The national cost of foodborne illness has been estimated at the astronomical sum of $152 billion annually, but the information on who is getting sick and what is causing those illnesses is part of a state-by-state surveillance system that shows mixed results around the country, raising important new questions about how to improve state outbreak reporting.
In 2006, more than 200 people fell ill and 5 died after eating spinach contaminated with deadly E. coli bacteria. So in 2007, which also saw several nationwide outbreaks, state and local public health agencies should have been on full alert to investigate illnesses and report outbreaks to the Centers for Disease Control and Prevention (CDC). According to an analysis of 2007 outbreak reporting data by the nonprofit Center for Science in the Public Interest, outbreak reporting varied widely from state to state: nine states reported 10 to 15 outbreaks per million people, but many others reported only one. If states' reporting performance during 2007 (the most recent year when such information is available) is any indication, at least 23 states need to make dramatic improvements in their surveillance and reporting systems, according to CSPI.
"State and local health departments are our first line of defense when it comes to identifying the food that causes an outbreak," said CSPI food safety director Caroline Smith DeWaal. "But some states may not have enough investigators or the money to train and equip their staff, which can lead to lower-quality investigations and lower rates of reporting."
Oregon and Minnesota are well-recognized as having strong programs for foodborne outbreak surveillance, investigation, and reporting. Those states, which have excellent laboratory facilities and which quickly interview people who test positive for dangerous pathogens, each reported 10 outbreaks per million people in 2007. CSPI considered that a baseline for its analysis, and found that 7 states had even better reporting records, including Maine, Kansas, Wyoming, Vermont, Alaska, Hawaii and North Dakota. Those states generated more reports and provided CDC with better information to prevent future outbreaks.
On the other end of the spectrum, 12 states reported just one outbreak of foodborne illness per million people, and 11 states had reporting rates almost as low. Because there is no reason to think that those states would have such low incidences of outbreaks, CSPI is concerned that this variability in reporting reflects a failure to identify, fully investigate, and report outbreaks. The 23 states with the lowest reporting rates in 2007 were Delaware, Georgia, Pennsylvania, New York, and Massachusetts, each with three outbreaks per million; Missouri, New Jersey, Virginia, Alabama, West Virginia, and Kentucky, each with two outbreaks per million; and Texas, North Carolina, Indiana, Louisiana, Nebraska, Utah, Arkansas, Montana, New Mexico, Nevada, Mississippi, and Oklahoma, each reporting just one outbreak per million.
