Vigilance key in fighting foodborne illness

This summer, a miserable illness swept through 43 states, the District of Columbia and Canada. It sickened more than 1,400 people and sent at least 255 of them to the hospital. This insidious bug also was credited with hastening the deaths of two people with serious, underlying conditions.

It was an outbreak for sure. But in a society on edge over unfamiliar threats such as avian flu or MRSA, this infection came calling by way of a common dinner plate.

The culprit was a foodborne illness -- Salmonella serotype Saintpaul, to be precise. Epidemiologic data initially fingered certain types of fresh tomatoes as the carrier. Later the illness was linked to Mexican jalapeno and serrano peppers.

Ultimately, the complex effort to pinpoint the illness' source took weeks and cost the produce industry an estimated $200 million. It also drew a heightened level of scrutiny to the nation's fragile food safety system -- triggering public criticism and congressional interest.

But perhaps most importantly, the outbreak served as a reminder that foodborne illness has become an almost constant consideration in the health care enterprise. In this modern age, food is likely to be mass-produced and widely distributed. As a result, field-to-table contamination can be a national, even international, problem.

The Food and Drug Administration and the Centers for Disease Control and Prevention, along with a patchwork of state and local public health departments, combine to create the nation's defense system. But their capacities vary widely across jurisdictions because of differing levels of resources and expertise.

One aspect of the food safety continuum, though, is constant -- that of practicing physicians. They play a critical role in surveillance activities, reporting individual cases that sometimes unlock entire outbreaks. And that's why the American Medical Association considers this public health problem a priority. The CDC estimates that 76 million illnesses annually can be blamed on foodborne pathogens. Each year, 325,000 people are hospitalized; 5,000 do not survive.

The AMA has long worked with appropriate federal agencies, medical specialty societies and public health organizations to educate physicians and the public on measures to prevent foodborne illness and ensure enforcement of existing regulations for the safe production, handling and transportation of food items.

To provide physicians with the tools they need, the AMA collaborated with the American Nurses Assn., the CDC, the FDA and the Dept. of Agriculture to create in 2004 the Diagnosis and Management of Foodborne Illnesses: A Primer for Physicians and Other Health Care Professionals.

This resource, which has since been updated, covers a range of illnesses, including sections on newly identified foodborne pathogens as well as timely facts regarding the most common and damaging bugs.

In addition, it offers insights on the intentional contamination of food and water. An online interactive version is upcoming. In general, the primer reminds physicians of steps they should take.

It is up to doctors to recognize that a foodborne contaminant may be making a patient sick. In such circumstances, they should obtain stool cultures or request testing for other pathogens as necessary. Reporting results and suspect cases to public health officials is a must.

Physicians also are positioned to discuss with patients ways to prevent food-related disease and to educate them that the young, the old, pregnant and those with compromised immune systems are at greater risk.

Data published this year in the Morbidity and Mortality Weekly Report indicated the food safety system has, since 1996, shown improvement. But after steep declines through 2004, the rate of most diseases caused by foodborne pathogens -- Campylobacter, Listeria and Salmonella among them -- was unchanged in 2007.

Still, technological advances can help the public health system to identify outbreaks of foodborne illness more quickly than ever by genetically connecting individual cases. And it relies on primary care physicians to maintain a high index of suspicion. It's this vigilance that makes a difference.

Asking questions about recent travel, food eaten in the home and at restaurants, and whether other family members are ill can start a lifesaving public health process.

It's been said many times: It is often the report by an astute physician that leads to the detection and rapid containment of an outbreak.