State Surveillance of Foodborne Illness

In an effort to determine states' capacity to track produce-related cases of foodborne illness and gain a better understanding of how states conduct investigations of outbreaks,¹ the Produce Safety Project, an initiative of The Pew Charitable Trusts at Georgetown University, commissioned Safe Tables Our Priority (S.T.O.P.) to conduct a survey of state health departments.² The survey was sent to all 50 states and the District of Columbia, and 39 responded. The survey requested 2007 data on the types of questionnaires administered by state health departments to foodborne-illness victims, the time frame in which they were completed, the types of questions asked, and how states collected and stored the resulting data. These elements are key in the effective identification of the source of a foodborne illness.

Based on the survey results, state health departments:

• Are unlikely to ask about fresh produce on their initial questionnaire, even if that produce item has been associated with a past outbreak;
• Are far more likely to conduct a more thorough inquiry with an individual linked to an outbreak than with a sporadic case of foodborne illness;
• Generally use a questionnaire that combines open¬and closed¬ended questions, an approach that allows states to collect data in a systematic yet flexible fashion;
• Triage their response to cases of foodborne illness based on the severity of the disease; and
• Are unable to link different data sources to aid in investigation of foodborne illnesses.

While the survey did not ask states about the staffing or resources devoted to investigations of foodborne illness, the decisions of the responding states—to focus on large outbreaks of foodborne illness, to prioritize diseases that may cause serious illness or death over those that are gener¬ally milder, and to store some but not all of the available data they collect—appear to be driven by available resources and how they are priori¬tized and allocated to foodborne¬illness surveillance issues. Funding levels for health departments vary widely from state to state: some state agencies are well funded while others only have enough to keep modest staff but no money for training, equipment, and other physical infrastructure needed for a modern, food¬safety program.3 Issues of funding and staff may become even more acute as the economy forces more budget cuts on health depart-ments,4 which must deal with numerous other public¬health issues in addition to foodborne illness.