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Many States Are Weak
At Reporting Foodborne Illnesses

Jim Prevor’s Perishable Pundit, December 22, 2006

A Scripps Howard News Service report finds that states are doing a wildly varying job when it comes to identifying the source of food and water borne illnesses:

Scripps studied 6,374 food-related disease outbreaks reported by every state to the federal Centers for Disease Control and Prevention from Jan. 1, 2000, through Dec. 31, 2004. The causes of nearly two-thirds of the outbreaks in that period were officially listed as “unknown.”…

The poor track record of so many state labs also raises chilling questions about their ability to spot or deal with a food-borne terrorist attack….

The study found that Kentucky, Oklahoma and Nebraska are virtually blind to outbreaks of food sickness, rarely detecting that scattered illnesses have common food causes.

In Alabama, Florida and New Jersey, the cause of food poisoning is almost never found, even when it is known that dozens or hundreds of people became violently ill or died from something they ate, according to the Scripps study….

Alabama was the worst in the nation, diagnosing only 5 percent of its reported outbreaks, the study found. “It’s a real struggle. We’ve never identified a virus at the state level,” said Alabama State Epidemiologist John Lofgren.

After learning of the study’s findings, Kentucky officials ordered changes to their disease-reporting system. “We really hadn’t been categorizing food- and waterborne outbreaks,” admitted Kentucky Epidemiologist Kraig Humbaugh.

During the five-year period studied, Florida reported only seven people sickened by E. coli outbreaks, a suspiciously low number for a state of its size. Nationwide, at least 3,349 people contracted E. coli in food-poisoning outbreaks….

The study found that health departments are more likely to make a diagnosis when a very large number of people get sick. They failed to determine the cause in 31 percent of the outbreaks that sickened 50 people or more. But the failure rate increases rapidly with smaller groups.

Fifty-three percent of outbreaks affecting 10 to 49 people went undiagnosed, while 75 percent of outbreaks that sickened nine or fewer people were listed as “unknown” causes.

Several state and local epidemiologists said large outbreaks give them more chances to isolate the exact disease involved. More victims mean a better chance of obtaining blood, stool and urine samples that can be tested for specific pathogens.

But epidemiologists admit that failures to diagnose food illness are common, even when the only suspect for outbreaks of a widespread intestinal disease is food. The Scripps study found that the disease went undiagnosed in 4,054 of the 6,374 reported outbreaks. Those unknown causes sickened or killed 50,968 people….

Every year, an estimated 5,000 Americans die from food-based diseases like Salmonella, E. coli, Shigellosis and Campylobacter. Another 325,000 people are hospitalized. The CDC estimates that food-based sickness probably afflicts 76 million Americans annually.

Although the Scripps study found that the quality of the nation’s network of public health departments varies alarmingly, there were some bright spots.

Wisconsin, Minnesota and Hawaii do a good job of diagnosing disease outbreaks.

Wisconsin came out on top in the study by diagnosing the cause of 90 percent of its food-poisoning cases. Wisconsin also was the first state to detect and report September’s deadly E. coli outbreak from infected raw spinach grown in California and shipped nationwide. The outbreak killed at least three people and sickened at least 199 others.

But the study found little to celebrate overall since most outbreaks go undiagnosed.

Federal officials and public health experts agreed with the findings and conclusions of the Scripps study.

“Our surveillance systems were designed to ring a bell when there is a problem. Are they perfect? Absolutely not. Could they be better? Absolutely yes,” said spokesman Tom Skinner at the CDC’s Atlanta headquarters after reviewing some of the study’s findings. “We’ve already come a long way, but certainly, we can do better than this.”

Skinner offered no explanation when asked why the CDC didn’t warn underperforming states and local health departments.

“The CDC, like most government agencies, is pretty conservative. Why would they want to rock the boat?” said Ewen Todd, director of the Food Safety Policy Center at Michigan State University. “It takes someone who is independent to say: ‘This is crazy’.”

Todd agreed that the quality of public health is erratic in the United States. He said state health programs are especially poor in the South.

“Our laboratories are pretty good. But, overall, the whole public health system is not working very well,” Todd said. “There are no national standards for the surveillance and reporting of food illnesses.”

Other experts said they believe the quality of state labs also varies alarmingly.

“Lab capacity is a serious issue for many reasons,” said Jeffrey Levi, executive director of the Trust for America’s Health in Washington, which studies trends in public health. “The federal government should set minimum standards and expectations and provide the resources necessary to assure this capacity.”

The report also explains why small, local producers often seem to have better food safety records. As we’ve harped on in the Pundit, these small producers cause many small outbreaks, virtually none of which get linked to a specific producer. As the Scripps Howard piece states:

“Several state and local epidemiologists said large outbreaks give them more chances to isolate the exact disease involved. More victims mean a better chance of obtaining blood, stool and urine samples that can be tested for specific pathogens.”

So based on this statistical chimera, newspapers and magazines across the country are urging local production to displace California, Arizona, Washington, Texas, Florida and other major national shippers.

The implication of this study is that now that attention is being paid to this matter, state labs will be upgraded and under-reporting states such as Florida will identify many more outbreaks of E. coli 01257:H7. This means that we have to get constantly safer to keep the number of outbreaks constant.

Like gerbils on the wheel.

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