Slow to Pick Up The Pepper Trail
Wednesday, July 30, 2008
Just after the Fourth of July, Cheryl Grubbs called her local health department in Cortez, Colo., to report that her husband had nearly lost his only kidney to a salmonella infection after eating several raw jalapeños and a sandwich with a tomato in it during a camping trip.
By then, investigators had been searching for the source of a nationwide salmonella outbreak for more than two months; tomatoes were the prime suspect. Grubbs told three nurses her story and was transferred to the voice mail of a fourth. After hearing nothing for three days, she called the state health department in Denver. The next day, a nurse four hours away in Grand Junction called and instructed her to drop off her peppers with health officials in Cortez, who would send them to Denver for testing.
Grubbs didn't know that federal investigators had begun suspecting that jalapeño peppers might be responsible for at least some of the outbreak's 1,200-plus cases.
On Monday, Colorado's state health department announced it had isolated the outbreak strain in the samples she provided. It was the first time contaminated peppers had been linked to a case of illness. Investigators had announced the discovery of another contaminated pepper a few days earlier at a small distribution center in Texas.
Grubbs is still angry about the slow response. "Nobody seemed to be flipping concerned," she said.
Although the nation's ability to detect food-borne illness outbreaks has improved sharply in the past 20 years thanks to advances such as DNA fingerprinting, it still rests on the efforts of local and state public health departments. And not all states have the same resources or expertise. The uneven response can have repercussions far beyond a single jurisdiction's borders, slowing multi-state investigations where speed is critical to preventing illness and limiting financial losses for growers.
That disparity is one of the issues expected to be examined in two congressional hearings scheduled to begin today. Lawmakers plan to look at why it took so long -- from mid-May when the outbreak was detected to last week's discovery of the first contaminated pepper -- for investigators to figure out what was making people sick. Before the Food and Drug Administration changed its warning to include jalapeños on July 9, scores of consumers including Grubbs bought jalapeño peppers that made them or others ill. Tomato growers had incurred losses of more than $100 million.
Officials with the FDA and the Centers for Disease Control and Prevention have blamed much of the delay on the challenge of tracing raw tomatoes through a complicated distribution system. Although the 2002 Bioterrorism Act was supposed to improve traceability in case of an attack on the food supply, the salmonella investigators had to rifle through paper invoices instead of computer records. If they had been able to trace tomatoes more quickly, the FDA's top food safety official David Acheson said, they might have realized sooner that they needed to expand their investigation. They didn't begin pursuing peppers until early July, after the tomato warning failed to prevent more illnesses.
The salmonella outbreak became a real-time test of the abilities of the FDA, CDC and their state and local partners. The sooner they could find the source, the sooner they could stop the illnesses.
But public health officials are much better at detecting outbreaks than they are at determining what happened, said Michael Osterholm, the former top epidemiologist for Minnesota and now director of the Center for Infectious Disease Research and Policy at the University of Minnesota. He is scheduled to testify today.
Because it can take weeks to verify a food-borne illness and identify other cases with the same genetic fingerprint, many outbreaks are over by the time they are investigated. Frequently, public health officials never know what made people sick, let alone the source of the contamination. In 2005, the CDC took part in at least 49 multi-state investigations but in only 12 did investigators implicate a food, CDC data show.
Osterholm said lack of coordination among local, state and federal public health agencies was partly to blame. Each jurisdiction has its own procedures. Some have more funding than others. Responsibility for monitoring gastrointestinal disease, which could alert health officials to an outbreak, also varies. In half the states, it falls to local agencies; in a quarter, to a central state office; and in a fifth, to regional offices that can encompass several counties.