An estimated 1 million people every year are sickened by salmonella found in products such as eggs, cantaloupe and turkey burgers.
A News21 analysis of salmonella reporting practices found that differences across the country put residents of the worst-performing states at risk and undermine national outbreak surveillance.
In large outbreaks, underperforming states prevent efficient responses and rely on the surveillance of other states to catch outbreaks they miss. Some smaller outbreaks elude detection entirely.
“There are multi-state outbreaks out there that we don’t recognize and we don’t know about,” said Tim Jones, state epidemiologist for the Tennessee Health Department.
National outbreak surveillance depends on the collaboration of 2,800 state and local health departments subject to at least 50 different reporting requirements.
Although the CDC coordinates investigations when these multi-state outbreaks occur, it can only “provide guidelines and recommendations” as a non-regulatory agency, said Ian Williams, chief of the CDC’s outbreak response and prevention branch. Without a federal standard, each state has a unique set of disease-reporting requirements and practices.
The speed of response is critical for foodborne illnesses, yet 10 states allow a week to report a case of listeria — the bacteria that caused 15 deaths this year from contaminated cantaloupe — to the health department. Florida is the only state that requires immediate reporting of listeria, while the others fall somewhere in between, with 16 requiring health departments to be notified within one day.
The breakdown between stringent and lax reporting requirements among states holds true for most illnesses, provided that requirements exist at all. The CDC recommends reporting for 20 foodborne illnesses, but fewer than half of the states require reporting for all of them.
Although every state requires reporting for salmonella, 12 states and the District of Columbia do not require the submission of an isolate — a specimen from a stool sample — to the state public health laboratory, which is the way an outbreak can be identified and traced to its source.
For salmonella, E. coli and other bacterial illnesses, specimen test results can be uploaded to a national database known as PulseNet. Health officials can then try to match the genetic “fingerprint” on the samples with those of cases in other states, which will determine whether they were associated with the same outbreak.