Inspired To Heal
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Inspired To Heal
FoodNet: Monitoring Foodborne Illness for the United States
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In the early 1990s, a devastating outbreak of contaminated beef led to kidney damage and death among children, sparking a call to action on food safety. In response, the CDC, USDA, FDA, and several state health departments launched FoodNet in 1995—a surveillance system designed to monitor the incidence and severity of foodborne illnesses across the United States.
Dr. Kirk Smith, an epidemiologist, veterinarian, and director of Minnesota’s FoodNet site, he shares his insights from decades of work protecting the nation's food supply. Dr. Smith discusses how FoodNet works, best practices in food safety, and a particularly unusual and interesting Salmonella outbreak in an elementary school.
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Inspired to Heal, Season 2, Public Health Stories. We recount important public health advances, whether through outbreak investigations, policies, or program building. In each story, government agencies play critical roles. I'm Bill Trick, your host for Inspired to Heal. Today, I welcome Kirk Smith from the Minnesota Department of Health. He's the director for their state CDC-designated Food Safety Center of Excellence. He's an expert in foodborne illness and how to protect us, the public, from outbreaks due to contaminated food. Kirk, I'll start with your background. Can you tell me a little about yourself and how you got interested in foodborne illness?
SPEAKER_03Yeah, so I'm from a family farm in North Dakota. I raised cattle. And so I know I had always been interested in diseases that could be transferred from animals to people. Getting into public health was a bit of a roundabout trip. I'm a veterinarian, but my first goal was to work on diseases of free-ranging wildlife. I went to graduate school for that. But then when I got out of school, there weren't nearly as many jobs in that specific field. And so I had the chance to apply for, and I got into CDC's Epidemic Intelligence Service, which is a two-year training program in applied public health. Through that training program, I landed at the Minnesota Department of Health to conduct my two-year fellowship. And that's how I entered public health. And I ended up just staying in Minnesota and eventually becoming a supervisor and a manager of diseases that you can get through food, water, arthropod vectors, or animals. And kind of along with that came the role of the principal investigator for the FoodNet program.
SPEAKER_02And it's not that big a stretch for veterinarians to go through that epidemic intelligence service training and then go into public health. Can you speak a little bit about the role of veterinarians and was it a natural evolution to go into public health?
SPEAKER_03Yeah, absolutely. I think uh veterinarians make fantastic epidemiologists because, in fact, we get a lot of training on population medicine in veterinary school. So we're kind of taught to think that way from the get-go. And so it's uh a very natural extension for veterinarians to go into public health. And obviously, a lot of the diseases that we learn about uh of people do come from food and animal contact and things like that. So again, I think uh kind of a very natural extension that veterinarians make excellent public health professionals.
SPEAKER_02And looking through your many publications, you've investigated quite a few outbreaks, many of them related to salmonella, including infected delicatessen workers, frozen microwaveable breaded stuffed chicken products. And then you've had some that are not foodborne illnesses for humans. But there's been salmonella from bearded dragons, pet rodents, dissection of owl pellets in an elementary school. And this one's a little bit unpleasant, but frozen vacuum-packed rodents to feed snakes. Do any of those have an interesting tale?
SPEAKER_03Oh man, they they all do. But I think the the the one big point that this all brings up is you know, we're doing surveillance for these pathogens, right? But just bec all these pathogens are very commonly transmitted through food. However, for some, you can get them in a variety of other ways through animal contact, through ingestion of contaminated water, from person-to-person contact, say like in a in a daycare setting. And we don't know when we interview a case where they've gotten their infection. So you always have to keep all the different sources in mind, not just not just food. The uh owl pellet one was uh very fun. I think it was kind of the first time that had been documented that people can get salmonella from owl pellets. So this one started when uh two different physicians called to report two different cases of somolosis in elementary school kids on the same day. Called the school nurse, and there was a high absenteeism rate, and so we launched an investigation and found out that cases were associated with Science Club and Adventure Club. And Science Club were first to third graders who had dissected all pellets on the lunchroom table because that's where science club was held, was in the lunchroom. And then Adventure Club was kind of the after school program. Well, that was also held in the lunchroom, and they would have snack on the same table after Science Club was done. And then the the tables weren't sanitized until after lunch the following day. We tracked down the owl that provided the owl pellets. You gotta know that owls, they don't, not everything passes through their digestive system. They kind of package up a lot of the fern bones and then regurgitate them back out the mouth. So this owl was positive for the outbreak strain of Salmonella, typhomerium, and uh there were some frozen chicks that were left over from the batch that had been used to feed the owl, and those were positive for the outbreak strain of salmonella as well. Subsequently, there was another outbreak associated with owl pellets in Massachusetts, and and now I think it's still a very popular kind of elementary school science activity, but now sterilized owl pellets are are used for the activity, removing the risk.
SPEAKER_02Um whole new meaning to the to the adventure club. Their slogan is probably you know let's make it a little less of an adventure next time. Probably best known to us are the diseases that are caused by consumption of food from animals and foodborne illnesses. You are the director for the FoodNet program in Minnesota. I'm sure that everybody thinks that when they get a diarrheal illness, if they go to their doctor and a sample is collected, that that sample is sent to public health, public health knows about it. But FoodNet is a surveillance program that looks more intensively at these illnesses, tries to estimate how many illnesses are and are not detected. And so we get a national estimate for the number of illnesses that people get when eating food that is contaminated. So can you tell us a little bit about FoodNet? What else do you capture? What percent of the United States is covered by FoodNet?
SPEAKER_03Yeah, we have 10 different FoodNet sites. Some of those are whole states, and some of those are just certain counties with within that particular state. Our Food Net sites cover about 16% of the United States population. And it is thought that we're we're quite representative of the country as a whole.
SPEAKER_02So quick back of the envelope calculations, you're probably at like 40 to 50 million people are under this active surveillance. Does that sound about right?
SPEAKER_03That's pretty good math. It's about 54 million.
SPEAKER_02How long have you been with Fort FoodNet? And then why was it started?
SPEAKER_03So I started with FoodNet in 1999. And regarding why FoodNet started, I think it was a couple of things. In 1992, the National Institutes of Medicine came out with a big report on emerging infections, and very prophetic, rightfully so. CDC then began working on this whole emerging infections program, which includes not just FoodNet, but a whole host of other disease program areas as well. But then regarding foodborne diseases, in 1993 there was a big outbreak of, at the time, pretty new pathogen called E. coli 0157H7 that causes bloody diarrhea and sometimes a severe sequella called hemolytic remix syndrome that causes kidney failure and is sometimes fatal. There was a big outbreak in the Pacific Northwest associated with eating hamburgers at the Jack in the Box restaurant chain. And there were over 700 cases, over 50 cases of this hemolytic remix syndrome, and four deaths in young children. And so that outbreak, I think, was one of the big stimuli for why FoodNet was formed because it also led to a bunch of regulatory changes by USDA in ground beef processing in this country. 0157 was classified as an adulterant. It wasn't allowed to be in food. It stimulated a whole testing program for 0157 in beef processing plants. It led to more systematic evaluation of your food safety processes in the industry. And so with all these changes, then we needed a mechanism to determine whether or how effective these changes were in uh decreasing the incidence of A. coli 0157. Well, and even what the whole national incidence of 0157 was in the first place. So that really was probably the main impetus for the for the formation of FoodNet.
SPEAKER_02And so now the hamburger that we get is tested upstream, and it's probably much safer, but still not entirely safe. Is that correct?
SPEAKER_03Yeah, it's impossible to totally test everything and test your way out of a food safety problem. So it's not just testing, there's lots of other kind of food safety interventions that are done in beef processing plants. You know, it really has been a food safety success story. The prevalence of uh equalite 157 in ground beef has decreased quite markedly from the from the late 1990s. And subsequently, the, or I should say consequently, the incidence of 0157 infections in humans has decreased as well. However, there's many, many other types of foods and ways in which you can get E. coli 0157H7 that are not related to food directly, which are things that we've found out through FoodNets as well.
SPEAKER_02How do you order your hamburgers cooked?
SPEAKER_03Oh, do you mind medium? Well, I mean.
SPEAKER_01Yeah. No pink. You want the it cooked through.
SPEAKER_03Exactly. I mean, what what you technically should do is order it to a specific temperature, like 160 degrees would be would be perfect. But a lot of restaurants don't necessarily take the temperature of of every hamburger they cook.
SPEAKER_02Yeah, yeah. I I would think Jack in the Box does now.
SPEAKER_03Well, that's that's one thing I didn't mention about that outbreak was it really led to the standardization of cooking methods in fast food hamburger restaurants. So now actually eating hamburger at a at a fast food restaurant is all very standardized and much, much, much safer than eating a hamburger at table service restaurants. So that's another good thing that has come of it.
SPEAKER_02FoodNet historically has monitored six pathogens. Could you mention what those six are?
SPEAKER_03It's actually seven bacteria and then one parasite. We've talked about Silmonella and shigatoxin producing E. coli, E. coli 157 is one of those. And then there's Campbellbacter, Listeria, Shigella, Vibrio, and Ursinia for the bacteria. And Cyclospora is a parasite that we track as well.
SPEAKER_02Could you speak a little about the challenges of tracking foodborne illness in the population, how the diagnostic tests can change? And other than E. coli, can you highlight other success stories?
SPEAKER_03It's not just that these newer tests are more sensitive. It's like, well, you know, if we're thinking that we are actually finding out about only one out of every 40 actual infections, well, what if uh physicians are testing twice as many people now because they have better tests? That obviously has huge implications for the numbers that we're seeing. So I think it's an extremely complicated thing to try to tease out. And that again is one of the main values of FooNet. But you did ask about other successes. I mentioned that E. coli 157 decreased in incidence throughout the the first decade of the 2000s. Listeria, I think, is another success story. Yeah, the incidence of listeria has decreased as well. And that was largely tied to improvements by the regulatory agencies and the industry in the kind of production of deli meats. There's so many other things you can get listeria from that's still uh still an issue in uh lots of other food items.
SPEAKER_02So I wanted to name those major pathogens to you. It's a word association. Name a food that you would associate to the bacteria. Are you up for this? Oh, absolutely. Okay, fun. Okay, good. Campylobacter.
SPEAKER_03Chicken, absolutely.
SPEAKER_01Chitterlings, yes, which is pork intestines. Okay. Surprise for me. Listeria. Soft cheeses, but it can be lots of things. Salmonella.
SPEAKER_03Anything.
SPEAKER_01Seriously.
SPEAKER_03That's why salmonella is so so common and so successful. It can come from any sort of raw or undercooked food of animal origin or produce or processed foods, just because it survives wonderfully in food processing plants. It literally has the most wide array of potential vehicles of any foodborne pathogen. Two left. Vibrio. Oysters. Yeah. Okay. And Cyclosphora. Cilantro. It's always some sort of fresh produce and stuff. The uh kind of the original vehicle for which it was recognized was raspberries, but a lot of cilantro outbreaks these days.
SPEAKER_02So wash your cilantro.
SPEAKER_03Uh you can it's hard to uh remove pathogens that way sometimes.
SPEAKER_02Is there anything that we're doing upstream to make it safer compared to what it was in the past? Any successful policy or regulatory changes?
SPEAKER_03Well, it's tough to define success. You know, there was the whole Food Safety Monetization Act passed in 2011, and that's been implemented piece by piece over time. But a part of that is a big produce safety rule. But then you have the complication of it's like, well, it might be easier to implement those things in this country, but a lot of our produce is imported. And FDA tries to make sure importers are meeting the same standards that we have in this country. But as you might imagine, that that's uh an imperfect process.
SPEAKER_02There have been many threats to funding for public health and public health agencies. What should we be worried about if your budget was cut?
SPEAKER_03Where people are getting foodborne illnesses is always changing. Food production and processing and distribution are always changing, people's diets are always changing, and therefore foodborne disease risks are always changing. And FoodNet is is really the biggest weapon we have to try to kind of detect those changes and determine what are the biggest food safety problems out there, and is what our regulatory agencies are doing effective or ineffective at mitigating those risks. So, yes, agree that any sort of decreases in in food net form or function would be extremely concerning.
SPEAKER_02And it's we're not just talking about diarrheal illnesses. People get can get severely ill and die from foodborne illness.
SPEAKER_03Absolutely. And that is one kind of misconception that people have. There's lots of chronic sequelae, like even if, you know, of course, a certain proportion of people die. But there's also chronic sequelae that cause lifelong health effects.
SPEAKER_02Let's move on to food safety. One of the CDC recommendations that I had a little problem with was to not wash my chicken before cooking it. Did I remember it wrong? I'm probably doing the wrong thing. But go ahead and teach me.
SPEAKER_03When you wash it, you're not really removing all the camplobacter anyway.
SPEAKER_02Do you think I'm the only one? Have you figured out that people listen to that recommendation?
SPEAKER_03Oh no, people definitely still wash their chicken uh in their sink sometimes and stuff. I think it's a pretty common practice.
SPEAKER_02In addition to that, what would you recommend as the top things that people can do to make their food safe when they're cooking?
SPEAKER_03Well, we were just talking about relates to don't cross-contaminate. Anytime your hands or a surface comes into contact with uh a raw food of animal origin, eggs, poultry, meat, you gotta be careful not to transfer any contamination then to ready-to-eat foods like a salad or something like that. And so every time you or a surface touches raw food or utensil touches a raw food, they need to be kind of washed and sanitized before any ready-to-eat food comes in contact with them. Another one is kind of an axiom we have like hot keep hot foods hot and cold foods cold. And then I also have like don't prepare foods if you are sick or ever been sick recently with a stomach illness, you can carry all these pathogens for a time after your symptoms resolve.
SPEAKER_02Well, before you leave, I did have a final question. If you could choose one item to put into your public health backpack, literal or figurative, what would it be?
SPEAKER_03You know, I I think just some sort of magical risk communication tool, just the ability to uh reach everyone with our risk communication messages and ensure that everybody kind of receives, understands, and trusts these messages, and then considers them or um for what it what it means to their personal situations.
SPEAKER_02It's very similar to the microwave safety episode, I said a translator, to get messages out to people. I really appreciate you taking the time. It's been very informative, and I've enjoyed talking to you.
SPEAKER_03Thank you.
SPEAKER_00Inspired to heal podcasts for informational purposes only and should not be considered as health or professional advice. We are not responsible for any losses, damages, or liabilities that may arise from the use of this podcast. The views expressed do not necessarily represent those of the host or the guest's current or past employers.
