Questions and answers about the salmonella outbreak and flu

Michael Osterholm, the former Minnesota state epidemiologist and now director of the , the University of Minnesota Center for Infectious Disease Research and Policy is on MPR’s Midday (Listen here), discussion the nationwide salmonella outbreak.

I’m live-blogging the pertinent questions and answers. He’s also talking about other issues facing health investigators. The other big health story today is the word that Tamiflu may not be effective on this year’s strain.

Osterholm says there’s actually three strains of flu that float around the world, one of which was an “escapee” from a Russian lab years ago.

Q: Why isn’t Tamiflu working?

A: The strain changed in a way that makes it resistant to the flu. The good news is (a) the change may not stay. Next year’s strain may lose the resistance, and (b) this year “we have a great match on the vaccine with the strain that’s in Minnesota.

Q: Has the possibility of a pandemic or bird flu changed?

A: We’re closer to a pandemic today than we were yesterday. When people say “if it were to happen it would’ve happened by now, H3N8 strain jumped from birds to horses in the 1960s and we have no idea why. The same strain then jumped to dogs and we’re seeing problems with dogs. We know little about influenza.

Q: Why are we just hearing about the salmonella outbreak now?

A: The first cases occurred in early October. This has been gaining a head of steam with most cases occurring in the last six weeks. This is a common strain of salmonella. We have the ability to fingerprint the organisms. It took time for the “fingerprints” to be obtained. It has increased in the number of states which tells us a lot about the product involved. It’s probably a store-shelf product.

The cases in Minnesota are more recent nature. It’s likely that the Minnesota Department of Public Health will be the one to crack it.

Q: Has something changed in the food environment?

A: Even a loaf of Sara Lee bread, the ingredients are likely from 10 different countries. It’s remarkably how safe food really is, given how much food we eat. The average person has two food-borne illnesses a year. But we have so many more processes than we had before.

Q: Is food illness more insidious?

A: Think of all the food that you don’t cook. Even the things you do cook, there are things you don’t cook adequately. Part of the problem is some contamination occurs in plants (such as deli meats) after the cooking process.

Q: When the CDC investigated the “tomato outbreak” (which turned out to be wrong), does the CDC get gunshy about publicizing an investigation?

A: You’re right, but having been at the Minnesota Department of Public Health as long as I was, Minnesota doesn’t get it wrong and they get it quickly often. When the first outbreak of Salmonella St. Paul was identified in Minnesota, they identified it quickly that it wasn’t tomatoes, it was peppers. Had the other states been half as competent as Minnesota, it could’ve been picked up much earlier.

Osterholm says he’s worried the Health Department will “take a hit” in the coming budget cuts.

Q: Is there a fear that publicizing these things too early will hurt industry?

A: Yes, but I don’t think that’s the case here. Once the number of cases grew here quickly, they (the MDH) jumped on it. I wouldn’t be surprised to see this solved in just a couple of days.

Listener questions

Q: What advice would you give to Obama?

A: Osterholm says he’s working with the Obama transition team on who to bring in. “I’m excited about the interest in solid science,” he said. As a world, we are going to have to take major cuts in programs. What I worry about is public health, which is only 1% of the budget and much of that funding is in jeopardy right now. If you cut out some basic public health programs, you’ll pay more down the road. If the pandemic flu hits tomorrow, it’ll make everything else seem like child’s play.

Q: Should people have faith in federal health agencies?

A: I was critical of the CDC in the tomato vs. peppers outbreak, but I also saw the CDC do a great job overall. Is some of it a problem? Absolutely. But it’s unfortunate that people label everything dark or light or right or wrong.

Q: What do you think of Sanjay Gupta as surgeon general?

A: He’s a friend and his knowledge is exceptional. He’d make a great surgeon general. Having known past surgeon generals, the office has been “dumbed down.” The Obama administration wants to restore that to a very strong voice to the world. There’s very few health communicators out there than Sanjay Gupta. He’s an actively practicing physician. Every Monday morning he scrubs in and does some amazing brain surgery.

Q: What is the health impact of people coming across the border from the south?

A: At Hennpin County Medical Center, they needed to have 65 interpreters to provide health care. Of 65 6.2 billion on the face of the earth, 2 billion have TB. We want to make sure we deal with the populations from their health perspective. We don’t want it to spread to others and that’s where I get people’s concern about people coming in from other countries… there’s been very limited transmission of disease to other groups. We see it within their own family. We shouldn’t use it as a wedge issue to say “they shouldn’t be here.”

Q: Why is Minnesota better than other states at finding the answers to food-borne illnesses?

A: In 1965, we had three people who worked in infectious diseases. Over the years we built the group up through outside resources — research money, grant money — and since the early ’80s, the MDPH has had an ethic of excellence where some of the top people in the country have been trained and have stayed. We have people at the U who are on call all of the time. We can do some testing in three days that takes the state of Texas 6 weeks. Our laboratory is one of the best — if not the best — in the country. There’s been a sense of excellence that has stayed and we’re lucky to live in a state that values that.

  • Paul

    Ask Mike to explain why MN is so much better at cracking these things than everyone else.

  • MR

    Paul,

    My guess is that much of it has to do with willingness to spend money and people on tracking these things down.

    If I remember right, MDH broke the pepper case because they were willing to let their people track more cases farther up the supply chain.

  • I hope that’s Bob’s typo and he said 6.5 billion people. Either innumeracy or bad demographics would be a very bad thing in a public health guy.

  • Paul

    “Paul,

    My guess is that much of it has to do with willingness to spend money and people on tracking these things down.

    “If I remember right, MDH broke the pepper case because they were willing to let their people track more cases farther up the supply chain.”

    Not exactly. First, the food bourne units money comes a variety of grants, so it’s not a matter of deciding what to spend money on, they get paid either way. The MN Department of Agriculture did the trace back, and again, they don’t decide whether or not spend the money, they get paid either way. It doesn’t cost anyone anymore to do the work than to not do it, they all get paid by the hour.

    The difference is we have excellent people doing the work, and we have resources many states don’t have such as a first class lab that can deliver results incredibly quickly, and we have team D. We also have a really good surveillance system that detects and follows up on reported illness. I’m not the expert on this, but I think there are some structural differences between states as well. I think the MDH has the authority to take over outbreak investigations, or require procedures on the local level, this gets things done, and it helps even out disparities in resources between counties and cities. I think in some states the state health dept. has to defer to the local entity, or can only get involved if invited. In that circumstance, if you have a county or city with few resources that for some reason declines to invite the state in, the investigation is going to stall there.

  • Paul

    Sorry, didn’t mean to cross post: MDH statement about the salmonella outbreak.

  • Janet

    I , for one, am tired of hearing from mike O. everytime there is a public health crisis. Isn’t there someone else MPR could interview?