No Man is an Island

Fig.1. Salmonella bacteria can cause food poisoning and typhoid fever

One mild September day around 4 p.m. nearly two years ago, members of FDA’s Coordinated Outbreak Response and Evaluation (CORE) Network sat down with their state and federal partners to talk about a Salmonella outbreak. They quickly traced the outbreak’s source to a brand of peanut butter sold in Trader Joe’s. By 8 p.m. EDT that evening, they had a call with Trader Joe’s corporate offices, and by 9:40 p.m., Trader Joe’s issued a nationwide advisory to remove the product from their shelves.

Dr. Kathleen Gensheimer, CORE’s chief medical officer, remembered this outbreak investigation well. Although 42 people became sick, no one died and public health officials managed to efficiently stop the outbreak before anymore cases appeared. The official investigation went on for another month after the recall, but preventative actions by the FDA continued into winter. Not only did CORE assess how national safety standards of nut-butter processing could be improved, they looked at their own response process, as well. The critical approach both internally and externally was a vital part of CORE’s formation in 2011.

Response and Evaluation

“It was recognized that the FDA way of doing foodborne outbreaks could use some enhancements,” Gensheimer said of CORE's creation.

As a result, a multi-disciplinary network was formed to respond not just to foodborne outbreaks, but to prevent them from happening in the first place. The small program of 35 experts represents fields such as epidemiology, environmental health, microbiology, veterinary medicine, consumer safety, policy analysts, and communication. Despite their wide knowledge base, their success ultimately depends on the people with which they work, from CDC members to state and local partners.

“If their efforts are compromised, then our efforts are likewise compromised because we all very much work together,” Gensheimer said.

These programs face common challenges regarding available resources; decreased public health dollars mean a lessened ability for the state and local officials to do their work. The advantage of CORE and their partners allows them to extend their reach far beyond what the 35-person team could accomplish alone.

New Approach to Outbreaks

Another major advantage of maintaining partners is access to collections and databases. CORE does not maintain its own collections but rather utilizes reference repositories within the FDA, CDC, and NIH to track down particular disease strains. Lately, Gensheimer noticed a growing shift to whole genome sequencing, which offers rapid pathogen identification.

From outbreak response to pathogen diagnostics, CORE constantly changes to create a more efficient system. The structure allows for a steady, critical look at the program’s operation. After all, with disease outbreaks, lives are on the line.

Gensheimer reminded us, “It is a process that is undergoing continual evolution and improvement, but it is not an island in and of itself.”

References:

FDA Authorizes Sunland to Resume Preparing and Distributing Food at Peanut Butter Plant. (n.d.). In U.S. Food and Drug Administration onlin. Retrieved from http://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm320413.htm.

[SalmonellaNIAID]. Licensed under Public domain via Wikimedia Commons. Retrieved Sept 22, 2014, from: http://commons.wikimedia.org/wiki/File:SalmonellaNIAID.jpg#mediaviewer/File:SalmonellaNIAID.jpg.

Glossary

foodborne outbreak
When two or more people get the same illness from the same contaminated food or drink (FDA)