November 27, 2006
By Thomas Hargrove
Scripps Howard News Service
More than 50,000 people got sick or died from something they ate in a hidden epidemic that went undiagnosed by the nation's public health departments during a five-year period.
Photo: Microbiologist Tim Monson, left, shows "bands" produced by E. coli to Wisconsin health department Secretary Helene Nelson and Dr. Jeff Davis. Wisconsin ranks No. 1 in detecting food illnesses in a recent study. (Del Brown Photos © SHNS)
Americans play a sort of food-poisoning Russian roulette depending on where they live, a study by Scripps Howard News Service found.
Slovenly restaurants, disease-infested food-processing plants and other sources of infectious illness go undetected all over the country, but much more frequently in some states than others.
Scripps studied 6,374 food-related disease outbreaks reported by every state to the federal Centers for Disease Control and Prevention from Jan. 1, 2000, through Dec. 31, 2004. The causes of nearly two- thirds of the outbreaks in that period were listed as "unknown."
The findings translate into an alarming potential for tragedy. If health officials are unable to connect illness to food, victims who might eat from the same poisoned source cannot be warned. If food is known as the culprit, but the specific disease lurking within is not diagnosed, the victims may get even sicker or die without proper treatment.
The poor track record of so many state labs also raises chilling questions about their ability to deal with a foodborne terrorist attack.
Families of children who got sick during the five-year period in the study tell heart-rending stories of trying to convince the medical establishment they were victims of food illness.
"My daughter's death would have been listed just as a 'stroke' and swept under the rug," said Todd Nelson, a Continental Airlines pilot and father of a 19-month-old girl who died of E. coli. "But I wanted to know what my daughter really died of. And I wanted somebody to blame."
The Nelson family thinks Ana Leigh Nelson ate infected hamburger meat from a popular Minnesota restaurant in 2002. The family demanded further private tests that confirmed E. coli and then demanded that the medical examiner change her death certificate to correctly report death from complications of food poisoning.
"We sort of fell through the cracks," Nelson said.
The study found that Kentucky, Oklahoma and Nebraska are virtually blind to outbreaks of food sickness, rarely detecting that scattered illnesses have common food causes.
In Alabama, Florida and New Jersey, the cause of food poisoning is almost never found, according to the Scripps study.
The CDC defines an outbreak as two or more people who got sick or died after eating the same food. State and local epidemiologists are diagnosing an average of 36 percent of the nation's reported outbreaks.
Alabama was the worst in the nation, diagnosing only 5 percent of its reported outbreaks, the study found.
"It's a real struggle. We've never identified a virus at the state level," Alabama State Epidemiologist John Lofgren said.
After learning of the study's findings, Kentucky officials ordered changes in their disease-reporting system.
"We really hadn't been categorizing food- and water-borne outbreaks," admitted Kentucky Epidemiologist Kraig Humbaugh.
The study found that health departments are more likely to make a diagnosis when a large number of people get sick. But the failure rate increases rapidly with smaller groups.
The Scripps study also found that the disease went undiagnosed in 4,054 of the 6,374 reported outbreaks. Those unknown causes sickened or killed 50,968 people.
"We did what we could do," said Lisa Dallmeyer, epidemiologist for Peoria, Ill., after local and federal lab tests failed to discover why 95 school children started vomiting after eating lunches served in December 2005 and the following January.
Every year, an estimated 5,000 Americans die from food-based pathogens such as salmonella, E. coli, shigellosis and campylobacter. Another 325,000 people are hospitalized.
Although the Scripps study found that the quality of the nation's network of public health departments varies alarmingly, there were some bright spots. Hawaii, Minnesota and Wisconsin do a good job of diagnosing outbreaks.
Wisconsin came out on top in the study by diagnosing the cause of 90 percent of its food-poisoning cases. Wisconsin also was the first state to detect and report September's deadly E. coli outbreak from infected raw spinach grown in California and shipped nationwide. The outbreak killed at least three people and sickened at least 199 others.
Federal officials and public health experts agreed with the findings and conclusions of the Scripps study.
"Our surveillance systems were designed to ring a bell when there is a problem. Are they perfect? Absolutely not. Could they be better? Absolutely yes," CDC spokesman Tom Skinner said. "We've already come a long way, but certainly we can do better than this."
Outbreak analysis
• Number of outbreaks: 6,374
• People affected: 127,066
• Deaths: The federal CDC estimates that 5,000 Americans die each year from something they ate.
State-by-state findings
The number of food-borne illness cases reported to the CDC from 2000 to 2004, and the percentage of cases in which state health officers were unable to diagnose the cause of the outbreak.
State Outbreaks % cause unknown
Alabama 180 95
Alaska 27 37
Arizona 30 57
Arkansas 13 31
California 873 75
Colorado 106 54
Conn. 51 24
D.C. 28 61
Delaware 6 67
Florida 1,071 88
Georgia 168 54
Hawaii 185 22
Idaho 17 24
Illinois 412 73
Indiana 39 46
Iowa 51 39
Kansas 76 61
Kentucky 4 50
Louisiana 21 43
Maine 32 56
Maryland 324 73
Mass. 70 56
Michigan 330 78
Minnesota 204 33
Miss. 21 67
Missouri 42 64
Montana 7 86
Nebraska 6 33
Nevada 32 31
N.H. 16 50
New Jersey 52 79
New Mexico 13 15
New York 275 60
N. Carolina 54 41
N. Dakota 14 43
Ohio 280 49
Oklahoma 13 38
Oregon 179 40
Penn. 172 52
R.I. 3 0
S. Carolina 29 48
S. Dakota 10 40
Tennessee 108 36
Texas 97 58
Utah 16 31
Vermont 17 41
Virginia 64 23
Wash. 299 78
W.Va. 11 18
Wisconsin 138 10
Wyoming 20 25
Location of outbreaks
Restaurants 51%
Private residences 16%
Schools 3%
Workplace 2%
Hospitals 2%
Churches or temples 2%
Prisons 1%
Other 23%
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