Meet CORE, FDA’s team of food safety sleuths
With a globalizing food supply, brought to us by increasingly complex supply chains, foodborne illness outbreaks are notoriously tough to solve. These outbreaks often involve multiple states, dozens of illnesses, which are chronically underreported, they include patients who can’t remember what they ate for lunch last week, and, while they are often narrowed down to a list of possible culprits, nine times out of ten we will never know what food product was to blame.
The outbreaks we hear about – and that Food Safety News reports on – are usually the ones that were solved, meaning federal, state, and local health officials were able to put all the evidence together, pinpoint a food source, and alert the public with an outbreak announcement from the Centers for Disease Control and Prevention or maybe even a recall from the U.S. Food and Drug Administration. But an extraordinary amount of work goes into trying to crack these cases, whether the public hears about them or not.
That’s where FDA’s elite team of investigators comes in. This cohort – formally known as the Coordinated Outbreak Response and Evaluation Network – has been working tirelessly on foodborne illness outbreaks since the initiative launched two years ago this month.
Designed for more rapid response, CORE brings together epidemiologists, microbiologists, veterinarians, and other experts, under the same roof at FDA, so they can work together more efficiently and focus solely on outbreaks.
In interviews, CORE staff often used terms like “more efficient,” “better structured,” “more effective,” “faster, and “better organized,” to describe the shift to a consolidated team. But one of the biggest changes, according to FDA officials, is that CORE puts a fresh focus on learning from each incident and applying those lessons toward more preventive policies and practices.
Before CORE, FDA only had seven or eight people to do outbreak response within the Center for Food Safety and Applied Nutrition, according to microbiologist Elisa Eliot, a 24-year veteran of FDA who now works at CORE.
“We didn’t have people out there really evaluating information, looking for outbreaks, and working proactively working with CDC. Sometimes we’d get together in a work group, but it wasn’t an ongoing, continuing, day-to-day activity,” recalls Eliot. “We didn’t have the people power to look back and do al lot of the ‘lessons learned’ and come up with preventive, better practices. We were more in the response mode all the time.”
CORE, which now has a staff of more than 30 (including contractors), is divided into three parts to help ensure prevention is not lost in the shuffle: Signals and Surveillance, which works closely with CDC to identify any emerging outbreaks that might be linked to an FDA-regulated product, Response, which is comprised of separate teams that coordinate the response efforts on multiple foodborne illness outbreaks, and Post-Response, a team that is dedicated solely to gleaning what is learned from each outbreak and applying it.
Tip of the iceberg
In the past two years, CORE has been repeatedly tested with an onslaught of foodborne illness outbreaks, only a fraction of which ever made headlines.
“It’s seasonal for us, as outbreaks tend to be,” said Ashley Grant, an epidemiologist for the Signals team. “Right now we are in the peak of our season so we probably have about eight to ten on our plate at any given time in summer and spring months. As we get into the fall and winter, we probably have about five a week.”
Between August 2011 and the end of 2012, for example, the CORE Signals team evaluated 211 incidents, 63 of which were transferred to a response team. During that time frame, however, only 12 outbreaks were announced on the FDA website.
Of all the incidents CORE Signals tracked in that time, 144 were not referred to a response team. According to FDA, in 22 of those cases the vehicle turned out to not be an FDA-regulated product (remember meat, poultry, and processed eggs all fall under the jurisdiction of the U.S. Department of Agriculture). The agency said that in another 34 cases, “FDA response activities had already been initiated and completed,” which means the case might be handled outside of CORE by the enforcement branch or at the state-level. In the remaining 88 cases, the vehicle was not identified.
Staying on top of this is a lot of work, any way you look at it. CORE staff are known to work long hours and weekends when they’re assigned to an outbreak that’s particularly tricky – think Salmonella tuna scrape or pomegranate seeds recently blamed for a Hepatitis A outbreak. (links)
The slow-moving nature of foodborne illness reporting, which suffers from lag times, underreporting, and diminishing public health resources at the state and local level, adds another layer to an already complicated puzzle.
“Sometimes, the outbreak has concluded by the time we’re actually getting to the point where we have an idea of what the vehicle might have been,” said Jennifer Beal, an epidemiologist for the Signals team. “In that case, there’s nothing left for the response team to do.”
“Other times, the vehicle is never identified and that probably constitutes the bulk of the cases we don’t transfer,” added Beal. “But for any one of these things, we put in the same amount of effort to try to make that determination.”
For the bulk of incidents that are monitored, but not referred to a response team for further action, the team still pours “a lot of time and energy” into trying to figure out what the cause might have been. They save that information in case a similar situation arises so they might benefit from their previous legwork the next time around.
According to Gary Weber, a supervisory interdisciplinary specialist in animal science for CORE, each and every incident is “pushed as far as this team can take them to find out the linkages.”
“They don’t give up easily, that’s for sure,” said Weber.
When meeting with CORE investigators, the passion they have for their work and public health is evident – and so is their frustration over the outbreaks that could not be explained, despite lengthy investigations.
For Roberta Hammond, a supervisory interdisciplinary scientist for CORE, the heart break comes from multiple ingredient outbreaks. Oftentimes, investigators can narrow the source to a salad mix or a restaurant chain, but they aren’t able to take it one step further, to figuring out which ingredient.
Even when they do figure out the vehicle in time, comingling, and lot mixing, especially for produce, can complicate things.
“Something with a short shelf life is more challenging because there may not be product to sample, or if you do manage to trace it back to the firm or farm of field, it’s not there,” said Pamela LeBlanc, a leader of one of the CORE response teams.
Stelios Viazis, a microbiologist for one of CORE’s response teams, agrees: “That’s the most frustrating.”
These frustrations are likely to grow as Americans increase their appetite for fresh foods from a variety of sources, both domestic and foreign, year round.
Food Safety News