By Donna Campisano, specialist, Communications, APHL

There’s no shortage of ways food can get contaminated.

It can happen during the growing stage, while food is still in the soil. It can happen during production, slaughter or distribution. It can even happen in your home, when food isn’t stored, handled or cooked properly.

While the United States has one of the safest food supplies in the world, the US Centers for Disease Control and Prevention (CDC) investigates dozens of clusters of foodborne illnesses involving multiple states each week, looking for commonalities that would define an outbreak. And that’s what occurs at the federal level. Many more investigations are handled by state and local authorities.

Foodborne illness investigations don’t occur in a silo. They require the expertise of a variety of individuals, each performing a vital function and working in partnership. Who are the professionals behind the scenes working to identify pathogens and contain outbreaks? We’ll introduce you to some and highlight the important impact they have on the public’s health.

State and local partners

Most foodborne illness investigations occur within one state and even within one small area of a state; these investigations are handled by state and local public health officials.

They typically originate when a healthcare provider or individual reports a possible foodborne illness to a health department or when a food safety laboratory discovers contaminated food through routine surveillance.

While a clinical laboratory may perform initial testing on patient specimens, foods that the patient consumed might be sent to a public health laboratory to zero in on the pathogen(s) and determine if the food item(s) and patient specimen can be linked.

“If starting with a food sample, for example, the organism we test for is narrowed down by several factors, including the patient’s symptoms, their onset time, illness duration, etc.,” explained Christopher Benton, PhD, virology program manager, Bureau of Laboratory Services, New Hampshire Department of Health and Human Services. “If there is more than one organism or toxin that matches the patient factors, then we test for all. If there are already clinical isolates that have detected a specific organism, we only look for that one. Once we know which organism(s) we are looking for in the food samples, we do a PCR screen. If the screen is positive, then we get the organism in pure culture from the food by using selective broths and agar plates. Once we are confident the organism is in pure culture, we confirm the isolate using a VITEK 2 Compact, then give the isolate to our molecular diagnostics team for sequencing.”

Next generation sequencing (NGS) is a vital step in determining whether cases may be related in some way. It looks at a pathogen’s DNA fingerprint and helps scientists determine, among other things, which illnesses are part of the same outbreak, which ingredient in a multi-ingredient food is making people sick and even where the contaminated food may have originated from. Information from the sequencing is fed into a national laboratory database called PulseNet, which is designed to help scientists around the country rapidly detect clusters of foodborne illness outbreaks so they can be contained. Another critical resource is GenomeTrakr, a network of public health and university laboratories—both domestic and international—that collect and share genomic and geographic data on food and environmental samples so researchers and laboratory scientists can compare and analyze them in real time.

Also crucial to a food safety investigation are epidemiologists and food inspectors (formally known as environmental health specialists).

Epidemiologists—sometimes called disease detectives—collect and analyze data, including laboratory data, to connect the dots, detect patterns and help pinpoint a cause of illness or even food contamination. They may study what patients ate, where they obtained the item, what their symptoms were and when they started feeling ill. They work alongside food inspectors who, depending on what agency they’re employed with and the source of the contaminated food, conduct site visits to food service establishments, manufacturing facilities or distribution centers to see how food is prepared, manufactured or stored. If a site needs to be closed or a product should be recalled, a variety of partners work together with food industry partners to initiate the closing or recall and alert the public.

Federal partners

Federal partners such as CDC, US Food and Drug Administration (FDA) or the US Department of Agricultural (USDA) are brought on board if the foodborne illness outbreak spans several states or involves products distributed in multiple states.

A good example of how the system works: Earlier this year, 69 people in 21 states were infected with Salmonella Montevideo. Of the sickened people interviewed, many reported eating cucumbers.

Federal investigators got to work collecting cucumber samples and, with the help of NGS, found that the Salmonella strain infecting the sick people was genetically highly similar to the Salmonella strain found in cucumbers acquired from a particular grower. With a cause of the illness determined, these federal partners worked with public health officials and the manufacturer to issue a product recall and a public health advisory, giving the public need-to-know information such as where the cucumbers were sold, the dates they were sold and the symptoms of Salmonella Montevideo.

Collaboration is key

When it comes to curtailing foodborne illness, timely coordination is everything.

Without a report of a potential foodborne illness made by a healthcare provider, for example, a food or patient sample may never be collected. Without a sample, a public health lab may never have what they need to perform sequencing. Without the ability to sequence a sample, a disease cluster may never be identified. Without an identified cluster, a food item may stay on the shelf and continue to sicken others.

It’s a constant cycle that only ends when public health partners communicate and collaborate with each other, as outlined in the Council to Improve Foodborne Outbreak Response (CIFOR) Guidelines for Foodborne Disease Outbreak Response. CIFOR provides state and local public health officials with comprehensive information on how to build a foodborne outbreak response team.

“While each state, local and federal agency has different roles during a food safety investigation, it is imperative they all work together,” said Amy Bryant, specialist, food safety, APHL. “These collaborations are important because they promote resource and knowledge sharing. They enhance testing capacity, identify risks and encourage standardization and process improvement, leading to more efficient testing and reporting and faster turnaround times. All this ensures outbreaks are identified faster and fewer people are sickened by contaminated food products.”

The post From Report to Recall: Meet the Professionals Behind a Foodborne Illness Investigation appeared first on APHL Blog.

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