I have been talking about food safety and litigation for the last few decades.  The groups I have spoken to have been all types in the food industry – from beef to leafy greens – as well as the heroes of public and environmental health.  I had a chance today  to talk to leaders in the insurance industry about how they can save money by encouraging their insureds to put food safety first.

The FDA today published its “Investigation Summary: Factors Potentially Contributing to the Contamination of Romaine Lettuce Implicated in the Fall 2018 Multi-State Outbreak of E. coli O157:H7.”

First, a hat tip to the FDA investigators for getting at the report critically fast and during the governmental shutdown.  It is prompt, science based, investigations that will identify the “root cause” of an outbreak that will then be used to stop or at least minimize future foodborne illness clusters of outbreaks. Despite the good work, however, except for the one named farm the rest of the traceback work is shrouded in mystery.  The FDA and the leafy green industry knows way more than it is telling the public, and that is wrong for too many reasons.

Some interesting, and alarming findings the outbreak and the initial investigation impressions:

  • There were 62 reported illnesses in 16 states and the District of Columbia, resulting in 25 hospitalizations and two cases of hemolytic uremic syndrome (HUS). There were no deaths. However, the FDA and the CDC just gives the public numbers, not some of the brutal realities of the long-term impacts like the 70-year-old New York woman who will remain on dialysis for the rest of her life or the 3-year-old Canadian boy who suffered severe brain damage and will require a life time of ongoing care.
  • All E. coli O157:H7 isolates in Fall of 2018 from ill consumers had a rare genetic fingerprint, as determined by whole genome sequencing, that was closely related to one previously seen in ill consumers in the U.S. and Canada in the Fall of 2016 and the Fall of 2017. This is significant as it indicates, not only has there been multiple, significant E. coli outbreaks, but they are likely linked to the same growing region and probably the same farm.
  • The romaine lettuce that made people sick was likely harvested between late September and mid-November 2018, a conclusion based on: known production practices; the anticipated shelf-life of romaine lettuce; and the fact that reported illness- onset dates occurred from October 7 through December 4, 2018.

Through its investigation the FDA has identified the following factors and findings as those that most likely contributed to the contamination of romaine lettuce from one farm (Adams Brothers Farm) in Santa Maria in Santa Barbara County, California, that was linked to some illnesses during this outbreak.

  • The outbreak strain of E. coli O157:H7 was found in the sediment of an on-farm water reservoir in Santa Maria in Santa Barbara County, California.
  • The outbreak strain was not found anywhere else in sampling done during the investigation in various California leafy greens growing areas and counties.
  • FDA has concluded that the water from the on-farm water reservoir where the outbreak strain was found most likely led to contamination of some romaine lettuce consumed during this outbreak.
  • Traceback investigation analysis indicated that other ranches owned by the same farm as well as other farms may have introduced into commerce contaminated romaine lettuce or other produce items. These other farms did not use water from the water reservoir where the outbreak strain of E. coli O157:H7 was found and FDA was unable to identify a potential source of contamination.
  • FDA has concluded that the water from the on-farm water reservoir where the outbreak strain was found was most likely not effectively treated with a sanitizer and this may have led to contaminated water directly contacting romaine lettuce after harvest or by the washing/rinsing harvest equipment food contact surfaces.
  • There are several ways in which water from the on-farm water reservoir may have come into contact with the implicated romaine lettuce, including direct harvest/postharvest application to the crop and/or use of reservoir agricultural water on harvest equipment food contact surfaces.
  • Foodborne illness outbreaks caused by this specific strain of E. coli O157:H7 occurred in 2016, 2017, and 2018, indicating that the outbreak strain may have either persisted in the environment or may been repeatedly introduced into the environment from an unknown source. Public health officials in the U.S. and Canada were unable to definitively confirm the food vehicle and ultimate source(s) of the 2016 and 2017 illnesses.

Despite finding that E. coli outbreaks spanning years likely came from the same are or farm and was most likely caused by the same factors enumerated above, the FDA only sets forth “recommendations” that growers of leafy greens assess their growing operations for compliance with applicable requirements of the FSMA Produce Safety Rule and GAPs, including (see my snide comments in bold):

  • Assure that all agricultural water (water that directly contacts the harvestable portion of the crop and/or food contact surfaces and harvest equipment) used by growers is safe and of adequate sanitary quality for its intended use. This may (not must) include the development and use of validated and verified treatment of agricultural water, when growers choose to use agricultural water treatment as a preventive measure (any agricultural water treatment must also adhere to any other Federal, State, Local, or other regulations on implementation);
  • Assess and mitigate risks related to wild animal intrusion that may contaminate agricultural water (without a requirement to do so);
  • Assess and mitigate risks related to land uses near or adjacent to agricultural water sources that may contaminate agricultural water (without a requirement to do so); and
  • Perform a root cause analysis when a foodborne pathogen is identified in the growing environment, in agricultural inputs (e.g., agricultural water or soil amendments), in raw agricultural commodities or in fresh-cut ready-to-eat produce. The goal of a root cause analysis is to determine the likely source of the contamination, if prevention measures have failed, and whether additional measures are needed to prevent a reoccurrence (without a requirement to do so).

Other FDA recommendations have a broader target audience.

  • FDA urges (at least it is not begging) other government and non-government entities, produce growers and trade associations both domestically and internationally to develop real time procedures to quickly explore the possible scope, source(s) and route(s) of contamination when human pathogens of public health significance are detected by routine pre-harvest or finished product verification testing. Local in-depth knowledge and actions are critical in helping determine likely potential routes of contamination of leafy greens in the regions in which they are grown. This information is critical to developing and implementing appropriate science and risk based preventive measures to reduce the potential for another outbreak associated with leafy greens or other fresh produce commodities. Widespread sharing of such findings among the leafy greens and produce industry would also be helpful to increase awareness of potential routes of contamination and preventive measures (without a requirement to do so).
  • FDA continues to recommend (suggest, plead, beg, whine) that leafy green growers, buyer/shippers, and retailers be able to trace product back to the specific source in real time and make information about the source, such as harvest date and standardized growing regions, readily available for consumers on either packaging, point of sale signs, or by other means. In response to this outbreak FDA requested, and the leafy greens industry agreed to provide, voluntary labeling of romaine lettuce products to provide consumers with information on where their romaine lettuce is grown and the date on which it was harvested. The purpose of this new voluntary (why voluntary?) labeling was to help consumers discern, in the event of an outbreak, whether romaine lettuce products available for purchase at retail stores or restaurants were harvested after the outbreak or not grown in an implicated growing region. The voluntary labeling also provides for improved romaine lettuce traceability and, if need be, provides FDA with the ability to focus future public health communications about the safety of romaine lettuce from a particular growing region or harvest date.
  • FDA strongly encourages (emphasis on “strongly”) the entire leafy greens supply chain to adopt traceability best practices and state-of-the-art technology to assure quick, accurate and easy access to key data elements from farm to fork when leafy greens are involved in a potential recall or outbreak. Fresh produce, including leafy greens, are a highly perishable commodity, and traceability information should facilitate the rapid tracking of implicated product throughout the entire supply chain to expedite its removal from commerce, prevent additional consumer exposures, and properly focus any recall actions. A key element that would assist tracing efforts during an outbreak is the ability to identify specific farms or ranches and dates of harvest for product that contribute to production lots if product has been commingled. While it is important to understand where the product was grown and not simply the location of the business entity that shipped or processed it, it is equally important to be able to determine which farm(s) and growing region(s) are responsible for supplying the contaminated product, and the time frame when product was supplied.
  • This information is crucial to the development of accurate public health messages to protect the public and empower retail establishments and consumers to take appropriate actions to prevent exposure. Without the ability to identify the growing region or specific suppliers of suspected shipments, public messaging by FDA and other public health partners during outbreaks or recalls will continue to be broad out of necessity, likely including farms and growing regions that are not responsible for the contamination. If supplier data are maintained when the product is co-mingled and consumers can differentiate where and when product was harvested, it is easier to narrow the number of suspected shipments and suppliers of the contaminated product once it is processed – after so many outbreaks the co-mingling and lack of transparency may well be the point – keep things confused and perhaps no one will be singled out?

My takeaway?  FDA has the skill to help industry combat these outbreaks by getting to the likely “root cause” of an outbreak.  However, the FDA is hampered by lack of public transparency with its traceback findings.  This lack of transparency leaves the public in a fog as to how to be smart consumers of a food product that has an unfortunate history that is likely to be its future as well.  Furthermore, it is past time for pleas and voluntary requirements.  The FDA and the leafy green growers know what needs to be done to minimize illnesses and loss of life.  It’s past time for please!

I take a ferry to work guarded at times by now unpaid members of the Coast Guard.  Next week with increasing trepidation, I will go through TSA Security with more unpaid professionals on the job monitoring security to then board a plane to be routed to NYC by unpaid Air Traffic Controllers.  I am not sure I could focus on my job while wondering how bills were to be paid.

The shutdown hit close to home this morning when I opened my laptop at 5:30 A.M. to see a flood of hundreds of “Out of Office” notifications responding to emails generated from last night blog posts on Salmonella in flour and spinach.

Here are just a few:

“Thank you for your message. I am not in the office at this time. I am on furlough without access to email, due to the lapse in federal government funding. I will return your message as soon as possible once funding has been restored. For information about available government services, visit USA.gov.”

“Due to the absence of either an FY 2019 appropriation or Continuing Resolution for FDA, I am out of the office on furlough status and I am not able to read or respond to your message.”

“I am currently out of the office.” 

Odd way to run a government.

If anyone wants an informative read from a near Pulitzer-quality article and photos (if they would have also shown the real impacts on the consumers of the product, the article would have been a Pulitzer-lock – See The Burger that Shattered Her Life – 2010 Prize), please take the time to read Robert Anglen of the Arizona Republic recent article: Clues to a deadly medical mystery hide in Arizona’s romaine lettuce fields – Attempts to trace E. coli outbreaks are often unsuccessful and misleading. Outbreaks tied to romaine spread farther and sicken more.

Me, I am into the obvious, any real questions on why we have E. coli O157:H7 outbreaks linked to cows and romaine in Yuma?

Summary

In a new report, the Consumer Federation of America examines the legal and scientific foundations for USDA policy on Salmonella in raw meat and poultry. The report explains why the law authorizes federal regulators to treat Salmonella as an adulterant in raw meat and poultry, and it describes five policy options for harnessing new research and technology to protect public health.

Findings

The report shows that reforms to reduce Salmonella in raw meat and poultry are not only long overdue, but also legally and economically feasible. In particular, the report finds that:

  • Lack of enforcement has led to widespread incompliance with Salmonella standards introduced in response to recent outbreaks.
  • Progress on reducing Salmonella infections in the U.S. has stagnated for over a decade, with five large outbreaks associated with meat and poultry occurring in just the last year.
  • Many Salmonella reduction strategies with proven effectiveness, particularly on-farm, are not applied by major U.S. companies.
  • Federal regulators have refused to adopt common sense policies on the basis of legal precedent that is woefully outdated and scientifically wrong.Conclusion and Recommendations

    The report urges USDA’s Food Safety and Inspection Service to announce an interpretiverule under which the agency will consider raw meat and poultry “adulterated” if it iscontaminated with Salmonella. The report describes the pros and cons associated with five policy options for implementing such a rule, namely:

  • A zero tolerance approach to all Salmonella
  • Prohibiting particular Salmonella serotypes associated with human illness on rawfoods
  • Prohibiting Salmonella strains associated with an ongoing outbreak
  • Prohibiting Salmonella resistant to certain medically important antibiotics

• Prohibiting high loads of Salmonella bacteria

The report explains why any of these policies would protect public health better than the status quo.

Foodborne Illness Statistics

Each year 48 million Americans are sickened, 128,000 are hospitalized and 3,000 die from foodborne disease. (CDC, 2011)

Between 2009 and 2015, 35% of outbreak associated illnesses were attributable to meat and poultry products. (CDC, 2018)

The medical costs of treating Salmonella infection in the U.S. is estimated to exceed $3.7 billion each year. (USDA ERS 2014)

Timeline

1905 – Upton Sinclair publishes The Jungle. Six months later, Congress passes the Federal Meat Inspection Act (FMIA).

1974 – The D.C. Circuit rules in American Public Health Association v. Butz that Salmonella is not an adulterant under the FMIA or PPIA because “American housewives and cooks normally are not ignorant or stupid and their methods of preparing and cooking of food do not ordinarily resultin salmonellosis.”

1993 – E. coli O157:H7 outbreak in the Pacific Northwest linked to Jack-in-the-Box causes 400 illnesses and four deaths. A year later, Administrator Michael Taylor announces that FSIS considers “raw ground beef that is contaminated with E. coli O157:H7 to be adulterated”under the FMIA.

July 25, 1996 – FSIS issues landmark Pathogen Reduction/HACCP Systems rule.

December 6, 2001 – Fifth Circuit Court of Appeals rules in Supreme Beef Processors, Inc. v. USDA that FSIS cannot take enforcement action against meat processors on the basis of Salmonella testing results alone.

November 17, 2003 – European Commission issues Salmonella control rule that targets certain serotypes in livestock.

August 3, 2011 – Cargill Meat Solutions, Inc. recalls 36 million pounds of turkey for suspected contamination with Salmonella Heidelberg implicated in 136 illnesses and one death.

July 12, 2014 – Foster Farms recalls an “undetermined amount” of chicken products for suspected contamination with Salmonella Heidelberg implicated in 634 illnesses.

February 11, 2016 – FSIS finalizes updated standards for Salmonella and Campylobacter in ground poultry and poultry parts.

November 23, 2018 – FSIS publishes data indicating nearly all major poultry companies are operating plants that fail to comply with the new rules.

I have received a few emails and calls about what to do for Thanksgiving when there appears to be an ongoing outbreak and recall.  FSIS has some of the best advice – see below:

The Thanksgiving meal is the largest many cooks prepare each year. Getting it just right, especially the turkey, brings a fair amount of pressure whether or not a host is experienced with roasting one. The United States Department of Agriculture’s (USDA) Food Safety and Inspection Service (FSIS) is issuing food safety recommendations on how to properly prepare a turkey to make sure yours is both delicious and safe to serve.

“Unsafe handling and undercooking of your turkey can lead to serious foodborne illness, explains Maria Malagon, Director of Food Safety Education with USDA FSIS. “Turkeys may contain Salmonella and Campylobacter, harmful pathogens that are only destroyed by properly preparing and cooking a turkey.”

Consumers should follow certain steps to reduce the risk of foodborne illness. According to Ms. Malagon, “those handling and cooking Thanksgiving meals should be aware of the resources available to them and the measures they can take to keep food safe.”

Steps to follow before cooking a turkey:

  • Read labels carefully. Temperature labels show if the bird is fresh or frozen. If you plan to serve a fresh turkey, purchase it no more than two days before Thanksgiving.
  • Purchase two thermometers: a refrigerator thermometer to ensure the turkey is stored at 40 °F or slightly below and a food thermometer to make sure the cooked turkey reaches a safe 165 °F.
  • Thaw the turkey by using the microwave, the cold water method, or the refrigerator. The refrigerator method is USDA recommended.

Steps to follow when cooking a turkey:

  • Wash hands with warm water and soap for 20 seconds before touching any food to prevent the spread of many types of infection and illness.
  • Do not wash the turkey. This only spreads pathogens onto kitchen surfaces. The only way to kill bacteria that causes foodborne illness is to fully cook the turkey.
  • Keep raw turkey separated from all other foods at all times.
  • Use separate cutting boards, plates, and utensils when handling raw turkey to avoid cross-contamination. Wash items that have touched raw meat with warm soap and water, or place them in a dishwasher.
  • Cook the turkey until it reaches 165 °F, as measured by a food thermometer. Check the turkey’s temperature by inserting the thermometer in three places: the thickest part of the breast, the innermost part of the thigh, and the innermost part of the wing.

Steps to follow when consuming leftover Thanksgiving food:

  • Refrigerate leftovers within two hours to prevent bacteria from growing on the food.
  • Store leftovers in shallow pans or containers to decrease cooling time. This prevents the food from spending too much time at unsafe temperatures (between 40 °F to 140 °F).
  • Do not store stuffing inside a leftover turkey. Remove the stuffing from the turkey, and refrigerate the stuffing and the meat separately.
  • Avoid consuming leftovers that have been left in the refrigerator for longer than 3 or 4 days (next Tuesday to be exact). Use the freezer to store leftovers for longer periods of time.
  • Keep leftovers in a cooler with ice or frozen gel packs if the food is traveling home with a guest who lives more than two hours away.

The below from Dr. Scott Gottlieb just dropped into my inbox.  We all will miss Dr. Stephen Ostroff.  He has been a great champion for food safety for many years and will be missed.  I wish him well.  However, pulling Frank Yiannas from Walmart to the FDA is a brilliant move.  I have known and respected Frank for years.  His commitment to changing the culture of food safety – specifically through transparency – will be welcome at the FDA.

Dear Colleagues,

I’d like to share with you some important changes to our FDA food safety leadership team – changes that build on the program’s outstanding strength, but are also, for me, bittersweet.

Dr. Stephen Ostroff will be retiring from the agency on January 5th, after a distinguished and dedicated career in public service, including over five years of exceptional service to FDA.

Since joining the FDA in 2013, Dr. Ostroff has epitomized our commitment to the public health and science-based decision making, through his work across all of our product areas, and especially his work on modernizing the FDA’s – and the nation’s — food safety activities.

During his time at the FDA, Dr. Ostroff has served as a dedicated leader, first at the Chief Medical Officer in the Center for Food Safety and Applied Nutrition and then as the agency’s Chief Scientist.  Most recently, Steve has been instrumental in his role as Deputy Commissioner for Foods and Veterinary Medicine.

Notably, Dr. Ostroff served twice for a total of 15 months as the FDA’s Acting Commissioner, guiding the Agency through periods of transition, advancing its mission, and ensuring we upheld the FDA’s public health mission during times of change. Throughout my time as Commissioner, I’ve relied on Dr. Ostroff’s deep experience, thoughtful perspective, and strong leadership during many complicated and pivotal policy discussions, food outbreaks, and recall events.

Irrespective of his role at the Agency, Dr. Ostroff’s work advanced the FDA’s public health prerogatives and upheld its vital consumer mission. I’m immensely grateful for his many contributions. I know he’ll continue to have an important influence on the public health.

I’m delighted to announce that we’ll be welcoming Frank Yiannas to the FDA leadership team as Deputy Commissioner for Food Policy and Response. In this role, Mr. Yiannas will report directly to me, and he’ll head the Office of Foods and Veterinary Medicine.  Dr. Ostroff was instrumental in recruiting Mr. Yiannas to the Agency. Dr. Ostroff will remain at the FDA until January as a senior advisor to me, and will help Mr. Yiannas transition into his new role.

Mr. Yiannas is a globally renowned food safety and supply chain expert and thought leader.  Throughout his private sector career – most recently as Vice President of Food Safety and Health for Walmart, he’s been a food safety champion and instrumental in forging public-private collaborations to advance public health.

He’s been recognized for his role in elevating food safety standards and building effective food safety management systems based on modern science and risk-based prevention principles. Mr. Yiannas is a globally acknowledged pioneer in using blockchain technology to strengthen food traceability capabilities and enable greater food system transparency.

In addition to his food safety leadership roles at Walmart and Disney, Mr. Yiannas previously served as the president of the International Association for Food Protection. He’s an Adjunct Professor in the Food Safety Program at Michigan State University, and the author of many scholarly papers on food safety and books on food safety culture and behavior.

As Deputy Commissioner for Food Policy and Response, Mr. Yiannas will assume a critical set of charges related to food safety, first and foremost, leading the continued implementation of the Food Safety Modernization Act. In this role, he’ll work in close collaboration with the leadership of Center for Food Safety and Applied Nutrition, the Center for Veterinary Medicine, and the food components of the Office of Regulatory Affairs. Mr. Yiannas’s deep knowledge and diverse experience will support our continued efforts to advance the FDA’s strategies for continuing to reduce food safety risks and achieving high rates of compliance with our modernization standards.

Mr. Yiannas also will serve as a senior scientific advisor to the Commissioner on various food safety and supply chain matters, including FSMA implementation. Additionally, he’ll help lead and coordinate certain cross-cutting policy activities and associated external engagement activities related to food safety and animal health. We’ll also leverage his experience and leadership across the Agency, and all product areas, on the issues of supply chain security and the use of new tracking technology, recall effectiveness, and traceback investigation processes.

We look forward to his contributions to our food safety mission and our efforts to keep families safe. Please join me in wishing Dr. Ostroff well and welcoming Mr. Yiannas to FDA.

Sincerely,

Dr. Scott Gottlieb
Commissioner of Food and Drugs

From Food Safety News:

By Dan Flynn on September 24, 2018

A new edition of “Poisoned: The True Story of the Deadly E. Coli Outbreak That Changed the Way Americans Eat” by Jeff Benedict has been shipped to distributors by book publishers Thomson-Shore.

In the new edition, Benedict catches up with America’s best-known food safety lawyer in South Africa where the world’s largest ever listeriosis outbreak was underway with eerie parallels to America’s 1993 E. coli outbreak, which “Poisoned”explores in detail.

Twenty-five years after that game-changing E. coli O157: H7 outbreak, Benedict finds food safety lawyer Bill Marler older and grayer, but still going from one food safety crisis to another. And South Africa’s listeriosis outbreak is the worst of its kind ever, according to the World Health Organization.

The new edition of “Poisoned” is the first since the original hardback came out in 2011, followed by the paperback in 2014. Its release comes as Benedict, one of America’s top nonfiction writers, finds his book, “Tiger Woods,” riding atop the New York Times Best Seller list.

In the new second edition of “Poisoned,” he reports on Marler teaming up with South African human rights lawyer Richard Spoor to seek justice for more than 1,000 Listeria victims, including the more than 200 that died. “Nearly half of the victims were newborns that had been infected during gestation,” Benedict reports.

Benedict took some time out of one of his increasingly busy days to answer a few questions from Food Safety News (FSN). Here’s what we learned:

FSN: Jeff, we did not know just how busy you’ve been. Congratulations sir, on your new book, “Tiger Woods.” It’s a No. 1 New York Times bestseller with stunning reviews. How does that feel?

JB: “It was a privilege to write the biography of the world’s greatest golfer. Tiger is a Shakespearian figure whose popularity transcends sport. The great thing is that his comeback is a triumphant tale that has captured the attention of the world.”

FSN: About half of your books involve the world of sports. In addition to golf, you’ve authored serious works about college and pro football, the NBA, Indian gaming, and domestic violence involving athletes. How do you follow so many sports and still get anything done?

JB: “It’s not so much about following so many sports. When I write a book, I do full immersion into the subject matter, whether it’s a biography about a famous athlete or an exposé on a phony Indian tribe that built the world’s largest casino. Once I’m into a book, I pretty much block out everything else.”

FSN: You also made famous action on the Supreme Court with “Little Pink House,” the takings case out of New London, CT. Your book was made into a movie that was in theaters earlier this year. What was your role in that?

JB: “I was an executive producer on the film, which starred Catherine Keener and Jeanne Tripplehorn. One of my responsibilities was to persuade David Crosby to compose an original theme song, which turned out to be one of my favorite aspects of working on the film.”

FSN: In returning to “Poisoned” to write for the new edition, were you surprised to find so many instances of foodborne illness still occurring 25 years after the events your first wrote about?

JB: “Not really. What’s interesting is the diversity of foods that are now responsible for E. coli outbreaks. When the Jack in the Box outbreak, which is the subject of “Poisoned,” happened 25 years ago, E. coli poisoning was traced to contaminated ground beef. That used to be the norm. Now E. coli is found in leafy greens and other foods. It shows, in part, how complex our food system has become.”

FSN: Poisoned is a must read for anyone in the food safety community and many will likely want to read the updated version. Beyond this professional community, do you know who makes up the audience for a book like “Poisoned” with it’s behind the scenes look at food safety?

JB “I chose a narrative style that I thought would appeal to parents, especially mothers. I also tried to write the story in a cinematic way. It’s a very visual story. And I remain hopeful that one day it will find its way to the screen.

FSN: Jeff, you’ve been highly productive as an author and producer during the past decade and longer. What’s next for you?

JB:   “The biography of LeBron James.”

Editor’s notes: Jeff Benedict is licensed to practice law in Connecticut. He’s a distinguished professor of writing and mass media at Southern Virginia University. He is represented by Richard Pine at InkWell Management in New York City.

Poisoned FOREWARD 6-29-18

As some of the readers might know, in my spare time I am the managing partner at Marler Clark in Seattle.  Our long-time Epidemiologist, Patti Waller, has moved into semi-retirement and is running www.outbreakdatabase.com for us.  Katrina Deardorff, who has been with us for a nearly two years, has decided to take a job back in the public sector, and we wish her well.

So, I am working here on a Saturday (not that uncommon), thinking about how to replace the irreplaceable, but knowing how important this job is to the quality of work we do at Marler Clark.

Minimum requirements are a Masters in Public Health or Epidemiology and some experience in foodborne disease investigations and willingness to live in Seattle.

Please send your resume and salary requirements to me at bmarler@marlerclark.com.  Also, take a chance to see the below.  I think it helps understand the job and its importance.