direct the Commissioner of FDA to implement recommendations from the Institute of Medicine and National Research Council to develop, in conjunction with other federal agencies, a coordinated plan for crisis communications.

To address FDA’s communication challenges in advising the public about food recalls and outbreaks, the Secretary of Health and Human Services should direct the Commissioner of FDA to implement recommendations from FDA’s risk communication committee to develop a policy for communications during emerging events.

The full report is available at http://www.gao.gov/products/GAO-12-589.

California lettuce linked to E. coli outbreaks in NB, Quebec and Calif.

Posted on by
1

When California lettuce growers were courting Canadian hacks on a paid junket, they probably didn’t talk too much about the possible links between several E. coli O157:H7 outbreaks and California Romaine lettuce that were being uncovered at the same time.

Or the sick people.

The Sponge-Bob-Colbert leafy greens cone of silence was once again deployed.

Phyllis Entis of eFoodAlert confirms tonight that Romaine lettuce grown on a
California farm is the probable source of E. coli O157:H7 illnesses that were reported in April and May in California, New Brunswick and Quebec.

The binational outbreak sickened at least 18 people in New Brunswick (Canada) and nine residents of California. At least one resident of Quebec also was infected with the same outbreak strain.

The New Brunswick outbreak victims ate at Jungle Jim’s, a restaurant in Miramichi, between April 23rd and April 26th, and had consumed romaine lettuce, either in a salad, as part of a wrap, or as a garnish on hamburger. Most of the nine California victims had eaten at a single (unnamed) restaurant in April 2012, according to information provided by Ronald Owens (Office of Public Affairs, California Department of Public Health). A case control study implicated lettuce as the source of the California outbreak. No information has been released on the Quebec cases(s).

California was notified in May by the US Centers for Disease Control and Prevention (CDC) that CDC had learned of an outbreak in Canada, caused by the same strain of E. coli O157:H7 as the California illnesses. Traceback investigations carried out by Canada and California both led to a single California farm that supplied lettuce to the California restaurant and to Jungle Jim’s in New Brunswick. Lettuce from the implicated fields was also supplied to Quebec.

At the same time, Marie-Andree Guimont wrote a lovely puff piece in divine.ca after her educational – and funded – trip to Monterey, California, to see how leafy greens are grown.

“Awareness of food safety has allowed us to change the culture among producers, said Scott Horsfall, CEO of California LGMA, with a straight face. “They are proud of their training, and it therefore becomes their badge of honor.”

The Leafy Greens Marketing Agreement would be a lot more credible if they’d come clean about outbreaks and data, instead of ole’ timey public relations crap, buying off would-be journalists, one at a time. And governments. Canadian regulators will only accept leafy greens entering the country that are LGMA-certified. No idea why.

Health types may want to figure out a policy for going public about outbreaks. Finding out later just further erodes any remaining credibility.

A table of leafy green related outbreaks is available at http://bites.ksu.edu/leafy-greens-related-outbreaks.

66 sick with Salmonella in another chick outbreak

Posted on by
Reply

Media doesn’t tell people what to think; but it does tell people what to think about.

And that includes doctors, epidemiologists and other mere mortals.

So the numerous previous chick-related Salmonella outbreaks mean people of all professions may be more attuned to the chick link.

The outbreak is the fourth linked to mail-order chicks and ducklings since 2011.

The U.S. Centers for Disease Control reports at least 66 persons have been infected with the outbreak strain of Salmonella Montevideo in 20 states; 16 ill persons have been hospitalized. One death was reported in Missouri, but Salmonella infection was not considered a contributing factor in this person’s death.

35% of ill persons are children 10 years of age or younger.

Epidemiologic, laboratory, and traceback findings have linked this outbreak of human Salmonella infections to contact with chicks, ducklings, and other live baby poultry from Estes Hatchery in Springfield, Missouri.

CDC, why didn’t you say Hatchery A, or Hatchery A in Missouri? What are the guidelines on publicly fingering sources of food- or chick-related illness?

But will it mean fewer sick people? Canadian food rules being rewritten

Posted on by
Reply

First a single inspection agency, now a move to a single inspection approach across all commodities.

As reported by Sarah Schmidt of Postmedia News, the Canadian Food Inspection Agency released Friday its vision to modernize food inspection, making the case for getting rid of eight separate programs for dairy, eggs, seafood, fresh fruits and vegetables, imported and manufactured food, maple, meat and processed products.

“This challenges the CFIA to manage risks consistently across different types of establishments and different foods. It creates situations in which foods of similar risks may be inspected at different frequencies or in different ways,’” CFIA writes of the current system in its discussion paper.

“The model should raise the bar and set expectations for food control systems that are developed and maintained by industry with risk-based government oversight. It should also standardize requirements and procedures across all food, based on science and risk.”

The release of the proposal, dubbed The Case for Change, kick-starts consultations, with a final plan to be released by next year and phased in over the next five years.

A new food safety act, bringing together multiple laws under one piece of legislation, is also expected to be tabled as early as this month.

Together, these changes will represent the single largest transformation since CFIA was created in 1997, when food inspection programs from different federal departments were brought under the umbrella of the agency.

View the CFIA’s The Case for Change and the direction that the Agency is taking to improve food inspection on the inspection modernization section of the CFIA website.

Forewarned: multiple summaries are easy to find, actual details, not so much. Typical CFIA.

And it wouldn’t be CFIA without heaps of self-referential praise.

"We already have a top-tier food safety system but our goal is to be the best," said Agriculture Minister Gerry Ritz. "Simply put, we want Canadians to have the safest food in the world. That is why we are seeking input from consumers, inspectors, food safety experts, industry and everyone who has a role to play in food safety."

Sounds good. Walk the talk. Provide better information about outbreaks, especially homegrown ones.

316 sickened with Salmonella over 8 years from mail-order chicks ducks

Posted on by
Reply

Parents should think carefully about any pet, particularly small turtles, reptiles, and chicks or ducks, that can carry human disease. Young children are much more vulnerable to things like Salmonella.

And U.S. federal agencies continue to have a going public problem, and should develop public guidelines for when, or when not, to name a business or farm in a disease outbreak, and apply those guidelines consistently

That’s what I conclude from reports that health types have cracked an 8-year-old Salmonella outbreak linked to live, mail-order poultry.

JoNel Aleccia of msnbc.com writes, between 2004 and 2011, at least 316 people in 43 states were sickened by a strain of salmonella Montevideo that had stumped staff at the Centers for Disease Control and Prevention. An estimated 5,000 additional cases likely went unreported, officials say.

Only through careful analysis of the genetic fingerprint of the bug and cooperation with human and animal health officials and poultry experts did the CDC crew link the cases to “Hatchery C,” a supplier of 4 million birds a year identified only as being in the western U.S.

“It was definitely an interesting outbreak,” said Casey Barton Behravesh, one of a team of CDC researchers who reported on their investigation in the latest issue of the New England Journal of Medicine.

Because the hatchery was cooperative and because the threat of this particular infection appears to be over — with only one case of the outbreak strain reported so far this year — CDC officials declined to name the source of live young poultry popular as Easter presents or with urban backyard chicken farmers.

Since 1990, there have been 35 outbreaks of salmonella tied to contact with shipments of live, young poultry. CDC officials are investigating two separate outbreaks now, strains of salmonella Altona and salmonella Johannesburg, which together have sickened nearly 100 people in 24 states.

It was the salmonella Montevideo outbreak, though, that sent CDC officials scrambling to find out the source of infections whose victims were mostly children under the age of 5.

?In the end, about 80 percent of the illnesses were traced back to Hatchery C, which can ship as many as 250,000 birds a week in the spring, the peak season, according to the report. Even after the hatchery took steps to curtail salmonella transmission, the infections dropped, but did not stop.

Even when state agriculture officials have forced hatcheries to get rid of their birds, clean up the sites and start over, salmonella outbreaks have erupted again.

“Shutting down the hatcheries is not necessarily the answer here,” Behravesh said.

There are some 20 hatcheries in the U.S. that ship an estimated 50 million live poultry by mail-order every year, generating between $50 million and $70 million a year, said CDC officials, citing unpublished data.

In 2011, the U.S. Postal Service shipped some 237,778 boxes or 1.7 million pounds of live poultry, spokeswoman Sue Brennan told msnbc.com.

Many of those birds go to agricultural feed stores, where they may be sold as Easter pets. Others are shipped directly to urban farmers, including many who have adopted the recent trend of raising backyard flocks of chickens.

In this outbreak, the number of illnesses peaked in May of 2006, forcing interventions at Hatchery C, the paper reported.

Those included beefing up biosecurity and rodent control, decontaminating feed, replacing and updating old equipment, changing airflow, improving testing and giving vaccines to adult birds.

Such steps may be recommended, but not required, by the National Poultry Improvement Plan, a program of the U.S. Department of Agriculture. All compliance is voluntary, Behravesh noted.

Still, even after that effort, the salmonella infections didn’t cease completely, Behravesh said.

The CDC researchers called for more targeted efforts to raise awareness about the danger of salmonella infections from live poultry. Only about 21 percent of patients interviewed said they knew that poultry could transmit salmonella and only 7 percent said they were warned about the risk at the time of purchase.

Part of the problem is that people regard the young poultry as pets, often buying chicks dyed neon colors as holiday favors.

New England Journal of Medicine, 366;22

Nicholas H. Gaffga, M.D., M.P.H., Casey Barton Behravesh, D.V.M., Dr.P.H., Paul J. Ettestad, D.V.M., Chad B. Smelser, M.D., Andrew R. Rhorer, M.S., Alicia B. Cronquist, R.N., M.P.H., Nicole A. Comstock, M.S.P.H., Sally A. Bidol, M.P.H., Nehal J. Patel, M.P.H., Peter Gerner-Smidt, M.D., D.Med.Sci., William E. Keene, Ph.D., M.P.H., Thomas M. Gomez, D.V.M., Brett A. Hopkins, D.V.M., Ph.D., Mark J. Sotir, Ph.D., M.P.H., and Frederick J. Angulo, D.V.M., Ph.D.

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1111818

Abstract

Background

Outbreaks of human salmonella infections are increasingly associated with contact with live poultry, but effective control measures are elusive. In 2005, a cluster of human salmonella Montevideo infections with a rare pattern on pulsed-field gel electrophoresis (the outbreak strain) was identified by PulseNet, a national subtyping network.

Methods

In cooperation with public health and animal health agencies, we conducted multistate investigations involving patient interviews, trace-back investigations, and environmental testing at a mail-order hatchery linked to the outbreak in order to identify the source of infections and prevent additional illnesses. A case was defined as an infection with the outbreak strain between 2004 and 2011.

Results

From 2004 through 2011, we identified 316 cases in 43 states. The median age of the patient was 4 years. Interviews were completed with 156 patients (or their caretakers) (49%), and 36 of these patients (23%) were hospitalized. Among the 145 patients for whom information was available, 80 (55%) had bloody diarrhea. Information on contact with live young poultry was available for 159 patients, and 122 of these patients (77%) reported having such contact. A mail-order hatchery in the western United States was identified in 81% of the trace-back investigations, and the outbreak strain was isolated from samples collected at the hatchery. After intervention at the hatchery, the number of human infections declined, but transmission continued.

Conclusions

We identified a prolonged multistate outbreak of salmonellosis, predominantly affecting young children and associated with contact with live young poultry from a mail-order hatchery. Interventions performed at the hatchery reduced, but did not eliminate, associated human infections, demonstrating the difficulty of eliminating salmonella transmission from live poultry.

And, in a new and separate outbreak, CDC 93 additional people have been sickened. The complete CDC report is available at http://www.cdc.gov/salmonella/live-poultry-05-12/index.html. Highlights below.

A total of 93 persons infected with outbreak strains of Salmonella Infantis, Salmonella Newport, and Salmonella Lille have been reported from 23 states.

18 ill persons have been hospitalized, and one death possibly related to this outbreak is under investigation.

37% of ill persons are children 10 years of age or younger.

Collaborative investigative efforts of local, state, and federal public health and agriculture officials linked this outbreak of human Salmonella infections to exposure to chicks and ducklings from a single mail-order hatchery in Ohio.

Findings of multiple traceback investigations of live chicks and ducklings from homes of ill persons have identified a single mail-order hatchery in Ohio as the source of these chicks and ducklings. This is the same mail-order hatchery that was associated with the 2011 outbreak of Salmonella Altona and Salmonella Johannesburg infections. In May 2012, veterinarians from the Ohio Department of Agriculture inspected the mail-order hatchery and made recommendations for improvement.

Mail-order hatcheries, agricultural feed stores, and others that sell or display chicks, ducklings, and other live poultry should provide health-related information to owners and potential purchasers of these birds prior to the point of purchase. This should include information about the risk of acquiring a Salmonella infection from contact with live poultry.

Mail-order hatcheries, agricultural feed stores, and others who sell or display chicks, ducklings and other live poultry should provide health-related information to owners and potential purchasers of these birds prior to the point of purchase. This should include information about the risk of acquiring a Salmonella infection from contact with live poultry.

Going public: Iowa law shields targets of norovirus probe

Posted on by
Reply

In March 2012, dozens of people were apparently sickened with norovirus after visiting an eastern Iowa swim facility.

The Quad-City Times has been trying to name the facility, but an Iowa law allows public health officials to keep secret the name of a business involved in a disease investigation; this, say some of those sickened, puts business interests before public safety.

Johnson County and state health officials won’t release the name of the facility despite dozens being sickened, citing state law that shields businesses that have cleaned up their act after an outbreak. They also believe there is no ongoing public health risk.

“I just wish the name would be out there, so others could know about this happening at a family attraction,” said Courtney Evans of Blue Grass, Iowa. Evans’ two young boys and her husband fell ill from norovirus after a visit to the swim facility.

The Quad-City Times and The Gazette of Cedar Rapids jointly filed a complaint with the Iowa Office of Citizens’ Aide about the health department’s refusal to release the name of the swim facility or provide key details about the investigation, such as dates of when people got sick. The Citizens’ Aide ruled public health officials followed the law.

“The problem is that I have to obey the law,” said State Epidemiologist Patricia Quinlisk. “If people feel that is incorrect, they have to talk with their legislators (about changing the law).”

Some Iowa legislators say the current law might go too far.

“We have a duty to inform the public that this has occurred and that it’s been remedied,” said Rep. Rick Olson, D-Des Moines. “I want to keep my kids healthy.”

Rep. Vicki Lensing, D-Iowa City, said the public needs accurate information from the health department, not speculation. “It would seem like after an investigation is concluded that information could be released,” she said.

Records obtained by the Quad-City Times and the Gazette through an Open Records request with the Johnson County Public Health Department indicate more than 30 people contracted norovirus after visiting the swim facility in March. Johnson County, which handled the facility investigation, inspects pools in Johnson, Iowa, Louisa and Muscatine counties.

“Early this morning, all family members began vomiting and have experienced diarrhea,” states a Johnson County record-of-contact form. The complainant “contacted the family members they traveled with, and all are experiencing the same symptoms.”

“…the complainant believes that illnesses derived from exposure to pool water. The two individuals that did not enter the pool water have not become sick,” the report shows.

According to the records, which include handwritten notes, reports and emails, chemical tests leading up to the outbreak showed the pools had little or no chlorine, which kills pathogens that can cause disease. Pool management told officials a chlorine feeder was plugged.

Iowa Code Section 139A.3 states “information contained in the report may be reported in public health records in a manner which prevents the identification of any person or business named in the report.” This means public health officials can tell the public about the outbreak only in a generic way that doesn’t identify the business.

Before Quinlisk decides to keep investigation details secret she asks herself one question: Would she take her own child to the facility?

In this case, the answer was yes, she said.

Not every state gives businesses the same protection as individuals when it comes to disease reports. Minnesota, for example, only keeps the health records of individuals private, not businesses.

“If we have an outbreak at Joe’s Diner, that’s public,” said Richard Danila, deputy Minnesota epidemiologist.

The Illinois Department of Public Health has a policy to keep confidential the name of a business involved in a disease investigation, but the information can be obtained through open records requests after the investigation is concluded, said Department spokeswoman Melaney Arnold.

An accompanying editorial says several Quad-City area families sickened by the virus contacted us and were referred by Scott County health officials to the Johnson County Health Department in late March. We followed up, pursuing public records to confirm the account.

We were not seeking the names of the victims. The victims came to us. They spoke on the record.

So, yes, we know what business was investigated.

But we need public officials verifying the investigation to be able to report this responsibly and without fear of liability from a possible lawsuit since the origin of the norovirus has not been proven, the business complied with orders to take corrective action, and there was no perceived ongoing public health risk.

If I wanted to take my child to the facility, I would want to know their track-record and whether they could adequately manage things like chlorine levels, or whether I should bring my own pH strips.

Just like I want to know the track record of a restaurant before I spend my money there.

Provincial law in Canada to ban information on farm-based disease outbreaks

Posted on by
1

When someone asks, What’s wrong with Kansas, I reply with, What’s wrong with Canada?

My journalism friends have long complained that the flow of information about public health – public anything – is a tinkle in Canada compared to other places.

According to a report in The Province, British Columbia’s Liberal government is poised to further choke off the flow of public information, this time with respect to disease outbreaks.

The Animal Health Act, expected to be passed into law by month’s end, expressly over-rides B.C.’s Freedom of Information Act, duct-taping shut the mouths of any citizens – or journalists – who would publicly identify the location of an outbreak of agriculture-related disease such as bird flu.

"A person must refuse, despite the Freedom of Information and Protection of Privacy Act, to disclose . . . information that would reveal that a notifiable or reportable disease is or may be present in a specific place or on or in a specific vehicle," Section 16 of the Act reads.

It is quite conceivable that the provincial government, in the event of a disease outbreak at a farm, would delay releasing a warning in order to protect the farm in question or the industry it’s part of.

In that event, should you as a citizen hear about the outbreak, or if you were an employee at an affected farm, you would be breaking the law by speaking publicly about it or bringing concerns to the media.

Will the law also apply to farms identified as sources of foodborne illness, like tomatoes from a B.C. greenhouse, or BSE traced to a B.C. farm, or stupidity traced to a government bureaucrat who lives on a farm?

The proposed law will probably have no practical effect because there is no animal disease or foodborne illness traced to B.C. farms; it’s all imported.

Canada, where complacency rules.

Not naming names creates problems

Posted on by
Reply

Public disclosure avoids a lot of issues.

Luis Nunez, owner of two Corona Mexican restaurants in Spartanburg, South Carolina, told WSPA that health types should be transparent about which restaurant is linked to the E. coli outbreak.

He says limiting the information to a "Spartanburg-area Mexican restaurant" punishes all Mexican restaurant owners in town because people will just avoid eating Mexican in general.

Adam Myrick with DHEC explained the decision not to name the restaurant, saying the agency is confidant there is no "ongoing public health threat."

"Releasing the name of the facility wouldn’t really do anything to further protect the public health," says Myrick.

But it would help consumers make future dining choices and create an additional incentive for food service to get things right.

When 11 people get sick with E. coli and two end up in hospital with HUS, word is going to get around town.

So the restaurant, El Mexicano, went and outed itself, which will earn far more consumer trust long-term than any lame explanation from a lackey health type.

Restaurants sell food. They lose money when people don’t show up; health types don’t lose their jobs, although do have to listen to political types whine about their friends who own restaurants.

Government at any level sets minimal regulations and standards. The best will always go beyond the minimal standard.

Going public about foodborne illness: ‘I will be forever mad at FDA’

Posted on by
2

Michael Booth of the Denver Post published an excellent investigative piece Friday about a 2009 E. coli outbreak that appeared linked to lettuce at restaurants in six states, but was never made public. Excerpts below:

The FDA’s decision to let the six-state E. coli probe go dormant, despite clear leads, is part of what some food safety experts call a worrisome "cone of silence" around leafy green produce problems in the United States. These experts say the FDA dropping promising outbreak clues blocks efforts to force better growing and packing methods.

And they say the federal government’s tendency to avoid naming names — even when state officials know the producers and suppliers — robs consumers of vital information. In an October 2011 salmonella outbreak that sickened 68, federal agencies told journalists there was no public benefit in being more specific than problems at Mexican "Restaurant Chain A."

It was the Oklahoma health department that disclosed the chain where many victims had eaten was Taco Bell.

"As someone who is out in fields with farmers, it’s really hard to get them excited about food safety if they never hear about other outbreaks," said Doug Powell, a Kansas State University food scientist who advocates for wider probes and public disclosure. "We have evidence that telling stories makes a difference."

"I will forever be mad that the FDA didn’t pursue" the 2009 E. coli cases that included Colorado, said Kirk Smith, a veterinarian and supervisor of the foodborne disease investigation section of the Minnesota Department of Health.

"It was a smaller outbreak, but still, if you figure out what the food is, even after the fact, you can hopefully get back to where that food was produced and perhaps correct something so there’s not a bigger outbreak in the future."

State health officials grow nervous every September with the crowds, heat and open-air food at the Colorado State Fair in Pueblo. When two cases of E. coli O157:H7 matched at the state lab, one from a Jefferson County child and another from a Pueblo County child, health investigators moved fast.

County reporting forms showed both sick kids had attended the state fair. State officials urged the counties to speed up questioning, trying to nail down where the kids ate and what foods they had in common.

As they waited for more answers, cases in Minnesota, Iowa and three other states loaded illness cases into a national network and matched the genetic fingerprint.
Cases in Minnesota and Iowa had eaten at the same Italian-style restaurant in Omaha, Nebraska, in early September. So had a North Carolina case. When Colorado got its deeper case histories back, it found both state victims had eaten at an Italian-style restaurant in Pueblo.

More questions zeroed in on house salads. Even when the victims hadn’t ordered salad, they had nibbled from a family member’s plate. Eight of 10 cases had eaten lettuce at a restaurant, according to a Colorado outbreak memo obtained through the open records act.

States sought the restaurants’ suppliers. Colorado learned that the lettuce used in Pueblo came from a major produce supplier in the Salinas Valley of California, Tanimura & Antle.

The patients, meanwhile, made slow recoveries. Some were in the hospital for days. E. coli is particularly worrisome to food experts because it can cause severe gastroenteritis, pneumonia and kidney failure.

And then the FDA and CDC dropped the case.

Once state public health officials identify an out-of-state supplier, they rely on the federal government’s powers to move across boundaries and push outbreak probes forward. But what Colorado and Minnesota officials heard was silence.
By mid-October, officials in those states asked the CDC and FDA for a status on the case. On Oct. 28, according to e-mail records released by Colorado, CDC epidemiologist Colin Schwensohn told the states "with no recent cases, this cluster is less of a priority."

Minnesota’s Smith fired back the same afternoon, saying "I think it is a huge mistake for FDA to drop this." Smith’s e-mail to the CDC and other investigators, which he acknowledged was a "rant," went on:

"If FDA won’t fully engage and work backwards from 2 restaurants on a rock solid lead, then all of their claims about making things better are all so much talk."

Colorado officials took a more measured approach, but still protested. "Colorado and other states challenged this decision, but FDA did not change its position about pursuing the traceback further," according to a state memo.

Colorado epidemiologist Alicia Cronquist said in an interview, "We were extremely frustrated." The states got on a conference call and said a deeper probe would prevent future outbreaks, Cronquist said.

The FDA declined comment, beyond the limited information about the federal agencies’ reasoning contained in e-mails at the time, which were released by Colorado in the open records request. Neither the FDA nor the CDC offered responses to specific questions about the 2009 outbreak, or to general questions about how investigations end.

"Consumers of food have a right to know, period. And as taxpayers, consumers have a right to know what public health officials know about those same food producers," said Seattle attorney Bill Marler, a litigator for outbreak victims. Marler’s firm was briefly a co-counsel for one of the Colorado victims suing over the 2009 E coli illnesses.

Early e-mails in the 2009 outbreak identified the restaurants that consumers said they had in common. Colorado named the produce grower, Tanimura & Antle, in its wrap-up memo, but said the restaurants did not appear to be at fault. Tanimura & Antle did not return calls seeking comment.

KSU’s Powell argues for more disclosure. At the least, he said, CDC policy should make it clear why they name some restaurants and producers, and not others. The CDC stuck with "Restaurant Chain A" for the October 2011 salmonella outbreak even though Oklahoma had disclosed half the victims had eaten at Taco Bell.

"If Taco Bell keeps making people sick with lettuce, I want to know it’s Taco Bell," he said. "How bright are they in choosing their lettuce suppliers?"
Taco Bell did not return phone calls seeking comment.

Cronquist said Colorado tries to strike a balance. If the public is still at risk from food, companies are identified. But the state also needs compliance from various facilities while it investigates. Moreover, victim interviews can be skewed by early disclosure; if they have heard "Taco Bell" or "green onions," it can bias their answers.