Have a seat up here.
John, a 65 year old male, has gone to the emergency
room.
He clutches his stomach in intense pain, suffering
from an intense gastrointestinal illness.
The Centers for Disease Control and Prevention
estimates that about 48 million people get sick,
128 thousan are hospitalized, and 3,000
die each year from foodborne pathogens in the
United States.
Some germs make you sick within a few hours after
you eat the contaminated food.
Others may take several days before symptoms
appear.
Food poisoning symptoms may range from mild to
severe and differ depending on the
particular germ you swallowed.
Any diarrhea or vomiting?
I threw up this morning and last night and I've
had diarrhea for two days.
Ok, we're going to go ahead and get a stool
sample from you and do some bloodwork and I'll be
back shortly.
There are many different disease- causing bacteria,
parasites, and viruses that can contaminate
foods.
Laboratory testing is required to pinpoint
exactly what is causing John's illness.
Some of the more well-known causes of
recent outbreaks include Salmonella, Listeria, E.
coli, and Cyclospora.
In John's case, lab tests have detected Shiga
toxin-producing E.
coli bacteria as the culprit.
The laboratory reports the E.
coli infection to the doctor and the local
public health department.
The clinical lab may ship the E.
coli isolates to the state public health laboratory
for more testing and DNA fingerprinting.
Public health laboratories from across the nation
submit DNA fingerprints of bacteria from sick
patients.to CDC via a nationwide surveillance
network called PulseNet that monitors foodborne
illnesses caused by bacteria.
Since it began in 1996, PulseNet has detected
thousands of local and multi-state outbreaks.
There is at least one PulseNet laboratory in
every state.
CDC manages and monitors the PulseNet database,
which keeps track of each bacterial DNA fingerprint
collected nationwide.
The system currently has more than 1 million DNA
fingerprints on file.
CDC investigators use whole genome sequencing to
compare genetic fingerprints of bacteria
from sick people.
When multiple people get sick around the same time
from bacteria with the same DNA fingerprint, that
indicates a possible outbreak and we launch an
outbreak investigation.
CDC investigators use whole genome sequencing to
compare genetic fingerprints of bacteria
from sick people.
When multiple people get sick around the same time
from bacteria with the same DNA fingerprint, that
indicates a possible outbreak, and we launch an
outbreak investigation.
Keep in mind, there's always a background level
of potential foodborne illnesses reported by
doctors, and what we're searching for are spikes
above normal.
Disease detectives must work with speed and
accuracy to stop an outbreak in its tracks.
Local and state officials interview sick people
about the foods they ate before they got sick and
where they bought those foods.
People are often interviewed weeks after
thye got sickbecause of the time it takes their
sample to be tested and reported to health
officials.
So they may have trouble remembering everything
they ate.
Saving your store and restaurant receipts is
helpful, but many people throw them out or can't
find them.
This is where store loyalty cards used at
checkout by customers come in handy since they keep a
record of your purchases.
You can give the store permission to release
these data to investigators.
Investigators are looking for something in common
linking the illnesses to each other such as eating
the same food, eating at the same restaurant,
shopping at the same grocery store, or
attending the same event, The goal is to narrow down
how and where people got sick.
By analyzing the answers to these questions, we can
often identify a suspect food.
For the E.
coli outbreak that affected John in Michigan
, epidemiologic evidence indicates that leafy
greens sold in a chain of grocery stores in the
Midwest are the likely source of this outbreak.
Over the years, a wide variety of food types have
been linked to foodborne illness, including
cucumbers, cantaloupes, eggs, flour, cereal,
peanut butter, and chicken.
While millions of servings of leafy greens are
consumed safely every day, this commodity has been
implicated in numerous outbreaks, including a
multi-state outbreak of E.
coli in 2018 in which twohundred and ten people
got sick, of whom 96 were hospitalized, and 5 died.
Another example is a Salmonella outbreak in
2020 linked to contaminated onions that
caused illnesses in One thousand one hundred
twenty-seven people.
167 were hospitalized.
The Food and Drug Administration regulates
most types of food in the country, including fruit,
vegetables, dairy, and most packaged food.
Because the suspected product is a vegetable,
CDC contacts FDA to determine who produced the
contaminated food so it can be removed from the
market to prevent more people from getting sick.
If the source of the outbreak had been beef,
chicken, or another USDA- regulated product, CDC
would contact the U.S.
Department of Agriculture and work with them on the
investigation.
If CDC cannot pinpoint a specific food at this
early stage, they notify both FDA and USDA to
investigate further.
At FDA, the Coordinated Outbreak Response and
Evaluation Network (known as CORE) is responsible
for managing the outbreak response.
So how many cases are we looking at at this point?
The CORE teams have one goal: to control and stop
the outbreak as quickly and efficiently as
possible.
CORE works directly with state and local agencies
and investigators at FDA field offices scattered
across the country to track down leads, trace
the distribution of the contaminated leafy greens,
and perform inspections and lab tests.
Traceback investigations are the backbone of the
detective work FDA does to identify from where the
food may have come, and where it might have become
contaminated.
It's a race against time to solve the mystery
before more people eat that food and become sick.
Our response teams coordinate the
investigations of the locations where sick
people report buying food.
This may include contacting grocery stores,
restaurants, and other food retailers and looking
at their menus, ingredients, and supply
chain records which even today are mostly paper-
based.
FDA then works backward through the distribution
supply chain, focusing on where and how the food got
to the point of exposure.
We map this path through the supply chain from farm
to fork.
Food can change hands many times before it is
purchased by consumers, and all these touch points
are looked at to find out if they have anything in
common that would explain illnesses occurring across
different states.
This includes looking at any opportunities for
introducing and spreading E.
coli contamination.
Investigating the supply chain may involve
inspections of the facilities that handle and
process food.
These facilities may also combine ingredients from
multiple sources to make the suspect food product.
Any ingredient, or the processing itself, could
be the ultimate source or cause of the E.
coli contamination.
Depending on what the traceback information
reveals, FDA may go back to the source of the
ingredients to conduct an inspection, for example,
of a farm where a raw ingredient was grown.
If the sample tests positive for a pathogen,
FDA will determine the relationship of these
samples to the outbreak pathogen using a DNA
technology called whole genome sequencing.
The objective is to find the bacteria with the same
DNA fingerprint as the germ found in sick people
so that action can be taken to prevent future
illnesses.
When there is enough evidence from the
investigation and the product may still be in
the marketplace, FDA and CDC warn consumers about
the potentially unsafe product and works with the
affected food companies to do a recall and remove the
product from store shelves and restaurants.
Because companies have ready access to their
records and can help identify the specific
items that must be recalled, FDA gives them
the first opportunity to issue a press release to
notify consumers about the recall.
Often, FDA reviews the announcement to ensure all
vital information is included with no
conflicting messages.
If a company refuses to voluntarily recall their
product, federal law gives FDA the authority to keep
contaminated or potentially contaminated
product off the market.
However, we rarely have to take enforcement action
because most companies cooperate.
These actions include mandatory recall, seizure
of the food product, and obtaining an injunction to
prevent distribution of the food.
FDA, in coordination with CDC and state health
departments, posts an announcement about each
outbreak on its website and communicates to
consumers via email updates and social media
such as Twitter.
These announcements typically include product
recalls, how many people are sick in each state,
symptoms of the illness, and advice to consumers
and retailers about foods to avoid eating or
selling.
A foodborne illness outbreak investigation can
take many weeks to unfold and solve the mystery.
Also, there will always be a delay between when a
person gets infected and confirmation that he or
she is part of an outbreak.
That delay is typically about 2-4 weeks for E.
coli.
If the source and route of food contamination are
identified, the company will initiate corrective
actions to help prevent future outbreaks.
The sampling results are uploaded into a database
that allows public health officials to see if
problems persist in food facilities and take the
appropriate action when they do.
FDA CORE teams have identified and responded
to more than 230 outbreaks since 2011.
To reduce foodborne illness, we must remain
focused on prevention.
To speed up outbreak investigations, we must
leverage new technologies such as PulseNet to create
a more traceable digital food system.
For more information about foodborne outbreaks, you
can follow FDA on social media and sign up for food
safety alerts at the FDA website.