Early in December, a nurse in Roseburg, Oregon, contacted the state Public Health Division to report that two women, both in their 60s, had been sickened by toxic E. coli O157:H7. That report immediately got the attention of Dr. William Keene, Oregon’s senior epidemiologist.
Keene and others launched an intensive, two-week flurry of interviews and sleuthing, hoping to find the source of the outbreak before more people were poisoned. In all, they had eight sick people spread across four states–not much to go on. But their process of elimination zeroed in on a rural cheesemaker in neighboring Washington state, near the Canadian border, whose unpasteurized cheese proved to be the culprit.
It was a remarkable bit of medical detective work that almost certainly prevented a larger epidemic. That story was well told at the time by reporter Lynne Terry in The Oregonian.
For Keene, it was another day at the office. At age 54, he’s a veteran of countless food poisoning outbreaks dating back 20 years, from Jack-in-the-Box to King Nut Peanut Butter. Along the way, he’s earned a reputation as a sort of mild-mannered Indiana Jones of American epidemiology.
When the nonprofit Center for Science in the Public Interest graded state efforts to track foodborne illness, seven states got As. But CSPI pointed to Oregon and Minnesota as model programs, leaders in their field. And Keene is the personification of Oregon’s program.
He is a strapping fellow with a biblical beard wrapped around a round face, and a whimsical air of self confidence. He works out of a small windowless office on the 7th floor of a state office building across the Williamette River from downtown Portland. His office is cluttered with medical books, posters and scores of packaged foods–mementoes of two decades of food poisonings. A sign on his door reads: “National Outbreak Museum.”
Keene’s career path zig-zagged through the life sciences before lighting on epidemiology. Raised in a blue-collar Seattle neighborhood, he became an early fan of the Hardy Boys series of mystery stories, which should have provided a clue. “I have them all,” he says. But at Yale, he majored in anthropology and primatology. After graduation, he spent two years studying monkeys in the Himalayas, where “I decided I really like working in the field.”
While working in a research lab in San Francisco, a friend recommended the books of Burton Roueche, who wrote during the 50s and 60s about the emerging science of epidemiology. His stories included “Eleven Blue Men,” about some alcoholics whose odd skin coloring was eventually traced to a bad batch of oatmeal at a Manhattan greasy spoon.
“I didn’t know it then, but I was hooked,” Keene recalls.
Keene went on to study parasitology and microbiology at Johns Hopkins, then returned to the Bay Area where he took some courses in epidemiology while working on his PhD. Eventually, he realized: “This is what I want to do.”
He applied for a job at the Epidemic Intelligence Service at the Centers for Disease Control, but was not accepted.
But, in 1990, Keene landed a job with the Oregon Public Health Division. As things turned out, his timing was perfect. Genetic fingerprinting had developed to the point that outbreaks could be traced with virtual certainty to a specific source. And, as a result, a frightening E. coli outbreak linked to undercooked hamburgers at Jack in the Box restaurants pushed foodborne illness onto the national stage.
“We were well aware of O157 before Jack in the Box,” he stresses. “I worked on several E. coli outbreaks in the early 1990s.”
And Oregon was one of the first states to require doctors to report cases of E. coli O157:H7 to the state.
There are several reasons for Oregon’s success, Keene says. The foodborne illness program is funded almost completely by the federal government, thanks in part to its role in the federal FoodNet program, which uses data from 10 handpicked states to track trends in foodborne illness. Though Oregon has fewer people than neighboring Washington, it has more than twice the number of trained staff, he says. And the federal dollars leave them relatively insulated from state budget cuts.
Keene also points to the nine-page questionnaire that he designed for interviewing victims of foodborne illness. While it is longer than other state questionnaires, it relies almost completely on yes-or-no questions, which speeds up the interview, he says.
But Oregon’s biggest advantage may be Keene, who exudes a rare passion for his job.
Dr. John Kobayashi, a University of Washington epidemiology professor and former head of foodborne illness for the state of Washington, points to Keene’s long experience.
“He continues to investigate outbreaks with care and enthusiasm,” Kubayashi says. “People like Bill bring institutional memory to public health, which is frequently lost, even at the national level. It’s very important to have people who remember unusual modes of transmission or pathogens that occurred 20 years ago, and remind us when seemingly new problems are in fact ‘déjà vu all over again.’ “
That’s the rationale behind the food packages that line Keene’s office bookshelves. In this business, experience is important, he says.
“I’ve given up trying to figure out which outbreaks will become media stories and which will not,” he says.
“But, for me, it’s fun to stop outbreaks, and to see how quickly we can do it.”
Like government everywhere, Oregon struggles to balance competing demands for tax dollars, he says.
“Foodborne illness, while it seems to have become my life’s work, is only one of many public health problems that compete for funding interest and attention. In a zero-sum game, is it more important to invest resources in trying to decrease diarrheal disease? Or should that money and staff go to preventing sexually transmitted diseases or tuberculosis or cancer?
Ultimately, he agrees that, in dealing with foodborne illness, experience and attitude may be more important than dollars.
“I think you really need to enjoy doing battle with these bugs and figuring out their insidious secrets,” Keene says. “That enthusiasm can be contagious.”