Foodborne-illness mystery? Call in the Minnesotans

Source of Article: http://www.twincities.com/allheadlines/ci_11734975

After solving salmonella outbreak, state held up as a model to follow

Posted: 02/19/2009 12:01:00 AM CST

While others celebrated the holidays, Minnesota investigators were tracking a killer.

A nationwide salmonella outbreak had sickened hundreds of consumers, leaving a growing death toll, and nobody was sure why. Within days, state investigators in St. Paul had cracked the case — tracing the salmonella to tainted peanut butter from a troubled Georgia plant.

How did they do it? That's what Congress wants to know as it seeks to improve the nation's uneven food-safety patchwork. If the salmonella outbreak revealed how the food-safety system faltered, it also showed how Minnesota investigators shined during a deadly outbreak.

"Time and time again, it's the foodborne disease unit at the Minnesota Department of Health and the Minnesota Department of Agriculture that has come up with the answers," said U.S. Sen. Amy Klobuchar, D-Minn.

More than 40 states were involved in the peanut case, but Minnesotans were the first to zero in on the type of tainted peanut butter. The first to trace it back to a Georgia plant. The first to confirm salmonella in peanut butter. And first to warn the public about the danger — prompting the U.S. Food and Drug Administration to shut down the plant that same day.

"Because institutionally-served peanut butter, in five-pound containers, was identified by the state of Minnesota as a potential vehicle, our investigation began with a strong lead: the brand name of a company and the address to begin our trace," the FDA's director of food safety, Stephen Sundlof, told Congress last week.

Minnesota officials credit no single thing for making the system here work. It's a complex network and a culture of teamwork: health and food investigators who work side-by-side; state laws that provide strong consumer protections; good facilities and resources to detect problems; and experienced investigators who know how to interview patients, trace products and draw linkages.

"It's almost thinking like a criminal investigation, like you're trying to solve a murder," said Mike Schommer, spokesman for the Minnesota Department of Agriculture.

Here's how Minnesotans cracked the peanut case, as told by some who helped do it.

1: Outbreak begins. On Nov. 10, federal investigators noted a bump in the number of salmonella cases. Within weeks, it was clear a major outbreak was under way. But from where? Deadly salmonella bacteria can hide in many foods, but most commonly it's in poultry, so chicken and eggs were suspected early.

2: Minnesota hit. The first Minnesota case was reported on Nov. 17. By Dec. 21, there were eight more. State investigators probed for telltale clusters and patterns. "They were all around the state, and there wasn't any clear, obvious pattern at that point," said Carlota Medus, epidemiologist with the Minnesota Department of Health.

3: Interview victims. Health officials in Minnesota interview everyone who falls ill from salmonella, rather than wait for an outbreak. Then state epidemiologists can comb through the data, looking for common threads. Early on, an investigator noticed that "pretty much all of our cases were mentioning peanut butter," Medus said. "But there wasn't a clear name, or a product name."

4: The wave hits. Three days before Christmas, a long-term care facility in Brainerd reported several salmonella infections. A separate Brainerd facility had another case. Yet another case in town surfaced. A cluster had emerged, and investigators bore in.

5: Search for clues. "We worked with that long-term care facility, looking at things like menus and invoices," Medus said. The menus didn't even list peanut butter. But Medus persisted. She thought, "Hmmm, they had no snacks? I don't think so." Turned out, peanut butter was a common snack at the facility.

6: Connecting dots. When two schoolchildren in northern Minnesota fell ill, more links emerged. State agriculture officials asked a regional food distributor — which delivered to the long-term care facility — whether it also supplied the school. It did. Both received the same brand of peanut butter: King Nut.

7: Round up suspects. Food inspectors working with the Minnesota Department of Agriculture fanned out to seize samples of King Nut peanut butter. "Ideally, you want the product that the person ate," Schommer said. "But once it's opened, there is a risk of cross-contamination. So you (also) go and look at that production lot, and look for unopened products in that lot."

8: Probing a source. Minnesota investigators traced the King Nut peanut butter back to a processing plant in Blakely, Ga. Said Ben Miller, who supervises the response unit at the state Agriculture Department, "We spoke with the QA (quality assurance) manager in Blakely, and told him we were looking at King Nut as a possible source of salmonella contamination." Separately, Minnesota alerted the FDA that its probe was pointing to the Georgia plant.

9: To the lab. On Jan. 9, lab tests in St. Paul confirmed that a 5-pound tub of King Nut peanut butter was contaminated with salmonella. "They took like 15 samples (from the tub), and they didn't find it (salmonella) in every single one of them," Schommer said. "The contamination isn't uniform." Because the FDA had been notified earlier, the federal probe got a jump-start. "They were on the ground and in that facility right after we found out the presumptive positive," Miller said.

10: Retracing a killer. Even before test results were in, investigators had started retracing the peanut butter's distribution path. So when the result was found Friday, Jan. 9, Minnesota officials immediately warned the distributor in North Dakota. Said Miller, "By 5:30 that evening, they had 30 to 35 people crawling all over the establishment," removing tubs and alerting every customer who'd bought King Nut peanut butter in the past six months.

11: A public warning. The positive test and distribution pattern — while not definitive — impelled Minnesota officials to warn the public. On Friday afternoon, a consumer advisory told people and institutions to avoid King Nut peanut butter. "We knew King Nut peanut butter was distributed to nursing homes and schools, and we didn't want to wait over the weekend," Medus said. But even then, officials couldn't "explain all the non-institutional cases" turning up.

12: A genetic match. On Monday, Jan. 12, genetic testing in Minnesota labs revealed a match. The strain of salmonella in the peanut butter was the same one cultured from ill Minnesotans.

13: Cop on the beat. Agriculture officials fanned out across the state, checking that questionable products were being removed from store shelves, warehouses and storerooms. If need be, Schommer said, "We do have the power to embargo product."

14: Final proof. Because outside contamination is possible in opened jars, officials seek confirmation from sealed jars, too. Connecticut found it first. Then Minnesotans identified three strains of salmonella in an unopened jar from the Georgia plant.

Nine consumers, including three in Minnesota, have died in the outbreak. More than 600 have become ill. The plant owner, Peanut Corporation of America, is closed and has filed for bankruptcy.

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