You heard it here first: Changing our food borne illness public notification process

Since June, we’ve written in this space about a spate of food borne illness outbreaks that have kept all hands on deck here at Public Health – Seattle & King County and at times across the state – the salmonella outbreak connected to pork from Kapowsin’s slaughterhouse, the E. coli O157 outbreak linked to food trucks and farmers markets, and the current multi-state outbreak of E. coli O26, associated with Chipotle restaurants.

newspaper readerOur epidemiologists (disease detectives), food safety experts, public health nurses, investigators and other staff work to identify and stop disease outbreaks before they become widespread. Nonetheless, large outbreaks inevitably occur and gobble up even more resources and time to investigate and respond to. But the outbreaks you’ve read and heard about in the media are just a few of the infectious disease issues that we have been grappling with this summer.

In fact, in a typical week, we receive reports of other enteric (intestinal) illnesses including campylobacteriosis, salmonellosis, shigellosis, and norovirus. At the time of this posting, we’re investigating reports of mumps, pertussis, tularemia, varicella, and suspected rabies exposures. We’re continuing to monitor returning travelers from countries impacted by Ebola and have had several returning healthcare workers evaluated for Ebola infection (none have had it).  And we’re in the early phases of our annual ritual tracking the upcoming influenza season.

Why have we publicized some investigations but not others?

As the health department, our top priority is to keep the public safe and healthy, including preventing and responding to disease outbreaks.  When we hear about possible outbreaks from individuals, healthcare providers, laboratories or businesses that report cases of illness to us, we investigate but we don’t divulge the ill person’s identity, even if it is a communicable disease. Not only are people’s identities protected by state and federal law, breaking confidentiality could discourage people from reporting diseases – putting us all at risk.

Similarly, if we learn from a food business or from its customers that people got sick from eating at the restaurant, we want that food business to work with us to figure out what happened, confident that we will not prematurely place blame before we have done an investigation to evaluate all possible causes, including (but not limited to) restaurant food safety practices that could have contributed, contamination of a commercial food product the restaurant may have received, and other causes unrelated to the restaurant, business or organization.

But if there’s ongoing risk we’re going to tell you about it.  We will always make a public announcement (including names of implicated restaurants and commercial entities) when there is an ongoing outbreak or risk that people need to know about in order to protect their health. We’ll provide information on how to avoid illness and what to do if you’ve been exposed.  We may also make a public announcement if it will help us solve an ongoing investigation. In addition, we can inspect and close restaurants immediately if we find food safety violations contributing to an outbreak.  We post these closures on our website and publicize with Facebook and Twitter.

On the other hand, health departments, including ours, typically don’t make public announcements about an outbreak when the outbreak is over, there is no ongoing risk to the public and there are no actions or steps for the public to take to protect their health. In addition, just as we seek to avoid stigmatizing people, we avoid public announcements that implicate businesses, organizations or restaurants when we don’t have good evidence about the source or cause of the problem or we don’t have a confirmed link to the commercial facility and there is no ongoing risk. Our public notification practices are consistent with health departments in our region and around the country.

Providing more information on outbreaks`

But here’s where Public Health Insider gets philosophical. We are learning that people want to know more about our outbreak investigations, above and beyond our public alerts when there’s an immediate heath risk, and we respect that interest. This is part of a larger trend toward greater openness from government, which values the public’s right to know. Conversations with local media that also value public access to information, including the Seattle Times, raised issues that helped our Health Officer, Dr. Jeff Duchin to decide in July 2015 to develop a way to routinely provide public information about outbreaks.

Information about the causes of outbreaks is occasionally straightforward, but more often is unclear and/or inconclusive. In order to provide information about the circumstances and possible causes of outbreaks responsibly, we need to provide important context and background. We don’t want readers to confuse associations, (which are relationships between two or more events or other variables that may or not indicate cause and effect), with actual causes. For example, in many investigations we are not able to identify the cause or source with certainty. This typically happens when there is simply not enough epidemiologic and/or laboratory evidence available to draw reliable conclusions.

We will need to present information in a way that would incorporate at minimum the key facts of an outbreak as well our conclusions regarding potential causes and  limitations of the available information. We are going to approach this work thoughtfully and seek input from experts in both public health and communications, and hope to have this ready to roll out in January 2016.

In addition, we are currently in the process of expanding how restaurant inspection information is made available to the public – via storefront signs and improved online access. This will be an update to our current practice of posting inspections online – we were one of the very first health departments to do this way back in 2001!

Keep your eyes on Public Health Insider for both of these new developments in early 2016.