Effects of biological attack on US food supplies.

Abstract

In their discussion on the preparedness and response of US agencies to a terrorist attack on the country's food supply, Jeremy Sobel and colleagues (March 9, p 874)1Sobel J Khan AS Swerdlow DL Threat of biological terrorist attack on the US food supply: the CDC perspective.Lancet. 2002; 359: 874-880Summary Full Text Full Text PDF PubMed Scopus (81) Google Scholar do not mention vulnerabilities existing in the current system used for recognition and investigation of food poisoning outbreaks. While researching outbreak investigation techniques in different cities and counties in New York State, I identified several issues that might compound the investigation of an intentional or unintentional food poisoning outbreak. The investigation of an outbreak depends on its detection, and under the current system, there are difficulties associated with detection of outbreaks. Clinicians are poor reporters of food-poisoning cases, especially when patients are examined in hospital accident and emergency rooms. Merely providing clinicians with a list of Health Department officials, as Sobel and colleagues suggest, will not improve reporting rates, since various studies have shown that there are many reasons why clinicians do not report. These include unawareness of statutory obligations,2Durrheim DN Thomas J General practice awareness of notifiable infectious diseases.Public Health. 1994; 108: 273-278Summary Full Text PDF PubMed Scopus (21) Google Scholar concerns of violating doctor-patient privilege,3Hume J On reports and rapport from VD control.Am J Public Health. 1980; 70: 164-166Crossref PubMed Scopus (5) Google Scholar and a lack of understanding of the purpose of notification.4Voss S How much do doctors know about the notification of infectious diseases?.BMJ. 1992; 304: 755Crossref PubMed Scopus (35) Google Scholar Furthermore, food poisoning cases are reported to different divisions in the same health department; it is not uncommon for the communicable disease programme to receive information about confirmed cases from laboratories or medical professionals, whereas the food safety programme gathers information from the public and other agencies. There is no central database that collates this information. Consequently, even if there are epidemiological commonalities between cases they will not come to light because the information is inadequately shared between the different divisions. In fact, information sharing is an issue that also arises when local officials have to work with federal agencies during investigations. Indeed, the involvement of federal agencies during investigations is fraught with difficulties. There is substantial jurisdictional overlap between products regulated by federal agencies. For example, closed meat sandwiches are regulated by the US Food and Drug Administration, whereas open meat sandwiches are regulated by the US Department of Agriculture.5Office of Regulatory Affairs, Office of Regional Operations, Center for Food Safety and Applied NutritionCFSAN emergency response procedures. Food and Drug Administration, Washington, DC2000Google Scholar Consequently, it can be challenging for local officials to correctly identify the agency in charge. Moreover, bureaucratically run public-health organisations may abdicate responsibility when jurisdictional responsibility is unclear. Unfortunately, even when the correct agency is approached they seem to hesitate to get involved unless there is conclusive evidence to prove that the food in question was the cause of the illness. This type of evidence is unavailable in most investigations. Therefore, trace-back investigations by federal agencies to identify the source of the food may not be done because of lack of evidence. An intentionally or unintentionally contaminated food source can, therefore, continue unabated. Protocols and simulated exercises do not obviate the weaknesses inherent in the system; most of which are solvable. Detection of outbreaks and the thoroughness of investigations needs to be improved.