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Foodborne Illness Outbreaks, Investigations and Outcomes

William D. Marler

Food Production is a Risky Business

Competitive MarketsStockholder Pressures for Increasing Profits over Long-term SafetyLack of Clear RewardFor Marketing and Practicing Food Safety

Gross-Out Claims

I opened a box of Buffalo wings and saw an unusually shaped piece of chicken and I picked it up. When I saw that the piece had a beak, I got sick to my stomach. My lunch and diet coke came up and I managed to christen my carpet, bedding and clothing. I want them to at least pay for cleaning my carpet etc.

It is a Global Food Economy

To Put Things in PerspectiveMicrobial pathogens in food cause an estimated 48 million cases of human illness annually in the United States125,000 hospitalizedCause up to 3,000 deaths

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Strict Product LiabilityNegligenceAre you a product seller?Did you act reasonably?Strict LiabilityAre you a manufacturer?Was the product unsafe?Did product cause injury?Punitive Damages/Criminal LiabilityDid you act with conscious disregard of a known safety risk?

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Who is a Manufacturer?A manufacturer is defined as a product seller who designs, produces, makes, fabricates, constructs, or remanufactures the relevant product or component part of a product before its sale to a user or consumer. RCW 7.72.010(2); see also Washburn v. Beatt Equipment Co., 120 Wn.2d 246 (1992)

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The only defense is preventionIt does not matter if you took all reasonable precautionsIf you manufacture a product that makes someone sick you are going to payWishful thinking does not helpIts called STRICT Liability for a Reason

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Ill person

Specimen collection

Pathway of a Foodborne Illness Investigation

Health Care Provider

Organism identified

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Ill person

Organism identified

Specimen collection

Pathway of a Foodborne Illness Investigation

Health Care Provider

Epidemiologic investigation

Public Health Laboratory

If there are more ill persons than expected, an OUTBREAK might be underway.

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Ill person

Organism identified

Specimen collection

Pathway of a Foodborne Illness Investigation

Health Care Provider

Epidemiologic investigation

Public Health Laboratory

Environmental investigation

Product Trace Back

Product Recall

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Investigative PartnersLaboratory investigatorsMicrobiologic diagnosisVirology/Parasitic LabsMolecular analysis

Epidemiologic investigatorsIndividual case interviewsOutbreak investigationCohort studiesCase/control studies

Environmental investigatorsFacility investigationEnvironmental samplingProduct traceback

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EpidemiologyBasic Tools of the TradeSymptomsIncubationDurationFood HistoryMedical AttentionSuspected sourceOthers IllReal-time interviewing with a broad-based exposure questionnaire

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Pulsed Field Gel Electrophoresis (PFGE)Process separates chromosomal fragments of intact bacterial genomic DNA grown from patient isolateResults in 10 to 20 DNA fragments which distinguish bacterial strainsGenetic relatedness among strains is based on similarities of the DNA patternsOutbreak strains are those that are epidemiologically linked AND genetically linked

A Powerful Outbreak Detection Tool

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Whole Genomic Sequencing (WGS)

What we all want to Avoid

Litigation as Incentive

Odwalla

Jack in the Box

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Are Things Different Today?

It Started with just a Little Salmonella714 persons infected with the outbreak strain of Salmonella Typhimurium were reported from 46 states.. Additionally, one ill person was reported from Canada.Among the persons with confirmed, reported dates available, illnesses began between September 1, 2008 and March 31, 2009. Patients ranged in age from