Information Sharing and Collaboration: Applications to Integrated Biosurveillance: Workshop Summary by Deepali M. Patel

Author:Deepali M. Patel
Language: eng
Format: epub
Tags: ebook, book
Publisher: THE NATIONAL ACADEMIES PRESS
Published: 2012-12-24T00:00:00+00:00

THIRD MOVE

In the third move, the source of the exposures turns out to be bean sprouts contaminated with E. coli. There is no credible evidence of terrorism, but the investigation continues.

Braden emphasized the difficulty of identifying such a source. Implicating bean sprouts could mean finding a person who ate bean sprouts, knows where the bean sprouts were bought, and had a shopping card linked to a shopping card database to show when the bean sprouts were bought. “Getting that kind of information is quite hard. People don’t remember that they ate bean sprouts—it’s often kind of a stealth vehicle.” Yet an accurate trace back is essential to keep partner agencies from being led astray.

Braden also observed that identifying a specific pathogen increases the ability to predict what is going to happen. For example, E. coli can produce different types of Shiga toxins, which will influence the characteristics of the outbreak. This information in turn would need to be conveyed to public health authorities at all levels. He also pointed out that this system is currently threatened, because more and more clinical laboratories are adopting non-culture-based diagnostics, which means that cultures are not available to characterize infectious organisms. “We’re not going to have that isolate and be able to characterize it to be able to know what to do.”

Braden also described the difficulty of acting as a communicator at CDC while participating in an investigation. “Sometimes the incident commander is spending half the time in the studios in front of the cameras.” Joint press conferences with all of the involved agencies on the phone, along with as many as 150 reporters, also take up time.

Tan reiterated that the epidemiological information starts with state and local health departments. USDA can rely on internal databases to investigate hypotheses, but without enough information the investigation cannot proceed. “The boots-on-the-ground element cannot be underestimated, because there’s often not enough information for us really to understand exactly what establishment [was involved], what were the production dates, what are the lot codes. Often, people unwrap their food and then they toss the package, and all of our information goes into the garbage. And our folks on the ground are not adverse to going into the garbage and getting the information for us. They can, they have, they remind me often.”

Kautter observed that implicating bean sprouts is a significant advance because it provides a path to pursue. Bean sprouts are not particularly seasonal, but if the contaminated food were seasonal, the first question to ask would be where the food is grown that time of year. If the food was imported, were import samples taken, or are there domestic samples that can be tested? Can the genetic fingerprint of an infectious organism from the food be linked to a clinical sample? Also, once a source is known, industry calls become much more numerous, because industry or trade associations could have information about the origins and treatment of the food.

On this point, Quitugua said that NBIC would not necessarily have all of the information that other agencies have.

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