Tracking Outbreaks Five Days a Week
Last month's deadly E. coli outbreak in fresh bagged spinach is beginning to fade from public memory. Spinach is back on supermarket shelves and in salad bars, even as a team of about two dozen California state and federal investigators continue to work around the clock searching for the source of the outbreak.
The all-out intensity of the effort is warranted given that the outbreak has sickened 200 people and killed at least three. It provides a contrast, however, to the system that is supposed to be the front line for detecting outbreaks of foodborne illness--an even bigger issue these days with the potential threat of a terrorist attack on the food supply.
The system that health officials rely on to track outbreaks is called PulseNet. It's a network of public health labs run by the Centers for Disease Control. State and local labs that suspect an outbreak submit information such as the genetic makeup of whatever nasty bug is making the rounds into the network's database. That allows federal health officials to link clusters of illness in different locations across the country.
But the spinach outbreak highlighted one potential flaw in the PulseNet system. Wisconsin was among the first state to realize early on that we may be in the midst of a nationwide outbreak. A state epidemiologist dutifully punched in data on their cluster of cases into PulseNet, where it landed at 5:14 p.m. on Friday, Sept. 8.
PulseNet was already closed for the weekend. The discovery of the outbreak had to wait until Monday.
It then took federal health officials a few more days to put the pieces together and call in the Food and Drug Administration, which put out its warning to consumers to avoid all fresh spinach on Sept. 14.
Blogger James Prevor takes on the question of why PulseNet, our nation's first alert for outbreaks of foodborne illness isn't a 24/7 operation after the LA Times reported details of the spinach outbreak, including the information about the weekend closure of PulseNet.
Peter Gerner-smidt M.D., Ph.D., Acting Chief, Enteric Diseases Laboratory Response Branch, Center for Disease Control & Prevention, told the Perishable Pundit that the PulseNet lab and database at CDC is shut down during the weekends because the state labs are, too, and they don't submit data.
After federal health officials figured out they had an outbreak on their hands, Gerner-smidt said, PulseNet checked for submissions that came in during weekends. He argues that any delay doesn't substantially add to the time it takes to recognize an outbreak, which averages about two weeks--the time between when a person comes down with an E. coli O157:H7 infection and when the genetic info about the bacteria makes its way to PulseNet.
Gerner-smidt's disheartening kicker, though, is this: "It would increase the cost of the PulseNet system considerably if the public health labs and CDC were to work routinely on weekends... funds that are not available."
Would those 48 hours have made a difference and even prevented people from getting sick?
The family of June Dunning wonders whether health officials moved fast enough.
Dunning, 86, of Hagerstown died of E. coli the day before the FDA issued its warning against eating spinach. Moving up the warning two days earlier wouldn't have helped her since she ate fresh bagged spinach two weeks before she died. But word of an outbreak might have kicked health officials into gear more quickly. Genetic info on the strain that infected Dunning didn't reach PulseNet until she had passed away, even though she was told she had been infected with E. coli as early as Sept. 8.
Knowledge that her case could be part of a larger outbreak might have changed the way her tissue samples were handled. Her death is still being investigated for links to the outbreak, but it may never be conclusively linked because of problems completing a genetic test on the bacteria that infected her. State officials have declined to comment on her case.
Prevor suggests at the very least, PulseNet should stay open during the week long enough to receive data from labs in the central and western time zones.
What would make you feel safer? Should PulseNet stay open longer?
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