STEMMING OUTBREAKS HARD WORK

At a celebration a few years ago, people were having a good time until one or two got sick, complaining of nausea, abdominal pain, fever and diarrhea.

Within two days, about 60 people were reporting those symptoms.

The illness was salmonella, traced back to food served at the party.

"We had many, many people who were ill at the same time," said Vicky McDowell, communicable disease coordinator for the Cape Girardeau County Public Health Center. "It took us weeks and weeks to find it, and the state people came in to help."

For sanitarians and communicable disease specialists, pinpointing the source of the outbreak meant talking to everyone who got sick and finding out what they had eaten and where, who they had talked to, where they had been and what they had done in the three or four days before they became ill.

During an investigation, health workers also find out who else was present in the home when symptoms appeared, if animals are in the home, what water and sewer services patients have and whether anyone in the home who may have been exposed works with food, in health care or with children.

In communities like Cape Girardeau where people may eat out for all three meals in a day, that can mean a lot of legwork, said Diane Gregory, an environmental sanitarian for Cape County.

"We can end up with eight or nine or more places that we need to check," she said. "That makes it very difficult, because people assume it was the meal they just ate that made them sick, and it may have been, but it may have been something they ate five days ago."

It's detective work, Gregory said, "and we're working with microscopic evidence."

Most of the time, the real culprit is "carelessness," she said. Food wasn't kept hot or cold enough to prevent bacteria, hands weren't washed, the same utensils were used for cooked and raw foods.

Ironically, the fact that so many people were affected by the salmonella outbreak made health workers' jobs much easier.

"So many times, it's just an isolated case and we don't determine where it came from," McDowell said. "If there are several people reporting symptoms, we can usually zero it down to a common factor."

Her office averages 10 to 15 investigations a month.

Speed is important, Gregory said.

"We want to try to get as much information as we can as quickly as we can," she said. "We want to find out what chain of events led up to that person becoming ill."

It's important to move fast, because most food-borne illnesses run their course quickly, and the sources of those illnesses -- the food itself -- is usally disposed of quickly, Gregory said.

In the meantime, health workers are waiting for lab results, which can take a few days to a week.

Not all communicable diseases are caused by contaminated food. Influenza, tuberculosis, encephalitis, meningitis and other diseases are also tracked by a similar process.

McDowell estimates Cape County public health workers might see two active cases of tuberculosis a year.

Many more people have positive skin tests for TB, but that only means they've been exposed to the disease, not that they have symptoms or can transmit it. People who test positive for exposure to TB are given antibiotics to make sure they don't develop the disease.

There are other public health nightmares.

"The worst call I've ever had was meningitis on a college campus," McDowell said. "It's swift and it's deadly and there are usually young people involved that may not be accessible because they've gone home to wherever they live."

Cape County, and other rural communities, aren't at great risk for outbreaks of more exotic infectious diseases because there is so little traffic from places likely to harbor those exotic germs, she said.

But because food is such a common source, the food profile is the first step in all communicable disease investigations.

Salmonella, shigella, campylobacter and giardia, all of which county health workers deal with on a regular basis, are oral-fecal infections, most transmitted through food or water.

Good hygiene stops most infections "in their tracks," McDowell said.

"I can't stress enough the importance of good hand-washing," she said.

Touching contaminated food or food products leaves germs, and those germs are spread to whatever dirty hands touch next.

Cross contamination, as it's called, also works with food utensils that aren't properly cleaned and sterilized.

McDowell and Gregory both stressed that restaurants aren't always the culprits in cases of food-borne illnesses.

Poor sanitary practices at home or in convenience stores or grocery stores serving prepared foods cause just as much sickness.

And incidentally, the fly that lands on your food could have as many as 5 million germs on its body, some of which will wind up on your lunch.

But because restaurants serve such large numbers of people and employee turnover is high, it's important to make sure food is being cooked, handled and stored properly.

And the cleanest restaurant in the world is no defense against sloppy customers, especially at food bars, said Jonell McNeely, Cape County's sanitarian supervisor.

People switch serving utensils, take dirty plates -- which may carry trace contaminants -- back for second helpings, or sneak samples with dirty hands.

"You have to be an informed consumer and try to avoid the things that can cause the most problems," McNeely said, such as foods prepared ahead of time which may not have been properly stored.

The county offers "food schools" in which restaurant workers learn how to handle food and clean up properly.