CDC plays a vital role but public health happens at the local level thanks to the work of thousands of our state, territorial, tribal, city, and county public health professionals. So it is always a pleasure to meet with state epidemiologists, leaders in using epidemiologic data to guide public health practice and improve health. On January 29th, I met with the Executive Board of the Council of State and Territorial Epidemiologists [CSTE]. Needless to say, the conversation quickly strayed to the current Salmonella Typhimurium outbreak associated with peanut butter produced at a Peanut Corporation of America (PCA) facility in Blakely, Georgia. These conversations among colleagues are noteworthy for being quite frank.
They made some pointed observations and identified some critical needs. The first was the usual delay in detection, response, and final identification of the implicated item. The initial patients became ill at the beginning of September and were identified as Pulsenet clusters at the end of November before being referred for assessment to the epidemiologists who make up the national OutbreakNet team. CDC sponsored the first nationwide conference call on December 4th and the Minnesota Department of Health implicated King Nut Peanut butter manufactured by the PCA on January 9th. One of the epidemiologists from a large state mentioned how they alone are monitoring 20-25 PulseNet clusters at any given time trying to prioritize which need a detailed investigation.
Multiply that many fold for what is required at the national level and you can see how difficult it might be to keep track of and conduct detailed investigations of all of them. Similarly, they were experiencing delays in conducting timely laboratory testing on all of their specimens forcing batching of results and triaging specimens from the current outbreak over isolates from other potential ongoing outbreaks. They specifically asked for more trained personnel to test all their specimens in a timely manner and “boots on the ground” at the local level to aggressively examine these clusters and investigate outbreaks. They also mentioned the need for new tools to visualize all these clusters and better laboratory technology. In addition to these needs, I have previously discussed other needs including a dedicated public health fund to pay for collection, testing, and transport of specimens that have public health implications but are not necessarily required to treat an individual patient.
Visualizing these timeliness issues has become so much easier thanks to an innovation by our Foodborne and Enteric Diseases Branch. In the latest MMWR – CDC’s weekly journal — they show epidemiology curves by both when people become sick and by when they are reported to Pulsenet. This shows the information that is actually available to public health authorities to make decisions. It is far better to describe the response than just the traditional epi curve which is designed to describe the outbreak. We can ill afford these obvious delays.