Editorial Commentary: The Detection of and Response to a Foodborne Disease Outbreak: A Cautionary Tale.

Fernandes et al [1] provide convincing evidence that an outbreak of Campylobacter (species not provided) infection occurred in the population of a small island in England in late September and early October 2011. The investigators conclude that a combination of descriptive epidemiology, genomic epidemiology, and environmental investigation identified the likely source of the outbreak: milk pasteurized using a malfunctioning milk pasteurizer. They are to be congratulated for their effort to identify the source of the outbreak, take necessary corrective action to ensure it does not happen again, and share their investigative findings with the scientific and public health communities. However, I believe that there is a cautionary tale to be told with this investigation and report— namely, that modern laboratory science can enhance foodborne disease surveillance and outbreak detection, but overreliance on it to solve many foodborne disease outbreaks poses a real shortcoming in our evolving public health practice. Almost 40 years ago, I had the good fortune to be appointed the director of infectious disease epidemiology activity at the Minnesota Department of Health. At that time, foodborne disease outbreaks that we investigated often related to situations where, for example, grandma’s potato salad was left in the hot sun for hours at the church picnic and the subsequent Staphylococcus intoxication cases were readily apparent among the picnic attendees. The primary epidemiologic tools that we had in our foodborne disease investigation tool kit were a simple casecontrol study methodology with simple 2-by-2 statistical analysis tables and nomemory calculators. Our laboratory support might include serotyping of Salmonella and Shigella strains and the use of animal challenge studies to determine the presence or absence of enterotoxins. There was no molecular characterization of the involved pathogens; no laboratory test methods for routine testing of Campylobacter, norovirus, or hepatitis A virus; and no multivariate analysis run on a computer. Despite our crude tools, at least by today’s standards of epidemiology, we solved some very complicated and challenging foodborne outbreaks. Over the course of the next 40 years, the Minnesota Department of Health made foodborne disease surveillance and outbreak investigation a priority. We pioneered a number of the epidemiologic methods used today to investigate foodborne disease, particularly those involving outbreaks related to mass-produced foods with low-level contamination and which are disseminated around the world. These pose among the greatest public health challenges for detection and intervention. We also pioneered the early use of laboratory-based molecular characterization of pathogens such as Escherichia coli O157:H7 and Salmonella species to assist in both detecting and defining outbreaks [2–5]. In the mid-1990s we formed Team Diarrhea, a now well-known group of public health graduate students devoted to the rapid and comprehensive interview and investigation of cases of likely foodborne disease reported through our statewide active disease surveillance system. Over these past 40 years, the Minnesota Department of Health has led many foodborne disease outbreaks of international importance and published widely on this work in the leading medical journals. The purpose of the brief history of the Minnesota Department of Health activities is to serve as a foundation for my Received 21 May 2015; accepted 22 May 2015; electronically published 10 June 2015. Correspondence: Michael T. Osterholm, PhD, MPH, CIDRAP, University of Minnesota, 420 Delaware St SE, MMC 263, Rm C-315, Minneapolis, MN 55455 ([email protected]). Clinical Infectious Diseases 2015;61(6):910–1 © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. [email protected]. DOI: 10.1093/cid/civ434