Foodborne Illness Outbreaks Need More Aggressive Response by Dan Flynn

From its headquarters on Baltimore harbor the 15-year old Center for Biosecurity of UPMC looks out on the historic Coast Guard Cutter Taney, the last ship afloat to have immediately fought back when Pearl Harbor was attacked in 1941.

The  way the Taney instantly turned its guns on the enemy  is just the sort of reaction the U.S. needs to mount whenever and wherever there is an outbreak of foodborne illness, according to the Center’s new report “When good food goes bad.”

“The sooner the source of an outbreak is identified, the sooner we can issue accurate targeted warnings and take the contaminated products off the shelves,” says Jennifer Nuzzo, who authored the report.   “And the sooner people stop eating contaminated food, the sooner the sickness stops.”

Now an independent nonprofit organization of the University of Pittsburg Medical Center (UPMC), the Center for Biosecurity’s report calls for strengthening the U.S. response to foodborne disease outbreaks.  Only by stepping up its current ability to respond can the U.S. limit illnesses and deaths and economic costs, the new report says.

“Foodborne illness sickens or kills an extraordinary number of people each year,” the report says. To illustrate how deadly foodborne illness outbreaks can be, the UPMC Center for Biosecurity pointed to the E. coli O104 outbreak in Germany that sickened 4,000 and killed at least 50 from eating sprouts and the U.S. Listeria outbreak that sickened and killed at least 33 from contaminated cantaloupe.

“If public health officials can more quickly recognize when a foodborne illness outbreak has occurred and identify the food causing the outbreak, lives can be saved and economic losses averted,” says the report. “The lessons leanred from outbreak investigations cn be used by industry and government to address the underlying causes of contamination that lead to illnesses , thus making food safer for everyone.”

The Biosecurity Center’s interest in food borne illness outbreaks apparently stems from the 2010 “credible threat” by Al-Qaeda terrorists to poison salad bars and buffets at hotels and restaurant over a single weekend, using ricin and cyanide.   “US officials cautioned that even in small amounts of these chemicals in food could cause serious harm,” says the report.

That plot was not executed, but illustrated the problem.  “Initially, it will be very difficult to distinguish deliberate contamination of the food supply from a naturally occurring outbreak,” it says.

It pointed to the 1984 incident in The Dalles, Oregon where a religious group out to influence a local election intentionally went around town poisoning salad bars with Salmonella, sickening many.  Before a criminal investigation found it was deliberate, public health officials blamed the outbreak on poor hygiene.

“The continued three of deliberate contamination of food supplies highlights the important of strong systems for rapid detection and response for food borne illness outbreaks,” the report continues.  “Since a deliberate contamination of the food supply is likely to resemble a natural outbreak at the start, initial responsibility for responding to deliberate contamination events will flu to state and local health departments.”

The Center says the report is intended to “catalyze improvements in the country’s ability to respond to large foodborne disease outbreaks. “

“We analyzed the existing data and studies on foodborne illness outbreak response, identified emerging trends, and interviewed dozens of federal and state level officials and experts from industry, professional organizations, academia, and relevant international organizations,’ it says.

Among its findings:

• Foodborne illness outbreaks continue to impose enormous health and economic burdens.
• Effective surveillance for and rapid response to foodborne illness outbreaks are critical to overall preparedness.
• National surveillance programs have led to meaningful improvements in detection of foodborne illness outbreaks and can drive improvement in food safety.
• Determining the source of foodborne illness outbreaks remains the top response challenge and will likely become harder as the complexity of the food supply increases.
• Heterogeneity in states’ capacities to detect and respond to outbreaks creates national vulnerabilities.
• Increased adoption of culture-independent diagnostic testing by the clinical sector threatens to undermine early detection of foodborne illness outbreaks.
• Tapping nontraditional data sources may help improve detection and response to outbreaks.
• Better integration of existing surveillance programs is necessary to improve outbreak detection and response.
• Federal funding cuts are expected to compromise the public health system’s ability to respond to foodborne illness outbreaks.
• The Food Safety Modernization Act has the potential to significantly improve the safety of the U.S. food supply, but will likely do little to improve public health response to foodborne illness outbreaks.

In its findings, the UPMC Biosecurity unit accepts estimates that foodborne illness outbreaks cost the U.S. more than $77 billion annually, including 128,000 hospitalizations and 3,000 deaths. It also recognizes the problem that so-called fast tests on patients are causing in spotting outbreaks because they do not require isolation and culturing of pathogens.

The report comes with five recommendations. They are:

1. The U.S. government should fund the development of next-generation technologies that provide rapid diagnosis while preserving the capacity to identify and resolve large outbreaks.
2. Congress should restore funding for state health departments.
3. The U.S. should develop a foodborne illness outbreak response network that taps expertise and data that exist in the private sector.
4. Congress should adequately fund and agencies should fully implement the FSMA, including provisions for strengthening surveillance and response to outbreaks.
5. The U.S. government should improve integration of existing foodborne illness surveillance efforts.

The report says a new technological solution is needed to the problem created by greater use of the fast tests. It says small increases in state health department capacities can substantially increase the country’s ability to respond to foodborne illness outbreaks. State and local health agencies need more direct connections with the private sector.

In addition, the report says more access to healthcare data would help expedite responses to outbreaks. It suggests using the “national framework” being built through electronic health records.

The nonprofit University of Pittsburgh Medical Center (UPMC) is a $10 billion health enterprise including 20 hospitals, 4,200 licensed hospital beds, and 400 outpatient sites with 1.5 million members and 54,000 employees.

The mission of the Center for Biosecurity of UPMC is to strengthen U.S. national security and resilience by reducing dangers posed by epidemics, bio threats, nuclear disasters, and other destabilizing events.  Among its research topics last year were “Preparing for Bioterrorism” and “Radiological Disasters: What’s the Difference?”

The Center has been associated with UPMC since 2003.

USCGC  Taney (WHEC-37) is a Treasury-class Coast Guard Cutter that was moored in nearby Honolulu Harbor when the Japanese attacked Pearl Harbor without warning on Dec. 7, 1941. Taney’s anti-aircraft guns were immediately put to use defending the airspace over the city. After 50 years of service, including World War II, Korea, and Vietnam, the Taney was decommissioned in 1986 and since then has been a museum ship on Baltimore harbor.