Global contagions always start off small, and like most small things, they're easy to miss. The patient in Hamburg who went to the hospital on May 18 complaining of diarrhea, cramps and vomiting and was first suspected of having an inflammatory bowel condition would likely have gone unnoticed. But when four more patients in the same city became ill over the next two days with similar symptoms, German health officials started to pay attention.
Within weeks, the country and soon the continent and the rest of the world had a disaster on its hands, battling one of the biggest outbreaks ever of deadly E. coli bacteria. The infection has spread to a dozen countries, sickened more than 2,600 people and caused 25 deaths. One American has a confirmed case of the bug, and three others in the U.S. who recently visited Hamburg may have gotten sick from it as well. Authorities know what is responsible a particularly nasty and rare version of E. coli called O104:H4 but figuring out how this pathogen made its way into the food supply is a trickier challenge. First it was Spanish cucumbers but then it wasn't. Then it was German sprouts, except it wasn't those either unless maybe it really was, some unconvinced health officials still warn, as the investigation continues. In both cases, smart epidemiological tracking pointed straight to those suspects, but DNA testing failed to nail them. Russia, which is hoping for membership in the World Trade Organization, took a characteristically extreme approach, banning imports of all European Union produce. U.S. consumers are holding their breath, knowing that an increasingly globalized food market means that E. coli in Hamburg could be just a single transatlantic shipment away from becoming E. coli in Houston or Harrisburg. And given the most recent report from the U.S. Centers for Disease Control and Prevention (CDC), that worry may be justified.
In its latest evaluation of food-borne illnesses, the agency reports that in the past 15 years, outbreaks of salmonella infection in the U.S. from contaminated foods such as eggs, meat, poultry and nuts have not declined, despite efforts to improve education about safe handling of food. And while a newly passed law gives the Food and Drug Administration expanded authority to inspect, test and hold imported foods until they are deemed safe to eat, budget cuts threaten to strip the agency of those powers before it can exercise them. President Obama requested $955 million for food-safety measures in his most recent budget, but the House Appropriations Committee slashed that request to $750 million, or $87 million below what the agency is already investing in the area. Still, while it's true that our food supply faces serious challenges, the U.S. has some advantages over the E.U. when it comes to preventing this kind of disaster.
Europe's response to the current outbreak has been so scattered mainly because there's no single authority in charge either across the continent or within Germany. The Robert Koch Institute in Berlin is the nation's federal authority for disease control, but state health officials are conducting their own tests and often release their findings directly to the public. "There is no central network to coordinate the response to an E. coli outbreak on a national level," says Flemming Scheutz, director of the World Health Organization's E. coli research center at Statens Serum Institute in Copenhagen. As an E.U. member country, Germany is obliged to report food-contamination incidents to the European Commission, which has its own disease-control center and alert system for outbreaks. Piecemeal surveillance leads to a fragmented investigative network, which, coupled with the pressure to find a culprit fast, can easily result in the kinds of unconfirmed reports that have occurred in the past few weeks.
The U.S. is hardly monolithic when it comes to dealing with food-borne contagions; 50 states means 50 state health departments that can get involved in an investigation. But the CDC links with local officials and serves as a centralized clearinghouse for information and laboratory testing. In a 2006 outbreak of a strain of E. coli that sickened nearly 200 people, it took the agency and two state health departments just six days from the first identification of clusters of illness to trace the contamination to spinach at specific processing plants.