If you’re going to come down with Salmonella or some other kind of foodborne illness, here’s some advice: Do it in Minnesota.
Getting sick won’t be any more comfortable up there on the edge of the prairie. But chances are somebody will take notice, track down the source, and do something about it.
When it comes to food safety, not all states and cities are alike. Far from it. Health officials and epidemiologists agree that some are consistently more successful than others at preventing and responding to outbreaks of foodborne illness.
Asked which states are best in the business, most experts also list Oregon, Wisconsin, Washington and Colorado. Connecticut gets some mentions. North Carolina is getting better.
The Colorado Department of Public Health and Environment demonstrated its prowess in recent days in helping to swiftly track the source of a rash of E. coli O157:H7 infections to a Costco cheese promotion.
Authorities are reluctant to name the worst departments. But they agree that eastern and southern states generally lag behind the rest of the nation.
Minnesota health authorities exhibited their skill two years ago, when health departments around the nation were confounded by an outbreak of Salmonella Typhimurium that infected thousands of people and killed at least nine. Investigators searched desperately for a common denominator that would point to a source, something that could link clusters of sick people scattered from coast to coast. Was it chicken? Spinach? Alfalfa sprouts?
Eventually, it was Minnesota health officials who tracked the source to the King Nut Peanut Butter and PCA peanut paste used in thousands of products. They accomplished this with a combination of sophisticated laboratory analysis and classic, gumshoe epidemiology. We’ll retell that story in a future posting here.
But that mix of laboratory technology and epidemiological sleuthing is typical of the work done by Minnesota’s health officials, a small cadre of scientists who operate in a big steel and glass office building next to the state capitol in St. Paul.
What distinguishes state departments such as Minnesota’s from the mediocre majority?
Authorities list several factors. Budget, of course, is one of them. Dr. Bala Swaminathan, a microbiologist who worked for years at the Centers for Disease Control in Atlanta, became acquainted with most state departments when he was setting up PulseNet, the nationwide network that links state and CDC laboratories by computer.
“When you operate a network, you learn that your system can operate only as well as the lowest performing member of the network,” he says. And states that spend more money tend to get better epidemiology.
In some cases, one passionate, charismatic individual can make the difference. Swaminathan cites the example of Dr. Bill Keene, senior epidemiologist at Oregon’s Acute and Communicable Disease Program. “Bill is totally dedicated. If something critical comes up, he drops everything.” And that attitude is picked up by his colleagues.
Dr. Kirk Smith supervisor of the foodborne illness unit at the Minnesota Department of Health, agrees that budget and personality make a difference. But Minnesota has other advantages over many states, he says. One is what he and his colleagues affectionately call “Team Diarrhea.” This is the SWAT team of University of Minnesota students assembled on short notice to conduct intensive phone interviews with sick people when an outbreak is detected. “They give us the people power we need to do rapid investigations,” Smith says.
Initially, Team Diarrhea took advantage of the health department’s offices just steps from the university labs. When the department moved several miles to its new offices, Smith worried that Team Diarrhea might be left behind. But it’s still going strong, and played a crucial role in tracking down the PCA outbreak.
“Proximity to a major university helps,” Smith says. “A lot of us serve as adjunct faculty at the university.”
Geography and politics also make a difference. States such as Texas, where health departments are scattered among hundreds of cities and counties, are at a disadvantage when confronted by a regional outbreak. Individual doctors report to local officials who report to county officials who eventually report to the state; by that time, dozens or hundreds more people have been sickened.
Minnesota’s health system is highly centralized. When sick people are diagnosed with foodborne illness, local doctors and hospitals are required to immediately notify the state health department. Stool samples are dispatched to St. Paul, where the health department is linked by a sky bridge to Department of Agriculture laboratories across the street. DNA analysis that might take days or even weeks in other states can be available within hours in St. Paul.
That’s crucial, Smith says. “Local health departments are naturally focused on local exposures, so they’re not as quick to recognize widespread, commercial outbreaks,” he explains. “In Minnesota, those reports come directly to us, so we don’t have that lag time.”
Successful epidemiology requires technology to quickly analyze stool samples and products, seeking DNA matches, he says. But that technology depends on more traditional techniques that come first – one-on-one interviews with sick people, searching for common denominators. What and where did these people eat two weeks ago that made them sick? How can we get people who barely recall what they had for dinner last night to remember a meal — or a free cheese sample at Costco — last month?
And that, Smith says, is as much art as science.© Food Safety News