Slow to Pick Up The Pepper Trail

The experience of front-line staff can also make a difference. In the 2006 spinach E. coli outbreak, Cathy Powers, a longtime nurse epidemiologist for New Mexico, discovered a leftover bag of spinach during a routine interview with a victim. The spinach turned out to be tainted -- and a major break.

The CDC keeps an eye on national disease trends and coordinates multi-state outbreak investigations, making sure state investigators ask the same questions and sending epidemiologists to help.

"In states that were heavily affected, this was an enormous challenge just to keep up with the cases . . . to do lab work and interviews. This strained the resources available in state health departments for food-borne illness investigations," said Robert Tauxe, a CDC deputy director.

Health officials at all levels faced a host of other obstacles, big and small.

Texas didn't immediately recognize the outbreak until the CDC informed officials there that they had salmonella cases with the same genetic fingerprint as ones in New Mexico. Once the CDC notified the state, its lab began requesting specimens. The state was soon backlogged and was still reporting illnesses from May well into June.

By contrast, New Mexico officials issued their first warning about a possible outbreak on May 23, two days after confirming they had three Salmonella saintpaul cases with the same genetic fingerprint.

Many of the early victims lived in remote parts of the Navajo reservation that stretches across New Mexico, Arizona and Colorado, which required more travel than the usual phone interviews, said John Redd, a top epidemiologist with the Indian Health Service. Health officials from New Mexico and the IHS spent more than a week at the end of May, including Memorial Day, driving around the high desert east of Monument Valley to locate victims.

The first reported cases didn't give epidemiologists much to work with. Initially, there were no clusters, in which two or more people get sick after eating at the same location, such as a restaurant. Some of the cases were separated by hundreds of miles, and it's hard to draw conclusions from a single case.

The first cluster wouldn't be identified by Chicago public health officials until mid-June. Another cluster that emerged later involving a Minnesota restaurant provided an important lead. Once Minnesota's health department identified the cluster on June 29, department officials said, it took 10 days for epidemiologists there to complete a statistical analysis that implicated raw jalapeños and for the agriculture department to trace the jalapeños to a distribution center. That center shares an address with Agricola Zaragoza, a small produce distributor in McAllen, Tex., where FDA inspectors found a contaminated pepper last week.

Minnesota has a centralized system of food-borne illness surveillance. All specimens go to the state, not local, health departments. There is a toll-free phone number for reporting food-borne illness. Whereas in many states it takes five or more weeks to confirm and DNA fingerprint a case and get the results to epidemiologists, in Minnesota it usually takes two to three days.

In the Grubbs case, the nurse at the county health department in Cortez who handles communicable diseases was out of town.

"I am generally the back-up. I happened to be out of the office that week as well," said Lori Cooper, director of the Montezuma County Health Department. "Any public health nurse who is here should follow up on it."

Grubbs said she didn't see any sense of urgency.

"I didn't know I could go to my local grocery store and buy something approved by the FDA that almost killed my husband. . . . Someone should have told me it was the jalapeño," she said. "I was so disappointed in how our system was working."