WASHINGTON(AP)
It was a hot lead for detectives on a cold case. People suddenly
were getting salmonella at a Minnesota restaurant more than 1,000
miles from the center of the nation's outbreak.
Not my tomatoes, protested the manager. He'd switched his
supply to government-cleared fresh tomatoes and even canned ones.
But a lot of his menu items had a raw jalapeno garnish sprinkled on
top, and that turned out to be a critical clue in the two-month
salmonella mystery.
On July 3, Minnesota e-mailed the feds. After tracing credit
card receipts _ to find what the restaurant's healthy customers
didn't eat _ there was good evidence that the jalapenos were
sickening people. And, officials had a diagram tracing the pepper
shipments all the way back to three farms in Mexico.
One of those farms shipped peppers through the same large
warehouse in McAllen, Texas, where Food and Drug Administration
inspectors weeks later would find a single contaminated
Mexican-grown pepper being packed by a neighboring vendor.
How could Minnesota pinpoint hot peppers just days after
discovering a cluster of sick residents, when federal investigators
had spent weeks fruitlessly chasing tomatoes?
To be fair, "there was already some doubt about tomatoes
causing this whole outbreak," cautioned Kirk Smith, foodborne
disease chief at the Minnesota Department of Health.
And federal investigators say Minnesota's information came
just as they were getting hints from two Texas restaurant clusters
that jalapenos might play a role.
"Ours was the first that pointed specifically to jalapenos
as an ingredient, not just the salsa," Smith said.
It's too soon to know if the Centers for Disease Control and
Prevention improperly blamed tomatoes in early June, based on
reports from the first people to fall ill in New Mexico and
Texas.
"I don't think we can find fault yet," said
University of Georgia food-safety expert Michael Doyle. "With
tomatoes, if you looked at the initial case-control studies, they
really came up high on the list."
The CDC didn't comment Wednesday, but FDA food safety chief
Dr. David Acheson told The Associated Press that every part of the
system should be scrutinized to see if it can be improved.
Regardless, the way Minnesota unraveled its own cases _ speedily
comparing the sick and the well and then racing to track food
suppliers _ offers lessons for a public health system grappling
with how to handle increasingly complex outbreaks from tainted
produce.
"We have got to put the appropriate perspective on this
outbreak as to what went right and what went wrong so the kind of
changes that are going to further foodborne disease (prevention)
can be made," said Michael Osterholm, a University of
Minnesota infectious disease specialist and frequent adviser to the
government.
He fears the salmonella mystery may be the "swine flu of
foodborne disease," and make federal health officials more
reluctant to issue consumer warnings in future outbreaks unless
they've found the smoking gun, an actual tainted food.
"That would be the worst legacy of this entire
situation," Osterholm said.
Reports of salmonella Saintpaul, the rare strain sickening
hundreds elsewhere in the country, began dribbling in to
Minnesota's state health department on Monday June 23.
Minnesota's system is different from those of many states:
Rather than county health departments initially checking outbreaks
and reporting to headquarters, Smith's state office handles
investigations from the beginning. By Thursday, with six cases
reported, he had epidemiologists interviewing the sick: What did
you eat in the few days before getting ill? Where?
By Sunday, two people had mentioned the same Twin Cities-area
restaurant. Smith ordered that other patients be directly asked
about that site. Monday morning, four more people fingered it _ and
by lunchtime, epidemiologist Erin Hedican was on the scene.
She quickly found seven more ill: employees who ate their own
meals at the restaurant and started getting sick after the first
customers had. Good to know: That meant the workers weren't the
source.
With the manager, Hedican combed ingredients. Any new items
added lately? New suppliers? She requested invoices from shipments
just before June 14, the first known meal date of one of the sick,
and started the hard push to get credit card receipts so she could
learn what people who didn't fall ill had eaten.
By Tuesday morning, a garnish made of diced jalapenos and red
peppers was topping a list of possible suspects.
"This is not like a sprig of parsley on the edge of your
plate. This was sprinkled directly on almost every entree,"
Smith said.
Still, "a lot of people didn't notice the
jalapenos," Smith said, while they were quick to mention
tomatoes.
"Recall, that's what makes it tricky. That's why I
wonder about all those initial cases" in other states, he
added.
By Wednesday night, Smith's team had interviewed 13 sick
people and 28 others who had eaten at the restaurant on the same
days but stayed well. The sick were 46 times as likely to have
eaten the garnish. The next morning, he alerted CDC and FDA.
Meanwhile, Ben Miller of the Minnesota Department of
Agriculture, which regulates food suppliers, was pursuing those
invoices. Miller knows traceback: He is credited with following
contaminated lettuce blamed for a 2006 E. coli outbreak back to two
suspect farms in California, before FDA singled out the
culprit.
This time around, Miller knew his colleagues down the hall were
suspicious of that garnish. He doubted a red pepper connection;
they're used in far more restaurants than jalapenos.
The Twin Cities supplier that delivered to the restaurant led
him to a larger distributor, also local. Miller whittled down
shipment dates to between June 5 and 9. That distributor had bought
from two sources: a shipper in California and another in McAllen,
Texas, who in turn got the peppers from three farms in Mexico.
Miller later ruled out one farm by further narrowing shipping
dates; now he's waiting to hear from FDA if his Texas link
panned out.
"A few phone calls and you can work it fairly quickly back
to the grower," Miller said.
Federal officials had lots of questions for Minnesota as they
matched that data with the clusters in Texas, the outbreak's
center.
The Minnesota data "helped us begin to narrow this
down," Acheson said, although he wouldn't call it the key
cluster.
But Smith's team wasn't done: By July 8, it had a big
enough group _ 19 sick and 78 healthy customers _ to do a
statistical comparison of multiple ingredients. The sick were 100
times as likely to have eaten a jalapeno as the well.
The next day, July 9, the CDC issued its first consumer
precaution, that people at high risk of salmonella should avoid
fresh jalapenos.
___
Associated Press Writer Ricardo Alonso-Zaldivar contributed to
this report.
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