First the Germans fingered cucumbers and then it was sprouts as the cause of the world’s most deadly E. coli outbreak, and they still may well be, along with tomatoes and lettuce – all the ingredients of a salad. Right now we do not know the actual vector for the E. coli O104:H4 outbreak that has killed 24, caused acute kidney failure in 642 with a total of 2,425 ill, but know the vector is a must. No, not to place blame (or file suit), but to learn how this preventable tragedy could have occurred and why it has taken weeks to tell the public that no one has any answers. We need Team Diarrhea (Team D) and Bill Keene too.
Team D, is a squad of graduate students at the University of Minnesota School of Public Health that works for the Minnesota Department of Health (MDH) performing epidemiological interviews in trace back investigations. Armed with a tantalizing knowledge of the gastrointestinal system, telephones, and a lot of gumption, the work of Team D gives Minnesota an unusual prowess in cracking some of the most infamous foodborne illness cases in the U.S., including the 2009 Peanut Corporation of America Salmonella outbreak.
By Minnesota state law, doctors must send stool cultures believed to be from cases of foodborne illness to the MDH laboratory where they are pulsed field gel electrophoresis (PFGE) tested to create DNA finger printing – which tell investigators if different samples came from a common host. If testing proves positive for foodborne illness, Team D gets to work immediately, interviewing the victims, often as they are suffering symptoms, looking for commonalities in what, where, and when they ate. Whereas some states may take weeks to perform the interview portion of an investigation, it is this real-time history gathering that adds an invaluable level of depth to trace back investigations, something Germany desperately needs, and something nobody does better than Team D, and that would include Dr. Kirk Smith, Dr. Carlota Medus, Dr. Craig Hedberg and Dr. Mike Osterholm.
So my suggestion, while we’re waiting for results from a German investigation that may or may not produce answers, is to send “Team D” on over on the next direct flight to Germany and hand them some pens and let them get to work. I would also nominate Dr. William Keene, senior epidemiologist on the U.S.’s other top foodborne illness investigative team at Oregon’s Division of Public Health. Keene has been unraveling the path of pathogens from victims to the source for over 30 years, and has an impressive list of solved cases under his belt.
In his suitcase, he could pack one of his most valuable contributions to the food safety world: the shotgun questionnaire, which lists hundreds of foods for foodborne illness victims to choose from to help them recall what they recently ate. Which, if it turns out to be sprouts over in Germany, could be a very helpful tool. The list even includes frozen pot pies, which would have solved the 2008 outbreak that took investigators months to track down the source.
Perhaps they can hitch a ride back to Germany on Chancellor Andrea Merkel airplane?