Carla Winn for The New York Times
In just about every major contaminated food scare, Minnesotans become sick by the dozens while few people in Kentucky and other states are counted among the ill.
Contaminated peanuts? Forty-two Minnesotans were reported sick compared with three Kentuckians. Jalapeño peppers last year? Thirty-one in Minnesota and two in Kentucky became ill. The different numbers arise because health officials in Kentucky and many other states fail to investigate many complaints of food-related sickness while those in Minnesota do so diligently, safeguarding not only Minnesotans but much of the rest of the country, as well.
Congress and the Obama administration have said that more inspections and new food production rules are needed to prevent food-related diseases, but far less attention has been paid to fixing the fractured system by which officials detect and stop ongoing outbreaks. Right now, uncovering which foods have been contaminated is left to a patchwork of more than 3,000 federal, state and local health departments that are, for the most part, poorly financed, poorly trained and disconnected, officials said.
The importance of a few epidemiologists in Minnesota demonstrates the problem. If not for the Minnesota Department of Health, the Peanut Corporation of America might still be selling salmonella-laced peanuts, Dole might still be selling contaminated lettuce, and ConAgra might still be selling dangerous Banquet brand pot pies — sickening hundreds or thousands more people.
In these and other cases, epidemiologists from Minnesota pinpointed the causes of food scares while officials in other states were barely aware that their residents were getting sick. From 1990 to 2006, Minnesota health officials uncovered 548 food-related illness outbreaks, while those in Kentucky found 18, according to an analysis of health records.
The surveillance system is vital because even with reforms intended to prevent outbreaks, food-related disease will remain among the most common sources of illness. One-quarter of the nation’s population is sickened every year by contaminated food, 300,000 are hospitalized and 5,000 die, and decades of steady improvements in the safety of the nation’s food supply have ended in recent years.
“The longer it takes you to nail an outbreak, the more people are going to get sick,” said Dr. David Acheson, associate commissioner for foods at the Food and Drug Administration. “And if it’s a pathogen that causes death, the more people are going to die.”
With states cutting back in the face of budget crises, disease surveillance is worsening, several officials said.
“Just $50 million spread over the entire country would make a huge difference,” said Dr. Timothy Jones, the state epidemiologist in Tennessee.
Take the case of Lauren Threlkeld, who went to a Kroger grocery store in Lexington, Ky., in August 2007 and bought a bag of Dole baby spinach contaminated with E. coli O157. She became violently ill with bloody diarrhea and was hospitalized for nearly a week.
When Ms. Threlkeld finally went home to recuperate in Madisonville, Ky., a county health worker called only to verify that she had fallen ill in another county. No one asked about the foods she had eaten or what might have made her so ill, she said. Later efforts by her lawyer pinpointed the source of her illness — far too late to help others avoid similar fates.
Dr. William D. Hacker, the public health commissioner in Kentucky, blamed tight budgets. “We have had a historically poor record of reporting” food-borne illnesses, Dr. Hacker said. “We are working hard to change our culture even with limited resources.”
In Minnesota and a few other states, victims of food-related illnesses tell very different stories. Sarah Kirchner of Belle Plaine, Minn., said health workers called her three separate times and spent hours discussing her children’s diet almost immediately after a laboratory test verified that one had fallen ill with salmonella. Officials in Minnesota traced the outbreak to peanut butter in part because of Ms. Kirchner’s responses.
“There is no question that some states take this far more seriously than others,” Dr. Acheson said.
Even when county and state health departments investigate, their methods often differ so greatly that federal officials have difficulty uncovering patterns. This leads to terrible delays.
“Everybody does things differently, even within many states,” Dr. Acheson said. “It’s a huge challenge.”
Some delay is inevitable. Most people sickened by food do not bother to see a doctor. Many of those who do are not asked to provide a stool sample, and when asked, some refuse.
When patients are willing, laboratories may not be. In Utah, for instance, only 18 of the state’s 1,388 medical laboratories process stool tests, said Dr. Pat Luedtke, director of the Utah public health laboratory. Well-meaning doctors who wish to send stool samples sometimes must pay the postage because insurers often refuse to pay for a test that largely serves a public health function; many doctors do not bother.
By the time public health officials notice that a growing number of such samples carry the same genetic fingerprint — a clear sign that a popular food is contaminated — weeks have passed. By then, victims’ memories of what they ate have faded. So rapid and thorough responses by health officials, a rarity in many states, are crucial.
“I’ve learned in the last few months that the real secret to our success is that we have urgency,” said Dr. Kirk Smith, supervisor of the food-borne diseases unit for the Minnesota Department of Health.
Dr. Acheson of the F.D.A. said federal authorities had been meeting with state health officials to seek ways to improve the surveillance system, including standardizing menu questionnaires and improving response times. But he said more federal financing was crucial.
Dr. Robert Tauxe, deputy director of the Centers for Disease Control and Prevention’s division of food-borne diseases, said the agency planned immediate investments “to increase the capacity of several health departments.”
Ruth Ann Merrick of Somerset, Ky., said she was still bitter about how her case was handled. She went with friends to a local Chinese restaurant on June 26, 2004. Within 45 minutes, she was vomiting so violently that she passed out and her heart stopped. After her husband performed C.P.R., she was taken to Lake Cumberland Regional Hospital, where she remained in intensive care for four days.
Although four of the eight people in her party were sickened, the state never investigated, she said.
“I thought I was going to die,” Ms. Merrick said.
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