By; Ryan Robinson, PhD

Foodborne illnesses place a heavy toll on everyone involved. Those who contract a foodborne illness are hit the hardest, but the surrounding community often suffers as well. Nearby or related businesses lose vital revenue, even if they were not involved in the outbreak. Local employees lose wages, and chronically understaffed hospitals are pressed to accept additional patients. According to research from Texas A&M University, the economic impact to the United States of the virulent O157:H7 strain of E. coli is near half of a billion dollars annually.

Recent outbreaks of the dangerous E. coli O157 strain at The Chicken & Rice Guys, a popular middle-eastern cuisine chain in Boston, have prompted a renewed public interest into how public health agencies prevent and respond to foodborne illness outbreaks.

The following is a review to help our readers understand how local, state, and federal agencies help prevent foodborne illness, how they react to outbreaks when they do occur, and how the reaction to recent outbreaks like the recent O157:H7 outbreak at Boston based The Chicken & Rice Guys measures up.

Outbreak Prevention: Who is involved?

Getting clean, safe food from farm to table is a complex, nuanced process that involves many different parties. Each of the parties below has a vital and distinct role in preserving community health through food safety.

The Federal Government

The United States maintains an exceptionally high standard for food-safety in manufacturing, production, and distribution. There are two federal agencies that play a role in drafting and enforcing food safety regulations relating to commercially produced food in the United States.

The US department of Agriculture (USDA) is responsible for ensuring that commercially produced meat complies with, or exceeds important safety guidelines. For example, the USDA operates a monitoring, inspection initiative to helps to minimize contamination of beef and poultry by pathogenic strains of bacteria like Escherichia coli, Listeria monocytogenes, or Salmonella. (See USDA FSIS guidelines)

The Food and Drug Administration takes over where the FDA leaves off, with a broader mission that includes ensuring that commercially sold food products and food additives are safe, fit for human consumption, and accurately labeled and represented. When alerted to a food safety issue, the FDA also announces recall notices for dangerous or contaminated food products. (See an FDA list of recent recalled food items)

While both the USDA and FDA play a vital role in ensuring the safety and security of our food-chain, their actions are far closer to farm than to table, and they generally leave policing local establishments to state and local authorities.

State and Local Governments

Each state and most municipalities maintain and operate an independent department of public health  and an associated health laboratory. State and local health departments are responsible for establishing local guidelines for safe food handling (which may be more stringent than federal guidelines). State and local health departments are also responsible for inspecting and monitoring restaurants, grocery stores, food-carts, and other direct-to-consumer food-distribution centers to ensure that safe food-handling practices are being observed.

The helpful “health grades” publicly displayed in most restaurants are the most well-characterized examples of efforts put forth by local and state health authorities. The health grade at your favorite locale eatery was most likely assigned by a health inspector working under the authority of a state or local department of health.

State and local health departments also undertake educational campaigns, spreading awareness of the risks associated with improper food handling, teaching restaurant employees how to handle food safely, and disseminating information to the public regarding about recent outbreaks.

The Consumer

As important as it is to recognize the efforts of the diligent health professionals employed at the state, local, and federal level, it is also vital that we recognize that food-safety begins and ends with the consumer.

It is up to the consumer to pay close attention to restaurant health grades, understand what is being inspected, and comprehend how that corresponds with their own health. If consumers have questions about food-safety or need to report a foodborne illness the CDC suggests that they reach out to their local or state health department officials.

Outbreak Response: Who is involved?

In the wake of an outbreak of a foodborne illness, many of the same players are also responsible for coordinating an efficient response. State and local authorities, aided by various federal agencies, must quickly identify the offending pathogen, trace its source, and take fast action to prevent additional harm.

State and Local Governments

The state and local response to foodborne illness often begins before an outbreak ever occurs. Local authorities regularly communicate with hospitals, local physicians, and other health care providers, sharing information about potential threats, how to identify a foodborne illness, how to characterize an outbreak incident, and who to report these incidents to when they occur.

Following an outbreak state and local authorities are often the “first responders”. Their initial role involves interviewing patients and collecting samples for laboratory analysis. Samples are forwarded to a state health laboratory, where they are tested to confirm the presence and identity of the offending pathogen.

As data is collected state and local epidemiologists combine all available information and attempt to trace the source of the outbreak. After identifying the source of an outbreak a health departments may mandate the temporary or permanent closure of an establishment to prevent further illness.
The Federal Government

The simplicity and ease of interstate travel along with the prevalence of regional and interstate restaurants and food-distributors presents a unique challenge.  It is very common for a foodborne-illness outbreak to cross state lines, infecting people regionally or nationally rather than in an isolated area. Federal agencies provide critical logistics, laboratory, and informational support. They coordinate efforts between multiple state or local health departments.

In fact, the FDA operates in conjunction with CDC and several other Federal authorities to manage a special program known as CORE (Coordinated Outbreak Response and Evaluation network). This cooperative network exists for the sole purpose of managing and responding to foodborne illness outbreaks.

In addition to the response to known outbreak events the CDC meticulously tracks data from seemingly isolated illnesses and maintains a variety of different informatics tools like PulseNet (https://www.cdc.gov/pulsenet/) to help trace individual pathogens across incidents and identify outbreaks that have gone unreported.

The Chicken & Rice Guys – 2017 Outbreak: Where are we now?

Unfortunately, most data on outbreak response is not made publicly available until well after the event has concluded. The CDC indicates that identification and characterization of an E. coli outbreak commonly requires two to three weeks.

Presently, relatively little information regarding this outbreak is publicly available. It is public knowledge that more than a dozen people became ill with the O157:H7 strain of E. coli after eating at one or more of The Chicken & Rice Guys locations in the Boston or Watertown, MA area.

O157:H7 is a particularly virulent strain of E. coli that can produce severe, life-threatening symptoms, and authorities are pursuing this case with all due care. Still, the specific details of the outbreak are unclear.

As a precautionary measure all The Chicken & Rice Guys locations in the greater Boston area are presently closed pending the conclusion of the health department investigation. According to Eater.com (a popular culinary website) owners were reporting that locations would reopen once all employees had been tested for E. coli.

It remains to be determined whether this specific outbreak was a result of improper food handling by employees of the restaurant chain, or whether it is the product of contaminated food from an upstream source. (The most common sources for E. coli are undercooked beef, unpasteurized dairy, or uncooked/improperly washed vegetables.)

The scale of this recent outbreak has also not yet been determined. 15 illnesses have been reported thus far but outbreaks of foodborne illness are particularly difficult to characterize as afflicted parties do not always recognize or report their symptoms. Authorities urge anyone who became ill after eating at one of the locations to contact their local health department and consult a physician if symptoms persist or become particularly severe.