Source of Article: http://www.cidrap.umn.edu/cidrap/content/fs/food-disease/news/jul3108outbreaks.html
Jul 31, 2008 (CIDRAP News) – Experts and industry leaders speaking at congressional hearings this week on the nationwide Salmonella outbreak said federal agencies should take cues from state programs if they want to improve the traceability of fresh produce and the success of foodborne disease outbreak investigations.
a House subcommittee hearing yesterday, a
Osterholm, who is director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News, also proposed the establishment of regional surveillance teams or a national surveillance team patterned after teams used by the MDH.
a separate House subcommittee hearing today, tomato industry leaders from
The Food and Drug Administration (FDA) had a difficult time tracing the sources of tomatoes, which were the prime suspect in the huge outbreak for several weeks, until suspicion fell on jalapeno and Serrano peppers in early July. The FDA maintains that the main problem was that many businesses which handle tomatoes use paper instead of electronic records. In the early weeks of the outbreak, the agency published an often-revised list of growing areas that were considered safe, while warning consumers to avoid certain types of raw tomatoes from other areas.
Salmonella outbreak included 1,319 cases in 43 states,
FDA announced Jul 21 that a jalapeno pepper contaminated with the outbreak
strain had been found at a tomato distributor in
Lack of standardization
In written testimony presented to the House Agriculture Subcommittee on Horticulture and Organic Agriculture yesterday, Osterholm said epidemiologic investigations are carried out by many different jurisdictions, with no general agreement on best practices. His statement was co-written by Craig Hedberg, PhD, a foodborne disease expert with the University of Minnesota School of Public Health, and John Besser, PhD, clinical laboratory manager at the MDH.
"There are great differences in the ability of states to collect and analyze the basic information needed to resolve outbreaks, which places intrinsic limitations on the ability of CDC [Centers for Disease Control and Prevention] to investigate multistate outbreaks," Osterholm stated. "This in turn limits the ability of FDA or USDA [US Department of Agriculture] to pinpoint the sources of contamination and to break the chain of transmission."
Contributing to the lack of standardization is the fact that foodborne disease investigations are handled at different levels in different states, Osterholm reported. He said a survey reported last year showed that gastrointestinal disease surveillance was conducted by local agencies in about half of the states, was centralized in a state office in about a quarter of the states, and was handled by regional state offices in another 20%.
He explained that the role of CDC in multistate foodborne outbreak responses is to aggregate surveillance data on a national level and provide consultation and coordination; the agency does not have the authority to independently investigate an outbreak in a state, though it can respond to a state request.
In many foodborne disease outbreaks, the food vehicle is never found, Osterholm said. The prime reason many outbreak investigations fail is the long time lag between when people get sick and when the outbreak is recognized, he said. It can take 3 to 4 weeks for investigators to learn from DNA fingerprinting that they have a cluster of cases caused by the same strain of pathogen. When patients are interviewed, they have to try to recall what and where they ate as long as 5 to 6 weeks earlier.
Adding to the difficulty, Osterholm wrote, is that many public health agencies do not use a standardized questionnaire or collect detailed source information about food items when they interview case-patients. "Systematically collecting detailed exposure information during early interviews with cases is a critical need to improve the effectiveness of our surveillance and outbreak investigation efforts," he said.
Osterholm said a group called CIFOR—the Council to Improve Foodborne Outbreak Response—has developed guidelines that could help to standardize the response to outbreaks. The practices, many of which have been used successfully in Minnesota, include interviewing all patients when their cases are first reported, using a standardized form to collect detailed exposure information when recall is the greatest, and then to interview patients again after possible new sources are suggested during the investigation. "We believe these should be adopted as best practices, and that where resources limit the adoption of these practices, we must find a way to build the infrastructure of our public health system to make it possible," he stated.
further key to successful outbreak investigation in
testimony dovetailed with comments at today's hearing by Kirk Smith, head of
the MDH's foodborne disease
unit. He summarized how the MDH investigated a cluster of Salmonella Saintpaul cases that surfaced in
reason for the successful investigation was that foodborne
disease probes in
Does Bioterrorism Act need updating?
Today's hearing, held by the House Energy and Commerce Subcommittee on Oversight and Investigations, focused on lessons learned from the Salmonella outbreak and response.
In an opening statement, Rep. Bart Stupak, D-Mich., the subcommittee chair, said the group would consider whether the Bioterrorism Act of 2002, which was designed in part to improve the traceability of food products, needs to be amended for that purpose.
panel heard from tomato industry and state officials that
Beckman, president of California Tomato Farmers, based in
"What we did was link the 'one step up and one step back' requirements of this (Bioterrorism) act at each level of the supply chain," he said.
Concerning FDA claims that it was difficult to trace tomatoes, Beckman said, "We can't help but ask specifically, where was the problem?"
The reply from David Acheson, MD, the FDA's associate commissioner for foods, was that many of the businesses that handle tomatoes had only paper records, which took time to sift through.
Acheson was asked whether the Bioterrorism Act "worked" in the case of this outbreak. "The Bioterrorism Act worked as written," he replied. "We rarely ran into a situation where people were not keeping records. It was many of the small producers, the small restaurants . . . they do not have electronic records; the vast majority of information we got was paper."
Boothe, president of a tomato company in
Acheson told the panel that the FDA, in proposing its Food Protection Plan last fall, asked for 10 specific legislative authorities. Of those, "probably the one that's most important is the one that requires preventive controls [in food production and processing]. That's absolutely critical across the board," he said.
list for Jul 31 House subcommittee hearing
Salmonella outbreak page
May 23, 2008, CIDRAP News story "Group charts ways to improve foodborne illness probes"
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