Where Federal Funds Should Go to Avoid Another Outbreak

By Bala Swaminathan, 12 February, 2009, No Comment

It doesn’t look like food safety is going to make it into the economic stimulus bill that President Obama will likely sign before week’s end. As we mentioned earlier, a number of politicians, however, have called for reform. As the United States Congress works to appropriate additional funds to enhance food safety and prevent the recurrence of the peanut butter fiasco, here are a list of priority needs that I wrote up with the help of my friend Craig Hedberg of the University of Minnesota. (I am excited to announce that Craig will soon be contributing to our humble blog.):

1. FDA’s Food Protection Plan is built around the concepts of prevention, intervention and response. Although no amount of inspectors will ever provide an absolute guarantee for the safety of food, more are needed for FDA’s Office of Regulatory Affairs (ORA) in order to ensure that food processing establishments are checked out on a regular basis.  Beyond more inspectors, a broader scope to the inspection process is needed: Regular inspections that were informed by knowledge of the 2007 outbreak of salmonella in peanut butter and included reviews of critical control point-monitoring records and environmental and product test results might have prevented or at least limited the impact of the Peanut Corporation of America outbreak. Interestingly, the ORA website doesn’t express our concern about the need for more inspection resources:

The FDA’s ability to protect the public health has been enhanced by additional resources authorized by Congress in the wake of the Sept. 11, 2001, terrorist attacks. The FDA hired 655 new ORA employees, 600 of whom strengthen food safety, 35 enhance the safety of animal drugs and feed, and 20 are part of the drug, biologic and device programs. About 420 of the new inspectors and other employees either are stationed at border locations or are working specifically on imports. All of the new hires will be trained in both import and domestic operations to help ensure adequate coverage of both domestically manufactured and imported products.

Obviously, that wasn’t enough to conduct inspections of the Peanut Corporation of America’s manufacturing operations.

2. Timely intervention and response requires ongoing surveillance that can identify potential outbreaks early and investigate them rapidly.

a. Because public health surveillance is primarily conducted at the state and local levels, CDC needs funding to enhance epidemiological capacity at state and local health departments. This should be directed to ensure that food history questionnaires will be administered to persons contracting foodborne diseases in a timely manner. The “Team Diarrhea” concept pioneered by the Minnesota Department of Health has proven to be an efficient and cost-effective model for accomplishing this objective. CDC, with assistance and input from the Minnesota Department of Health and University of Minnesota School of Public Health, should use these additional funds to create a series of regional centers for surveillance based on the “Team Diarrhea” model. Standardized questionnaires should be developed to allow for electronic data collection and transmission to a national database that could be linked to PulseNet.

b. Funding for CDC should be increased and directed to assure rapid DNA “fingerprinting” of foodborne disease-causing bacteria and viruses by state and local health departments and timely submission of the DNA “fingerprint” patterns to the national PulseNet database maintained by CDC. CDC and the state and local health departments should be adequately funded so that they can use the best available technologies to obtain the most accurate possible information on disease clusters in a timely manner. States must be encouraged to make appropriate changes to their existing laws to ensure that foodborne pathogen isolates are submitted to the local or state health department as soon as possible for DNA “fingerprinting.”

c. CDC and the state health departments should be provided adequate human resources to conduct frequent and timely review of epidemiological information and PulseNet data to rapidly identify disease clusters and follow up without delays.

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