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...Illnesses spinach were confirmed in 26 states, and one case was confirmed in Ontario, Canada. In all, nearly 205 cases of illness were recorded during the outbreak, including 31 involving a type of kidney failure called hemolytic uremic syndrome (HUS). More than 100 people were hospitalized, and three deaths were recorded, including a 2-year-old boy in Idaho.
"One foodborne illness is too many," says Robert Brackett, Ph.D., director of the Food and Drug Administration's Center for Food Safety and Applied Nutrition (CFSAN). "We've seen that there is no such thing as a small error when it comes to produce safety. Even what may be perceived as a small error can have disastrous consequences."
Fresh produce is especially vulnerable to contamination because it's grown in a natural environment. It may be grown in a field or orchard, and it is often consumed raw, without cooking or other treatments that could destroy bacteria and other pathogens.
The FDA works with many partners to prevent contamination, but it's impossible to eliminate all problems through prevention. "When there is a problem, we want to catch it early and contain it through efficient outbreak response," says David Acheson, M.D., director of food safety and security in the CFSAN. "In this case, the FDA mounted a collaborative effort with public health authorities throughout the country to identify the source of the problem and prevent its spread."
The CFSAN has the lead responsibility for ensuring food safety, regulating everything except meat, poultry, and processed egg products, which are regulated by the U.S. Department of Agriculture (USDA). The Centers for Disease Control and Prevention (CDC) has a complementary role, serving as the lead federal agency for conducting disease surveillance and outbreak investigations. Surveillance systems coordinated by the CDC, in collaboration with the states, provide an essential early-information network to detect dangers in the food supply.
Detecting an Outbreak
When a patient is diagnosed with E. coli O157:H7, a sample of the bacterial strain is sent to a participating PulseNet lab, says Christopher Braden, M.D., chief of outbreak response and surveillance at the CDC. PulseNet is a national network of public health laboratories that perform genetic fingerprinting on foodborne bacteria that result in human illness. Scientists use a process called pulsed-field gel electrophoresis (PFGE), a technique that subtypes bacteria.
"After the bacterial strain is subtyped or 'DNA fingerprinted' at a lab, the fingerprint is then uploaded electronically to the national PulseNet database where it can be compared with other patterns in other states," Braden says. "This gives us the capability to rapidly detect a cluster of infections with the same pattern occurring in multiple states. The strength of this system is its ability to identify patterns even if the affected people are geographically far apart."
Epidemiologists in Wisconsin were the first to alert CDC officials about a small cluster of E. coli O157: H7 infections on Sept. 8, 2006. At that time, the source of the problem was unknown. Wisconsin posted the bacterial strain to PulseNet to alert the entire network. PulseNet confirmed that E. coli strains from infected patients in Wisconsin had matching PFGE patterns and identified the same patterns in other states.
"Once a cluster of cases with the same DNA pattern is identified, epidemiologists interview patients to determine whether cases of illness are linked to a food source or what other exposures they have in common," Braden says.
Oregon's state health department also had noted a small cluster of cases and began interviewing patients. On Sept. 13, 2006, Wisconsin and Oregon health officials both notified the CDC that eating flesh spinach was reported. Most of those interviewed reported eating prepackaged raw spinach that came from a bag.
That same day, the CDC Director's Emergency Operations Center notified the FDA's Emergency Operations Center (EOC)...
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