Will State Departments of Health and Agriculture step up and fill in the gaps left by the CDC and FDA?

Will state health officials alert their own citizens of the vector of foodborne illness outbreaks and which companies produced and supplied it – now, in most outbreaks the victims are never told what the cause of their illness actually was.

Presently, when a person or child is stricken by a reportable foodborne pathogen (like E. coliO157:H7), local and state investigators reach out to the victim or the victim’s family to find out where they shopped or dined and what they consumed in the week before the onset of symptoms.^[1]  In addition, the positive stool culture is then sent to state lab for whole genome sequencing (WGS).  This epidemiologic and laboratory, along with product traceback work, is critical in determining the source of the outbreak, pulling the product (if still available), and stopping the outbreak.  It also helps investigators understand how the outbreak happened and what can possibly be done to stop the next one.

In the past, the date collected by state health officials is share of the CDC and FDA, in many respects co-equals to the state.  As DOGE cuts accumulate it will be interesting to see of the CDC and FDA become bit players and the states become the leaders in determining the outbreak and alerting the public to the cause.

In November 2024, the CDC and FDA began an investigation into an outbreak of E. coli O157:H7. By the time the CDC and FDA closed the investigation in January 2025, and reported it February 5, 20205, the outbreak included 89 people across 15 states: Arizona (2), Colorado (1), Illinois (7), Indiana (8), Kansas (1), Kentucky (1), Missouri (50)^[2], Montana (1), North Dakota (2), Nebraska (3), Ohio (8), Pennsylvania (1), South Dakota (1), Tennessee (1), Wisconsin (2). Onset dates ranged from November 4, 2024, to November 30, 2024. Ages ranged from 4 to 90 years, with a median age of 24. Outcome information was available for 74 cases, of which 36 (49%) were hospitalized. There were 7 reported cases of HUS, and 1 death attributed to the outbreak. All cases were linked by whole genome sequencing (WGS) to each other.^[3] See NCBI WGS to Marler Clark Outbreak cases.

According to documents reviewed, 7 subclusters of illnesses were identified across the multistate outbreak. These included 3 MO catered events, an OH secondary school, an IN restaurant, an IL restaurant, and an IL event catered by a different MO-based caterer. Salads were the common link across all 7 subclusters, and cases in all subclusters ate a romaine lettuce blend. At the time, based on information available at the points of service (POS), the traceback focused on romaine lettuce.

The CDC and FDA investigation consisted of three traceback legs representing twenty-eight cases and five POS. The three traceback legs identified four distribution centers, one broker, two processors, one grower, and one ranch – all names redacted in the documents. The traceback investigation determined that a sole processer sourced romaine lettuce from a single grower that would have been available at all points of service during the timeframe of interest. Additionally, romaine lettuce supplied to four of the five POS were traced back to the common ranch and lot. Through analysis of records, four lots of romaine lettuce were implicated, resulting in confirmation of romaine lettuce as the outbreak vehicle. Epidemiologic and traceback data supported the conclusion that romaine lettuce was the source of illnesses in the outbreak. The CDC and FDA closed the investigation on January 15, 2025, with the confirmed vehicle being romaine lettuce, without alerting the public who was the source of the outbreak. See, CDC Report and FDA Report.

William “Bill” Marler has been a food safety lawyer and advocate since the 1993 Jack-in-the-Box E. coli O157:H7 Outbreak which was chronicled in the book “Poisoned” and in the recent Emmy Award winning Netflix documentary by the same name. Bill’s work has been profiled in the New Yorker, “A Bug in the System;” the Seattle Times, “30 years after the deadly E. coli outbreak, A Seattle attorney still fights for food safety;” the Washington Post, “He helped make burgers safer, Now he is fighting food poisoning again;” and several others. 

Dozens of times a year Bill speaks to industry and government throughout the United States, Canada, Europe, Africa, China, and Australia on why it is important to prevent foodborne illnesses.  He is a frequent commentator on food litigation and food safety on Marler Blog. Bill is also the publisher of Food Safety News.

^[1] One oddity is that it is rare if a local, state of federal health official once they collect all the information and culture of the ill person to reach back to them to inform them that they are in fact a part of a recognized outbreak.  Many of the ill or there family either never learn the cause of the infection or simply stumble on to it via the news or social media.

^[2] According to the St. Louis Health Department, there were a total of 115 cases, including 13 hospitalizations with two with HUS.

^[3] “What is whole genome sequencing (WGS) and why is it pivotal in foodborne illness investigations?”

Republished with permission from Bill Marler and Marler Clark. Copyright (c) Marler Clark LLP, PS. All rights reserved.