Like all disease, foodborne illness seems to strike at random. When people are exposed to foodborne microbes, some of them get sick while many others will suffer few or no ill effects.
Now it appears that the randomness extends to the public response. Some outbreaks of disease are quickly traced to their sources while other epidemics — probably the great majority — will take longer to be detected, if at all.
And that response depends in large part on where the outbreak occurs. Recent studies confirm what authorities have long suspected — that there is wide variation, from state to state and from city to city, in the ability of public health officials to detect and respond to foodborne disease.
“No matter how you look at it, you find this variability,” says Dr. Tim Jones, the Tennessee state epidemiologist and a respected authority on foodborne illness.
Last year, Jones participated in a national study conducted by the Council of State and Territorial Epidemiologists (CSTE), which sent out questionnaires to all 50 states and the District of Columbia, asking about structure, systems, training and more.
“The outbreaks that get the most attention are the large, multistate outbreaks, which tend to distort reality,” Jones says. “Most outbreaks of foodborne illness are small and local”
How well the health systems deal with those illnesses depends in large part on the capabilities of any of 50 state health departments and about 3,000 city and county agencies, he says. Many have little or no experience or training with foodborne illness, and there are few legal or professional standards.
The CSTE study suggests there have been some modest improvement in state health departments since the last such survey in 2002. Specifically, the number of fulltime epidemiologists working in state health departments increased 61 percent, from 92 in 2002 to 148 last year.
But the report emphasizes that “critical gaps remain.” State health agencies reported they need a total of more than 300 more epidemiologists – a 200 percent increase.
The actual trend, of course, is in the opposite direction. State and local health agencies lost more than 44,000 jobs between 2008 and 2010.
Meanwhile, the nationwide CSTE survey indicates that the number of foodborne illness officials trained in epidemiology drops dramatically to 48 percent at the regional level, and just 26.5 percent at the local level.
Education level is only one indicator of a health agency’s capacity to respond to outbreaks, Jones says. Others include health laws and political organization.
The Minnesota Department of Health, for example, consistently rates among the best at tracking down outbreaks of food poisoning. And experts attribute this in part to a highly centralized public health system where doctors are required to promptly report cases of food poisoning and send stool samples to a single state lab for testing.
Other states, like Texas and Florida, have decentralized health systems which tend to be slower on the pickup, Jones explains.
And only one-fourth of states report that they use an electronic database to keep track of local outbreaks.
“It’s frustrating,” Jones says. “We have all these negative studies, but no single factor explains the variability from state to state.”
That inconsistency may be even greater within states – especially states with decentralized public health systems.
His state of Tennessee is an example. Some parts of the state respond well to outbreaks, and some don’t, he said. In many cases, this has to do with how much time passes – hours or days – between when a person gets sick and health departments are able to test for foodborne microbes.
This finding gibes with another study released Sept. 20 by the Centers for Disease Control and Prevention (CDC.) That study reports that state health agencies have improved their abiity to detect and respond to outbreaks of disease or chemical threats. But many states are lagging behind the nation.
One CDC benchmark is the ability to quickly submit bacterial samples to the CDC’s PulseNet database for testing. The CDC standard is to submit 90 percent of E. coli samples within four days of receiving them.
Some states, such as Minnesota, Oregon, Tennessee and Washington, were able to meet that standard with 100 percent of their samples. Others, including South Dakota, Texas, Idaho, Kansas and Florida, fell far short of that standard.
Florida was able to submit timely samples in only 71 percent of cases last year, the study says. For Kansas, the rate was only 38 percent.
Part of the solution may be to standardize health department responses to foodborne illness, Jones says. This might include standardized questionnaires used by epidemiologists to investigate outbreaks.
But state and local health agencies may resist greater federal intervention, he warned. Some won’t even allow federal epidemiologists to interview sick people.
The CSTE study makes several recommendations for reducing the variability across the nation, including:
— More staff working in outbreak surveillance at the state and local levels.
— More training in epidemiology, both for existing and potential staff.
— More investment in electronic databases and other technology.
— Improved relationships between federal, state and local health agencies.© Food Safety News