By Dan Flynn | Jan 24, 2012
In a crisis communication training exercise a few years ago, the federal Centers for Disease Control and Prevention (CDC) made "table top" emergency decisions about what to do if the agency became involved in such high-risk situations as the Virginia Tech shooting, a flu vaccine shortage, an Adenovirus outbreak, and an erroneous announcement that happened to involve Taco Bell.
In that crisis communication exercise, CDC's challenge was what to do when one newspaper and one radio news station reported that Taco Bell restaurants had been ordered to close, when in fact they'd only been ordered to remove and dispose of food items from locations in one state. CDC called for participants to take actions that would allay public concerns, mitigate risks of the outbreak, and provide timely and accurate information to the public.
Four years later, the Atlanta-based agency is apparently still leery about naming Taco Bell or any other "Mexican style" restaurant chain in connection with a 10-state Salmonella Enteritidis outbreak that left 68 people infected last October and November.
The outbreak primarily centered on Texas and Oklahoma, where 59 of the confirmed Salmonella cases that surfaced in a matter of weeks went unreported at the time. No public health warnings were issued, and investigators from the CDC were unable to pinpoint the source of the Salmonella contamination.
CDC's final report on the mystery outbreak only named "Restaurant Chain A" as the source. When it did that in August 2010 for multistate outbreaks of Salmonella Hartford and Salmonella Baildon, it later acknowledged those outbreaks involved Taco Bell.
This time, however, CDC has done a better job of circling the wagons. "We are not providing restaurant names," Texas Department of Health spokesman Carrie Williams told Food Safety News. The Lone Star State recorded 43 confirmed cases of Salmonella Enteritidis in this latest outbreak.
Food Safety News also invited someone from the 5,800-unit Taco Bell chain to comment directly, but did not get any response to inquiries. Then, reporters followed up with other states with reported illnesses.
In Oklahoma, Food Safety News asked for a copy of the state's report; Oklahomans accounted for 16 Salmonella illnesses. In the rest of the states identified by the CDC as reporting outbreak victims--all with only one case each, except for Kansas, which had two--we first had to find someone who'd heard of the outbreak.
A Kansas epidemiologist transferred Food Safety News to someone in infectious diseases. Our reporter was then transferred back to epidemiology. The call rang through and later went to voice mail.
Iowa did not want to release any information. Michigan did not know anything. Missouri passed our messages along to someone they said might know something.
Nebraska said it was not the health department's place to release the name of "Restaurant A" since the agency was involved only "peripherally" and the main investigators from the CDC are not releasing it.
We learned the state of New Mexico's only case was someone who'd been traveling, as the state does not have a "Restaurant A." Would he tell us the name of a restaurant not even doing business in New Mexico? No.
But New Mexico provided a possible clue. It pointed us away from Taco Bell, which has many outlets in New Mexico, to other Mexican-style or Tex-Mex style restaurants, and maybe not just fast food restaurants, but ones with table service.
Moving on, we talked to many people at Ohio Health. None had heard of the Salmonella outbreak. We left a voice message with the state epidemiologist.
Our experience with Tennessee was the same, so we left a message with the state epidemiologist.
The U.S. Food and Drug Administration (FDA) did not have anything to contribute and CDC has been silent since issuing the report on Jan. 19.
The surprise is not so much that public health officials do not want to name the restaurant chain involved, but that no one wants to talk about the outbreak at all.
Roy Costa, who owns Deland, Florida-based Environ Health Associates Inc., says it's "a tough one" and there are "many different takes on this." Costa says he does not think CDC has an opinion they've shared with health departments on "how to handle each and every case."
He also thinks different pathogens dictate differing public information strategies. "Clearly, with Hepatitis A, because of the treatment available and long incubation and relatively severe effect, most HD's will go public," Costa says. They may not, though, when they are too far into the incubation period or think that the transmission potential is low.
Costa, who is a frequent contributor to Food Safety News, says once investigators have an environmental test or other clinical evidence, "they are more inclined to stretch." Sick employees, however, also always mean naming businesses involved in an outbreak.
Salmonella Enteritidis is so common that it can be difficult for states with even the best surveillance to sort it out. Costa says 59 cases of Salmonella Enteritidis just might not stand out--especially if they're scattered across the state. A cluster at one or two restaurants would stand, he says.
Bill Marler, the food safety attorney who publishes Food Safety News, sees it a bit differently. "My thought is that consumers have a right to know who sickened them specifically and the general public has the same right to have information to make choices where they spend their money," he wrote on his personal Blog on Monday.
As we search for more information about this outbreak, we will do our best to follow the CDC's own advice and provide timely and accurate information for the public.