Category: Infectious Diseases

Investigating Food Outbreaks

Every year, Minnesota experiences more than 40 foodborne disease outbreaks. The summer months see scores of Salmonella cases or E. coli poisoning, while winter brings norovirus infections by the droves.

SPH student, and Team D member, Tess Peterson (left) with Team D director Carlota Medus (MPH '99, PhD '06).
SPH student, and Team D member, Tess Peterson (left) with Team D director Carlota Medus (MPH ’99, PhD ’06).

The Minnesota Department of Health (MDH) is continuously collecting information on potential foodborne illness outbreaks via routine surveillance, or when a patient, provider, or institution reports a suspected outbreak.

Investigating the source of those outbreaks takes hundreds of hours, many of which are conducted by Team D (“D” for diarrhea), a group in MDH’s Foodborne Diseases Unit made up in large part by School of Public Health students. Team D students are hired to investigate, document, and track outbreaks of foodborne diseases in the state. The program was founded by SPH professor and foodborne disease expert Craig Hedberg in 1996 and has continued to evolve under the direction of Carlota Medus MPH ’99, PhD ’05, and Kirk Smith for the past 21 years.

Identifying an Outbreak

“This is the true epidemiology experience,” says Medus, supervisor of the Foodborne Diseases Unit at MDH. “As part of Team D, you learn everything to do during an outbreak at the state level, and get a complete picture of what happens when you detect an outbreak.”

Amy Saupe (MPH '16) analyzes data from a recent outbreak.
Amy Saupe (MPH ’16) analyzes data from a recent outbreak.

Currently, all of the Foodborne Disease Unit epidemiologists, including Medus, are SPH alumni, and were part of Team D as students before getting hired by MDH. 

“Team D helps with every step of the investigation,” says Medus. Initially, a Team D worker will call a patient and take a detailed epidemiological history of their food intake and possible exposures. “They’ll ask about everything that happened in the seven days before symptoms began,” says Medus.

And, Medus says, Team D members often break open a case. “Since the students are the ones on the phone with patients, they’re often the first to notice if a certain restaurant has been mentioned more than once.”

Unique Experience

Having the chance to solve the mystery of an outbreak is what attracted Krista Bryz-Gornia to Team D. The first-year epidemiology MPH student heard about the program during a student fair before she started in SPH and knew she wanted to be a part of the team.

SPH student and Team D member Luke Magnuson conducts phone interviews.
SPH student and Team D member Luke Magnuson conducts phone interviews.

“I love that we get to see an outbreak or a case from beginning to end. It’s exciting to talk to other student workers when there’s an outbreak and say, ‘Did your patient eat at this restaurant?’ ‘Did they have this symptom?’”

As a fluent Spanish speaker, Bryz-Gornia has conducted bilingual interviews and says MDH has been flexible in letting her balance work and school. Team D staff members work about 20 hours a week from 9 a.m. to 8:30 p.m., often contacting patients in the evening to get information about their illness and symptoms.

“Team D has been a perfect complement to my public health education,” Bryz-Gornia says.

In addition to MDH, the program’s alumni work across the country in such institutions as the U.S. Department of Agriculture and the CDC.

Andrew Beron, MPH ’14, was a Team D member and is now an epidemiologist for the U.S. Virgin Islands Department of Health on the island of St. Croix, where he helps perform Zika surveillance. Beron says his time at Team D was helpful in preparing him for a career in the field.

“Team D is something students at other schools of public health don’t get,” says Beron. “It helped me build so much confidence as an investigator.”

Minnesota Leads the Way

That confidence is what sets Minnesota’s SPH apart from other institutions. “By the mid-1990s it became clear that foodborne infections weren’t going away,” says Hedberg. “What we wanted to do with foodborne disease surveillance was create a student worker team that could participate in surveillance and do routine interviews with individual cases, then the students have both practical experience and the opportunity to work with data they’ve collected.”

Hedberg says other state departments of health and even the CDC have taken note of Team D’s efficiency.

“We developed the model, and others have tried to replicate it,” says Hedberg. “The partnership between the SPH and MDH is still one of the biggest draws to our school for students who want to work in epidemiology.”

Vaccines Help Prevent the Spread of Disease

School of Public Health Regents Professor Michael Osterholm

Recent measles outbreaks have reignited the vaccine debate. Infectious disease researcher Michael Osterholm says that everyone should be vaccinated. “One of the challenges we’ve had is this growing body of anti-vaccination efforts out there. We are starting to see the return of vaccine-preventable diseases and we don’t have that institutional memory anymore,” Osterholm says. “Our job is to keep everybody vaccinated as much as we can as a barrier against any virus being introduced into the community and spreading.”

Osterholm also emphasizes the importance of a more effective flu vaccine. “If one looks back at all of human history, influenza has surely been the Lion King of infectious diseases,” he says. “The challenge we have today is that we’re using a flu vaccine that utilizes largely WWII technology. What we’re looking for in a game-changing flu vaccine is one that instead of being very specific to one strain or virus, actually it captures a number of different strains.”

Osterholm says that with a flu vaccine, we could take influenza pandemics off the table. “This would have to rival anything we’ve ever done in public health, including the eradication of smallpox. That would be an amazing achievement.”

Osterholm’s latest book, “Deadliest Enemy: Our War Against Killer Germs,” is now available.

Protecting Yourself from Lyme Disease

Assistant Professor Jonathan Oliver
Assistant Professor Jonathan Oliver

Deer ticks are found across Minnesota and they carry a number of diseases, including Lyme disease. We asked tickborne researcher Jonathan Oliver how we can protect ourselves.

“There’s definitely been an increase in the number of tickborne diseases in Minnesota over the last 20 or more years,” says Oliver. He credits the increase to the spread of deer ticks.

Oliver says about 30 percent of adult ticks carry the bacteria for Lyme disease, which is transmitted from deer ticks to humans after the tick bites and has a number of symptoms including fever and fatigue and, if left untreated, can spread to the joints, the heart, or the nervous system. “This is by far the most significant tickborne disease in the country and in Minnesota,” he says.

“To protect yourself from tickborne diseases, check regularly after you’ve been in tick habitats, mainly forested areas,” says Oliver. If you find you have a tick attached, Oliver says you should use a pair of tweezers to pull the tick off of the skin.

“It takes at least 24 hours for the Lyme disease bacteria to be transmitted into your body,” Oliver says. So as long as you’re checking regularly and you’re sure the tick has been attached for less than 24 hours, he says you have a low chance of being infected with Lyme disease.

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