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Marler Blog Providing Commentary on Food Poisoning Outbreaks & Litigation

Is E. coli O157:H7 really down since 2004, or is it “Fuzzy Math?”

Where is George Bush when you really need him?

I was pleasantly surprised this morning reading the 2009 CDC FoodNet data from MMWR (Yes, Morbidity, Mortality Weekly Review – Seriously) on the plane back from Washington D.C – perhaps.

Along with the FDA, FSIS, and 10 state health departments, the CDC has been tracking illnesses caused by nine food-borne pathogens since 1996 (three years post Jack-in-the-Box) through the FoodNet program. According to its 2009 report in MMWR, illnesses caused by E. coli O157:H7 have dropped by 25% over the past three years and are at their lowest levels since 2004. David Goldman, MD, MPH, administrator of FSIS, attributed much of the E. coli O157:H7 decline to meat processors (since last year) being required to test all components of meat used in ground beef. In addition, around the same time, inspectors received new guidelines for evaluating sanitation in meat processing plants. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5914a2.htm).

David, that did not work out so well for young Abby Fenstermaker and her family in 2009 – did it?

E. coli Victim: Abby Fenstermaker from Marlerclark on Vimeo.

Abby’s hemolytic uremic syndrome illness, and her Grandfather’s illness (note, he is presently on life support), were linked to a Class I Recall by FSIS in May 2009 – Illinois Firm Recalls Ground Beef Products Due To Possible E. coli O157:H7 Contamination.

However, perhaps the good work at FSIS is not the real reason for the drop in the number of ill?  Perhaps we simply stopped counting the real number of E. coli O157:H7 cases?

According to the CDC itself, the number of state health department epidemiologists, and the tasks they can perform, have decreased since 2006, according to a study published by the CDC in MMWR on Dec. 18, 2009. (www.cdc.gov/mmwr/preview/mmwrhtml/mm5849a1.htm). The report indicated that the reduction in health departments’ epidemiology capacity was due in part to diminished federal public health preparedness funding, and states’ overall budget cuts. Annual grants to states through federal preparedness funding decreased from a high of $1 billion in 2002 to approximately $698 million in 2008. The reduction coincided with a decrease in bioterrorism/emergency epidemiology and surveillance capacity, the report states. For physicians, this means less guidance on how to treat public health emergencies, and more patients with illnesses that potentially could have been prevented had data been available, the report said.  So, less funding, fewer epidemiologists means you count fewer E. coli O157:H7 cases?  How convenient – the fewer you count, the better you look.

So, a 25% decrease in E. coli O157:H7 illnesses at the same time state health department epidemiologists are decreasing? Hmm, sounds like “fuzzy math” to me.

  • Dr Raymond

    Bill, I respectfully disagree that states “might” have fewer epidemiologists, and certainly disagree that even if they did have a decrease in numbers that E coli numbers would go down. The Epi investigation as to the source cause may be less effective, but what the MMWR report is counting is confirmed, lab positive, illnesses. Nothing that the state Epi dude is responsible for. It is front line health care providers ordering the test and labs reporting to the CDC. Now, if you want to look at a possible reason other than we are getting better at washing our hands and produce, cooking our food to temps recommended and producing safer beef, then maybe take a stab at the recession. 9.7% unemployment means a lot of people without health insurance, no insurance, no trips to the Doc for diarrhea unless really, really sick, so maybe fewer tests?
    But the real reason the number is down? No spinach outbreak that made dozens ill. No lettuce outbreak that also sickened many. We are really talking small numbers here, and one less outbreak affecting 50 people reduces the number by 10%. Hit and miss. It will go back up.

  • You’re funny, Bill. The numbers go up, and we have a crisis. The numbers go down, and the officials aren’t counting everyone. Actually, these numbers are in line with an overall 25% decline in reported foodborne illnesses reported by CDC between 2004 and 2007. Kind of makes one wonder about the “crisis” that is prompting the new food safety legislation (S 510 and HR 2749), and why there is so little data presented by FDA and other proponents of the legislation. Having your cake and eating it, too, I suppose.