Doctors play role in tracking outbreak

The nation's recent E. coli experience shows how physicians fit into the public health continuum.

By Kathleen Phalen Tomaselli, AMNews correspondent. Oct. 23/30, 2006.

Last month, disease detectives pursued a DNA fingerprint across 26 states, searching for clues to the source of an unusually widespread outbreak of Escherichia coli 0157:H7. An early match to a bag of fresh spinach in Colorado helped state and federal epidemiologists trace the culprit back to a California grower on Sept. 29 -- 15 days after the Food and Drug Administration advised consumers not to eat the leafy vegetable.

"This is not the first time molecular fingerprinting has helped track outbreaks," said Mel Kohn, MD, MPH, Oregon's state epidemiologist. "For us, an astute epidemiologist picked up a trend and zeroed in on spinach. When we presented our five initial cases to the Centers for Disease Control and Prevention, it matched information from other states."

The current outbreak, associated with 192 reported cases, including 30 cases of hemolytic uremic syndrome, 98 hospitalizations and two deaths, is not the first. There has been a long history of E. coli outbreaks involving leafy greens from the central California region.

"This is the 20th outbreak since 1995," said Douglas Powell, PhD, associate professor and scientific director of the Food Safety Network at Kansas State University in Manhattan. "For example, in 1996 there was the Odwalla apple juice E. coli outbreak. In 2005 there was a national recall of Dole bagged lettuce."

While parallel laboratory and epidemiological investigations are crucial in identifying the source of such outbreaks, the hunt begins with the patient and physician. Without physician involvement, early patterns and clusters may go unnoticed, giving the bacteria time to spread. "Physician reporting is at the basis of tracking these down," said Dr. Kohn. "It's a very important function."