January 21, 2011
Sharon Shea, MHS, MT (ASCP), Director of Infectious Disease and Food Safety Programs, APHL
Those of us who work in the food safety arena are not surprised by the recommendations from CSPI in their report, All Over the Map: A 10 Year Review of State Outbreak Reporting. That report states that “public health efforts to detect, track, investigate, and report foodborne illnesses are vital to farm to table prevention efforts.” Strong recommendations are included in this report, aimed at the many players involved in these collaborative investigation efforts. Notably, public health laboratories (PHLs) are recognized as an important component of successful public health programs.
Budget Cuts a Threat to Investigations
In the current economic climate, most government agencies are looking for ways to cut budgets. CSPI is right on target when they state, “Most importantly, state legislators should consider the public health and economic toll of foodborne illness when making budget decisions, and should ensure that health departments are properly funded to carry out their critical public health mandates.” CSPI rightly acknowledges that “the hard work of outbreak investigations is still conducted largely at the local and county level,” and that these officials are often tasked with a number of additional job responsibilities. Yet if this work is not performed, contaminated food cannot be identified and removed from the marketplace, nor would the data be available to feed back into the preventive control systems used by industry and regulators to improve processes and prevent future contamination events.
Collaboration Across System Critical
State and local governments are not the only participants who must engage in outbreak investigations, whether those outbreaks are detected through consumer complaints or laboratory-based surveillance through PulseNet. An effective system requires consumers who seek medical treatment for possible foodborne illnesses, physicians who report suspected cases to public health agencies and order laboratory tests to confirm the cause of illnesses, public health laboratorians who further characterize bacterial and viral causes of illness using molecular methods, epidemiologists and environmental health specialists who collect data on case patients and analyze clusters of disease for possible connections, state and county governing officials who provide adequate resources for public health investigations into foodborne illnesses, and federal officials who provide guidance and assistance when needed, including the coordination of multi-state outbreaks and the collection of national outbreak data.
To further this work, multi-year capacity building grants should be provided to PHLs, including grants that will allow full participation in the PulseNet network.
Confirmation Not Essential to Effective Response
Yes, variations exist across the country in how state and local governments allocate their resources to address foodborne illnesses within their jurisdictions. Reporting of cases to the Centers for Disease Control and Prevention (CDC) is just one of many important activities that needs to be prioritized and funded by government. Yet finding the source of an outbreak, even in the absence of a confirmed pathogen, can protect the public by leading to improved food handling practices, by creating an opportunity to further train food handlers and producers, and by leading to a greater understanding of what can go wrong in the food production, transport, and service industries. The body of knowledge created through routine, well-organized, and nationally reported investigations also allows for the development of science-based regulations that impact what is already considered one of the safest food supplies in the world. We at APHL, as well as our member laboratories across the county, are committed to participating in this dynamic and collaborative system.