indicated that these samples were highly
related to the clinical cases. The four
samples were collected from a bread
rack dolly, a swinging door, and two different floor mats. It was recommended
that Establishment D hire a consultant,
replace the old floor mats, and clean
and sanitize the entire facility. They
were forbidden from serving ready-to-eat foods until cleaning and sanitizing
was completed and repeat environmental sampling indicated L. monocytogenes
was no longer present in the facility.
The use of WGS and collaborative
environmental sampling by different
agencies to solve L. monocytogenes outbreaks is a proven success story. Epidemiology, environmental health, or laboratory services individually cannot solve
an outbreak. The three-legged stool approach combining epidemiological information collected from patients, environmental health information collected
from establishments, and WGS results
from the laboratory allow us to detect
more clusters of illness, link more cases
to a likely source, identify unrecognized
sources of illness, and stop outbreaks
before they escalate in size and severity.
These three foodborne illness outbreak investigations exemplify the dedicated professionals working throughout
the United States. Their efforts result in
reducing the number of potential illnesses and finding root causes that can
assist in prevention of similar illnesses
in the future. While typically behind
the scenes, professionals managing the
outbreaks at state and local health departments are often the unsung heroes
of public health. n
Disclaimer: Development of the TNDOH
section was provided by funding through
CDC’s EHS-Net Food grant.
Randy J. Treadwell, M.P.H., is program manager,
rapid response & emergency management at the
Washington State Department of Agriculture. D. J.
Irving, M.P.H., REHS, is an environmental health specialist at the Tennessee Department of Health. David
C. Nicholas, M.P.H., is chief epidemiologist at the New
York State Department of Health. Steven Mandernach, J.D., is the executive director of the Association of Food &
Drug Officials and a member of the Editorial Advisory Board of Food Safety Magazine.
1. Park, GW, et al. 2015. Appl Environ Microbiol 81( 17):5987–5992.
2. Barton Behravesh, C, et al. 2011. J Infect Dis 204:263–267
4. Heymann, DL. Control of Communicable Disease Manual, 20th ed. (American Public Health Association, 2015).
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