Reprise of Salmonella summer

It's now two and half months since CDC and US FDA declared an end to the infamous tomatoes-no-it's-peppers salmonella outbreak of last summer. The outbreak itself was even longer: 3 months. There were some 1400 reported cases but probably many more that escaped detection. That's typical for foodborne disease outbreaks.

In case you've forgotten, here's a summary, courtesy Georgetown University's Produce Safety Project (PSP):

Although CDC and FDA initially pointed in early June to tomatoes as the cause of the outbreak based on epidemiological data, no contaminated tomato was ever found. In July, CDC and FDA identified jalapeno and serrano peppers as being responsible for illnesses, and the only microbiological evidence of food contaminated by Salmonella Saintpaul was, in fact, found in jalapeno and serrano peppers. However, as a result of the initial identification of tomatoes as the vector for the disease, the tomato industry, a significant sector of this country's agriculture economy, was another major casualty. Estimates of the economic cost to that industry in Florida alone have been more than $100 million and in Georgia close to $14 million. [3] A less tangible, but still very real, impact of the outbreak may well be its long-term effect on consumer confidence in fresh produce in general and fresh tomatoes in particular. (PSP)

The Georgetown PSP (supported by Pew Trusts) examined statements, press releases, conference call transcripts and other more or less public material. Their preliminary take is that there were three main areas of concern:

  • The produce safety system

    The FDA recognized that the system was not working but the PSP took issue with the agency's contention that it was up to Congress to fix things, pointing out that FDA has previously taken steps to safeguard the food supply with existing legislation. It was a failure of will, not a failure of authority;

  • FDA's and CDC's effectiveness and capacity

    The timeline from the first reported cases to the first public statements to the recognition of what was, wasn't and was perhaps the vehicle revealed a confused, disjointed and uncoordinated response.

    For instance, the epidemic curve (or "epi curve") published in the CDC outbreak report shows that some 50 percent of the confirmed cases began before the FDA nationwide consumer advisory on June 7 recommending that consumers avoid eating certain tomatoes. While there was a drop in cases after that announcement, it appears that the most sustained drop began around June 24. Maybe this drop was a factor of the incubation period for the illness, or maybe it points to an off-target intervention. A post-mortem analysis should examine this question. In addition, the discussion in the CDC outbreak report of cluster investigations in mid- to late-June raises questions about why FDA and CDC officials continued to maintain so steadfastly and for so long that tomatoes were the leading suspect for being the vector for Salmonella Saintpaul.

  • Communicating with the public and the industry

    Disjointed and confusing are the words the PSP uses to characterize FDA and CDC risk communications, with five agencies (two federal, three state) announcing the outbreak in the space of four days, each with different facts and messages. The descriptions were also inconsistent:

    Then, three weeks into the public-communications effort, the CDC significantly changed - with no explanation -- the manner in which it presented outbreak data, from raw number of cases in a state, to cases per million in a state, to a range of cases per state.

    Whatever the proper way to express events, CDC was clearly caught off guard and had no consistent message or approach.

The PSP report is interesting in that it doesn't focus on the most obvious failure, the failure to find the source and vehicle of the outbreak: Tomatoes? Peppers? Serrano peppers? Jalapeno peppers? Tomatoes and peppers? That failure was a symptom of a deeper problem, a problem that now will have to be faced and solved promptly by a new administration. The food safety system and the agencies tasked to carry it out is broken.

As if there wasn't enough on Obama's plate. He also has to worry about the generous helping of contaminated food the Bush administration dished onto it.

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I had to administer the hypothesis-generating questionnaires for that damned outbreak. We didn't even have any epi-linked cases in our jurisdiction. Wanna know who I'm gonna blame? The dumbasses who couldn't answer questions like "Where do you buy your groceries?" It was a long, bitch-ass questionnaire, and while I don't expect people to know what they ate for every meal in the last 30 days, I expect folks to know where they buy their food. Dunno what planet they were from, but in my world, I shop at the supermarket near my house, and I go there every week.

By Rogue Epidemiologist (not verified) on 18 Nov 2008 #permalink

Re. RE above: To what factors do you attribute the inability of people to answer those questionnaires? Sheer stupidity? Time pressure and other stresses of daily life, to the point were even normal to smart people truly don't remember where they ate and got their food recently? Possible effects of the illness, causing exhaustion that causes poor memory recall? Something else?

How innattentive do you have to be to not know where you buy your groceries? I mean, how utterly NUMB do you have to be to not know this? People usually buy their stuff from one or two stores.

One tactic we do use is we ask people what they won't eat, and it's pretty effective. Okay, if you're not sure how many peppers and tomatoes you ate in the last 30 days (I can understand if you don't know that answer), can you tell me if you never eat yellow tomatoes? Can you tell me if you never buy habañeros? Can you tell me if you never buy red onions? Problem is, process of elimination is even more time consuming than the actual questionnaire.

btw, when you cold call a Salmonella case and ask them to do a 30 minute phone interview (which is a light estimate -- they usually stretched into 45-60 minutes), they'll often say no, hang up on you, or just say "they're not there." We try to work around people's schedules. We did overtime to accomodate people who could only talk on weekend. We stayed late at the office to make these calls. We made *at least* three attempts per case before giving up. Gathering data from the cases was not easy.

g336, where do you usually buy your groceries? I shop at Trader Joe's, Albertsons and Ranch 99 (when I gotta buy Asian stuff).

By Rogue Epidemiologist (not verified) on 19 Nov 2008 #permalink