Forty years worth of outbreak statistics can be summed up in a twisted version of the infamous Powerball slogan, but the researchers at the Centers for Disease Control and Prevention didn’t come right out and say “if you don’t look, you can’t see outbreaks.”

The bottom line from the CDC’s report “Foodborne (1973–2013) and Waterborne (1971–2013) Disease Outbreaks — United States” is illustrated by the tall tale of Texas outbreaks. Doug Powell, publisher of barfblog.com, brought this to my attention in his post about the CDC’s data, which includes a map of the U.S. showing how many outbreaks each state had in 2013 and corresponding per capita rates.

The report on the “most recent data available” shows Texas with a low rate for outbreaks in 2013, as it has shown in previous years.

“To avoid foodborne illness, move to Texas. That hasn’t changed since 1973,” Powell quipped. Dramatic pause for emphasis here. “All it means is, cowboys and girls don’t look too hard. It’s just a little barfing  —  get over it.”

May I add, even cowgirls get the trots.

All kidding aside, Doug’s observation about the efforts, or lack thereof, of the guys and gals in Texas — and other states, too, based on the color coded map from CDC — is supported by the authors of the outbreak report.

“Reporting practices for foodborne and waterborne disease outbreaks vary among states and territories, which might have differing definitions or interpretations of which events are reportable and unique laws related to disease outbreak reporting,” according to the Interpreting Data section of the report.

“Thus, variations in reporting rates by state or territory might reflect variations in levels of effort and funding for foodborne and waterborne disease outbreak investigation, rather than true differences in outbreak incidence rates by state.”

Really? Seriously? Oh you wacky scientific types and your desire to compare apples to apples and your goofy government buddies who want to predict orange trends by using orange data.

Don’t you know E. coli acts differently in a person’s gut in California than it does when that person’s in Connecticut? It’s as clear as state’s rights, right?

You might want to wipe the sarcasm off your screen now before the goop dries into a permanent smear. But before you do, consider this. In addition to having varying laws defining outbreaks and responses, states are on the honor system when it comes to reporting crucial public health data to the federal government.

“As for all notifiable conditions, reporting to CDC is voluntary, and state and local laws, regulations, and practices vary,” the researchers reported.

“For example, CDC advises states to report outbreaks having cases occurring in the same household; however, state, local, or territorial jurisdictions might determine that these outbreaks do not require investigation or might deem them non-reportable at the state or territorial level.”

That’s right, first individual states get to decide how to look for — or not look for —outbreaks. Then, in their infinite regional wisdom, they get to write their own definitions of what constitutes an outbreak. Finally, after they have or have not looked for, and found or not found an outbreak, it’s up to states whether they report or don’t report the public health data to the feds.

So, at the risk of providing information that nay sayers may say is incomplete, and scientists have already said represents “only a small fraction” of actual outbreaks and illnesses, here are the highlights from 1973-2013.

• 

  Rate* of reported foodborne disease outbreaks and number† of outbreaks, by state for 2013 as reported by the CDC. (*Incidence of outbreaks per 1 million population based on the 2012 U.S census estimates. Cutpoints for outbreak rate categories determined by using quartiles.
  †N = 818 and includes 26 multistate outbreaks assigned as an outbreak to each state involved.)

  From 1973-2013, CDC received reports of 30,251 foodborne disease outbreaks with 742,945 outbreak-associated illnesses from the 50 states, Puerto Rico, the District of Columbia, and freely associated states/territories.

• An average of 738, with a range of 298 to 1,404, outbreaks were reported each year.
• The average annual number of foodborne disease outbreaks reported to CDC increased in 1998 in comparison to previous years, coinciding with the transition to an electronic reporting system, and decreased in 2009 in comparison to 1998–2008 coinciding with the transition to reporting through NORS.
• In 2013, the most recent year with complete statistics available, a total of 792 single-state exposure outbreaks were reported with 11,786 illnesses by 47 states and Puerto Rico.
• An additional 26 multi-state outbreaks with 1,530 associated illnesses also were reported.

Why anyone needs to know
Sometimes the numbers take so deep into the weeds you begin wondering how you’ll find your way back to reality. The CDC report authors anticipated that trip and provided a bit of a map to Relevance City.

“… information gathered from foodborne disease outbreak surveillance activities provides valuable insights into the agents that cause foodborne illness, types of implicated foods and ingredients, and settings in which transmission occurs,” according to the report.

The report authors also said surveillance of foodborne disease outbreaks:

• provides insight into the effectiveness of regulations and control measures;
• helps identify new and emerging pathogens;
• provides information regarding the food preparation and consumption settings in which outbreaks occur;
• informs prevention and control measures in the food industry by identifying points of contamination; and
• can be used to describe trends in outbreaks over time.

Knowledge is power. Not a bad use of my tax dollars, IMHO.

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