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Outbreak Investigation Class 101 Not Doing So Good

In case anyone is concerned that the tomato industry or the larger produce industry does not have a voice in this ongoing Salmonella Saintpaul outbreak, let us introduce you to Jim Prevor’s Perishable Pundit.

Through this saga, we’ve largely relied upon “official” sources of information. The states, especially New Mexico and Texas that were impacted early, the Centers for Disease Control & Prevention, and the U.S. Food & Drug Administration.

As the outbreak has dragged on, there’s been an occasional nugget of new information from some of the media covering it. What we’ve really been lacking, however, was for a true expert to speak out and tell us if we were wrong to be thinking this outbreak investigation is inept exercise by federal bureaucrats who couldn’t find a bleeding Elephant in the snow.

Then Mr. Prevor stepped forth with a comprehensive interview with Dr. Michael Osterholm, Director, Center for Infectious Disease Research and Policy, University of Minnesota. He is the true expert, highly respected and just maybe the man who forced FDA and CDC to come clean in their “well maybe its not tomatoes” news conference last Friday.

That’s what Mr. Prevor thinks. We found many of Dr. Osterholm’s quotes so compelling that we are taking the liberty of using a few of them here after questions that are a little shorter than the ones from the conversation between Mr. Prevor and Dr. Osterholm. We strongly encourage you to read the full version at the Perishable Pundit.

Should it make a difference where an outbreak occurs?

In the first instance, all infectious disease is local and only as good as local surveillance. Fortunately, we’ve had states such as Minnesota, Oregon and Tennessee that have really been on the cutting edge of detecting outbreaks because of very good surveillance. Local and state surveillance only works when health laboratories are equipped with the capacity to quickly characterize the bacterial isolates from these patients.

Where did the Salmonella Saintpaul outbreak begin and how did those states do?

New Mexico did a great job in this outbreak. On the whole, Minnesota, Oregon and Tennessee have led the way. The problem is that many states are not geared up to respond. In this outbreak, scores of cases are six weeks old or so. In Texas, many of the “new” cases are not new at all. The Texas Public Health Department is finally catching up in the lab with isolate characterization. The state only has two labs for this kind of fingerprinting.

And how about once the federal government arrives on the scene?

The whole system is flawed. The relationship between FDA and CDC is strained; it’s improved but still lacking. It’s not clear who is really in charge. Authority is split up in a way that decisions get bogged down and you don’t have anyone in command. You need that to effectively launch and oversee an outbreak investigation. I’m not sure who’s in charge. We have people identified as being in charge. We need someone that understands outbreaks, not just manages them. In this case, it appears that instead of experienced professionals, Outbreak Investigation Class 101 was doing the control study.

How did the federal government build upon the good work of the states?

The case control study initiated by New Mexico was important and did provide critical information. It used interviews comparing foods eaten by ill and well persons to identify consumption of raw tomatoes as the likely source of the illnesses. I believe New Mexico did try to do some trace back to the source but didn’t have the information or authority to go all the way back to Mexico.

New Mexico should be applauded for what they did relative to what they could do. CDC supports the overall epidemiological investigation. I know for a fact, however, that the government did not trace back any product reported by the control group. We don’t have a trace back to the source using the information from the control group. That was not done.

Has the investigation worked with tomato growers?

The final piece on this outbreak debacle: several of us have done a lot of work on outbreaks. We went to a wise group in the produce industry with no horse in the race. They looked at the patterns and they knew this market so well. This simple task of eliciting help from industry experts was not done by the investigators to any meaningful extent. We do very a poor job of bringing in the industry to help solve these outbreaks. What does this mean? That straightforward questioning didn’t happen in a way that would have been most helpful.

What about that list of safe growing areas?

Right from the get-go, it was unclear how FDA was coming up with that list; why certain states and countries made the list while others were excluded. If any place not producing in late-April/early-May is safe, why the confusion and piecemeal additions to the list day by day? It appeared there was no rhyme or reason why a state or country was on the list. The logic was lacking. If FDA believed states and countries not in production at time of the outbreak were safe, they should have included all states and countries in that category.

On the other hand, if FDA has the view that a re-packer could be involved, which it now says it does, then it means FDA’s list would have been invalid and in their view putting consumers at risk. Either way, it’s not based in logic. Is it by dates of production, or is it not by dates of production because product could come through a re-packer?

There is a major issue with transparency. Why would you say something is or isn’t involved? First, the formation of the FDA list is disingenuous. It was based on those that screamed the loudest, and from a public health standpoint, that’s not right.

  • Retired US Government Laboratory Scientist

    Why an obscure, non-lethal micro, Salmonella saintpaul, has become a major disease causing agent, and front page news?
    Again, the citizens of the United States have become a victim of a government experiment. If you do not think this can happen in the USA, then you are one of the majority of nieve individuals who has become a victim of your lack of knowledge of The U.S. Government. You can believe the Serratia experiment in the California Bay Area did not happen. The organism, Salmonella saintpaul, was classified as a non-lethal micro and used as a test organism in a terrorist food contamination test. I was involved in such experiments on unknown citizens. The news media is playing right into the hands of the government. Why does Texas have the most reported cases of Salmonella saintpaul, and the most military installations, and major government medical facilities? The control state.
    In a State of War, of which the USA is in, the government beleives they can justify unethecial medical testing without recourse. Germany and Japan did it during WWII. “Experiments are performed for the benefit of the government, and all.”
    An article of such testing was made public by a local news media, but did not get national attention. The Albany, NY, timesunion.com., article by Brenden J. Lyons, Dec 17th, 2007, “Widows’ VA Suit Thrown Out.” Iraq was a lie, and The US Government is a lie, and the nieve citizens are the victims.
    So you do not beleive me, just look up Salmonella saintpaul in any of the medical micro books.