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State and local health labs are ill-prepared
By Thomas Hargrove
Scripps Howard News Service
November 27, 2006

The cult followers of Bhagwan Shri Rajneesh purchased cultures of Salmonella typhimurium from a Seattle medical supply company in 1984 and began incubating a deadly brew they called "salsa" in a plot to poison residents of Wasco County, Ore.
The cultists wanted to rig a local election by sickening voters unfavorable to their cause. To test if their bioweapon worked, cultists began spraying the salmonella on vegetables at a supermarket and on salad bars in 10 restaurants.

A total of 751 people, including members of the Wasco County Commission, became ill with nausea, diarrhea, headaches and fever. Forty-five people were hospitalized, but no one died.
It was the first, and still the largest, germ-warfare attack in U.S. history. Oregon health officials closed salad bars in the area, but never determined they were victims of a bioterror attack. That discovery was made two years later when police raided the cult's compound and found a clandestine lab and vials of the disease.

It was a warning to the nation's public health system.

Can America's epidemiologists and its network of state and local laboratories detect and respond to a bioterrorist attack quickly enough to save lives?

"There are a lot of vulnerabilities in our system," said Jeffrey Levi, executive director for the Washington-based Trust for America's Health, a research group that monitors public health issues. "The most basic is whether we can rapidly identify a problem and thoroughly investigate disease threats."

Scripps' study of food-borne illness outbreak data collected by the federal Centers for Disease Control and Prevention found that states vary dramatically in their ability to detect and diagnose cases of food poisoning.

Many states rarely notice food-poisoning outbreaks. Other states realize that they have a problem, but rarely are able to diagnose the disease responsible for the outbreak. Medical experts agree that diagnosing the disease is usually critical to determining the source of disease.

"In an outbreak investigation, the first thing we want to know is what illness is involved," said Linda Gaul, an epidemiologist who heads the Texas Food-borne Illness Team.

Knowing the bacteria or virus responsible for multiple illnesses tells investigators when people contracted the disease and which meal to suspect.

"Salmonella has an incubation time of around 16 hours. But Hepatitis A has an average incubation time of 28 days," Gaul said. "This tells us which meal was probably involved."

Knowing the specific germ also offers clues to which foods to suspect. Salmonella is often associated with beef or chicken. But norovirus is only found in humans, not animals.

The Scripps study found that health departments are isolating the cause of food-poison outbreaks only 36 percent of the time, an alarming statistic if the nation ever faced a determined bioterror attack.

Trust for America's Health issued a study in 2003 examining the nation's capacity to handle biowarfare attacks. Its conclusions were summarized in the report's title: "Public Health Laboratories: Unprepared and Overwhelmed."

"State labs are hardly uniform," the report said. "As a result, the capabilities, responsibilities and practices of state public health labs vary substantially in many areas that directly impact America's ability to respond to chemical or biological attacks or other public health emergencies such as food poisoning or toxic substance exposure."


Ten biggest outbreaks

The 10 largest food-poisoning outbreaks reported to the federal Centers for Disease Control and Prevention from Jan. 1, 2000, to Dec. 31, 2004, sickened 7,840 adults and children, some of whom died, according to a Scripps Howard News Service study.

Since local and state health departments rarely announce food sicknesses, most of these outbreaks have not previously been publicized.

Details

An outbreak of the Shigella sonnei bacteria, usually spread through human feces, infected 964 people in seven West Texas counties during a four-month period in 2003. More than 70 percent of the victims were children under 12.

About 950 inmates in the Illinois River Correctional Center got sick after eating roast beef with mashed potatoes and gravy in September 2002. Investigators determined the gravy was contaminated with the Clostridium perfringens bacteria.

An 886-person outbreak of the Shigella flexneri bacteria began at the Shish Kabob Snack Bar in Port Washington, N.Y., and spread to four other restaurants in May 2001. Investigators concluded that an infected worker at a produce-distribution plant had contaminated a shipment of bruised tomatoes.

Another outbreak of Clostridium perfringens at a Louisiana prison sickened 880 inmates in November 2003. State health officials said the disease was spread by food maintained at improper temperature.

A norovirus outbreak at the Opryland Hotel in Nashville, in January 2001 sickened 811 people, six requiring medical care. Most of the infected were attending a pastors' conference sponsored by the International Network of Children's Ministry. Despite an extensive investigation, health officials were not able to determine the cause.

Watermelon contaminated with beef juice served at a children's buffet at a Sizzler Restaurant in Milwaukee was responsible for spreading E. coli to 736 people in July 2000. One child died of hemolytic uremic syndrome, a complication from E. coli infections. Investigators believe the infection occurred at a meat-packaging plant in Fort Morgan, Colo.

A food-borne outbreak affecting 707 people was reported in January 2004 in Texas, according to CDC files. But Texas health officials said they could find no records of this outbreak. No other information was available.

Texas health officials received reports from all over the nation after 700 people fell sick from the Salmonella enteritidis bacteria following a conference at the Wyndham Anatole Hotel in Dallas in March 2002. The outbreak lasted more than five weeks. Investigators eventually identified an infected employee who prepared fresh-made salsa.

A privately managed cafeteria at the St. Louis Children's Hospital was the source of an outbreak of Salmonella javiana that sickened 641 in 2003, according to CDC files. Missouri health officials said their records show only 324 people were affected. Investigators have not confirmed how the disease spread.

More than 500 customers of a Pennsylvania Chi-Chi's Mexican restaurant were sickened by Hepatitis A in October 2003 caused by infected raw green onions used to make salsa. Three people died. Investigators failed to identify the exact cause of the infection. The restaurant chain went into bankruptcy because of the outbreak.

-- Scripps Howard News Service