Food safety can depend on the state you live in

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http://www.scrippsnews.com/node/16861 Food safety can depend on the state you live in National News | News By THOMAS HARGROVETuesday, November 21, 2006The rate at which state health departments are able to detect and diagnose outbreaks of food illness varies alarmingly in the United States. Worst in the nation at finding outbreaks of food sickness is

Kentucky, which reported only four outbreaks affecting 35 people over a five-year period, according to a Scripps Howard News Service study of 6,374 food-sickness-outbreak reports to the federal Centers for Disease Control and Prevention. Kentucky's figures are especially suspicious since state labs reported at least 3,800 individuals contracted diseases like Salmonella, Campylobacter and E. coli from 2000 to 2004. These are diseases usually transmitted through food. But few of these were linked as having common sources of illness. "What we are reporting is just what we can document and substantiate from within our files," said Kentucky State Health Officer William Hacker. "I suspect we are underreporting what we deal with on a regular basis, just from my own experience." Public and private laboratory technicians make most of the contagious-disease reports in Kentucky. But lab techs usually are not told if the blood, urine or stool samples they've been

asked to test are part of an outbreak. A month after Scripps contacted Kentucky medical officials about the state's low reporting rates, authorities announced they are "enhancing" the state's Electronic Disease Surveillance Module to require people who report a communicable disease to check "yes" or "no" to questions of whether it could be part of a food- or water-related outbreak. "We really hadn't been categorizing food- and waterborne outbreaks," said Kentucky Epidemiologist Kraig Humbaugh. "This will help us with our reporting system. It should increase the number of food outbreaks that CDC sees from us." Ten other states reported food-sickness outbreaks at a rate of only half the national average or even less. They are: Alabama, Arkansas, Arizona, Delaware, Indiana, Mississippi, Nebraska, New Jersey, Oklahoma and West Virginia. The best is Washington, D.C., where the public health network does a good job of monitoring food illness among a

mostly economically disadvantaged population, health experts said. The city detected 28 outbreaks that sickened 1,024 people during the five years studied. The Wisconsin Department of Health and Family Services is detecting food-borne illness at a rate more than 80 times that of Kentucky. The state reported 138 outbreaks that killed or sickened 4,105 people. Most of those reports came from doctor's offices. Wisconsin also has the nation's best record in diagnosing the causes of food illness, confirming the specific bacteria or virus involved in 90 percent of its outbreaks. "This is not a magic trick. It has to do with our total system," said Wisconsin Health Secretary Helene Nelson. "We have local public health departments, we have clinicians (doctors and nurses) who are first encountering the diseases, we have a state public health division that coordinates and communicates and helps analyze with the epidemiologists, and we have really good state lab

facilities. It is all those parts working together." Wisconsin was first to detect a death from September's nationwide outbreak of E. coli-infected raw spinach. Wisconsin identified one of the three confirmed deaths and 49 of the other 199 known cases, more than any other state. And Wisconsin was the first to post the DNA characteristics of the outbreak on the CDC's database of communicable diseases. The Scripps study found that other states with large numbers of outbreaks also have performed well. Hawaii diagnosed 78 percent of its 185 outbreaks. Minnesota identified the cause of 66 percent of its 204 outbreaks. Tennessee discovered the source of 64 percent of its 108 outbreaks. But 24 states failed to identify the cause in at least half of their food-sickness outbreaks. States with worse-than-average diagnosis rates are Alabama, Florida, Montana, New Jersey, Washington state, Michigan, California, Maryland, Illinois, Mississippi, Delaware and

Missouri. Alabama epidemiologists found the cause in only nine of their 180 outbreaks that sickened at least 718 people. That is a 5 percent rate of diagnoses. "We just lurch from day to day. It's a real struggle," said Alabama State Epidemiologist John Lofgren. "We've never identified a virus at the state level. We've always had to send viral specimens to the CDC for testing." New Jersey offered a diagnosis for only 195 of the 1,134 people sickened in outbreaks, a success rate of only 17 percent.. Deputy Health Commissioner Eddy Bresnitz said the state recently has shown improvement, thanks to monies offered by the Department of Homeland Security and the Health and Human Services Department to fight bioterrorism threats. "It comes down to a matter of resources," Bresnitz said. Florida epidemiologists failed to diagnose the cause of food illnesses that sickened 5,051 of the 8,126 people reported in outbreaks. The state had some

embarrassing failures, including a bout of diarrhea that struck members of the Monroe County Health Department after they ate at a local buffet. The staff ultimately was suspected of psychosomatic illness. "There was an immediate investigation because we had our entire food-illness staff present. This was a best-case scenario for an investigation," said Dr. Susanna May, the county's health director. "But we never found conclusive evidence of what it was. Although it is purely conjecture on my part, there is something to the power of suggestion.Get off your ass and take your government back." ~Rocky Ward

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