All over the Map: A Review of Foodborne Illness Investigation in Fifty States

Introduction: State-level public health agencies provide the raw data necessary for attribution research—but not all agencies are equal.  For this study, foodborne outbreak data from 50 states were analyzed to determine the success rate of investigations in each state. States are ranked, and results benchmarked against states with historically robust investigation results. 

Purpose: This study aims to evaluate the relative performance of state-level public health departments to investigate foodborne illness outbreaks, and provide essential information for downstream attribution research.  Identifying successful state programs can help identify best practices to advance agencies’ public health mission.  

Methods: Foodborne outbreak data submitted by states to the Centers for Disease Control and Prevention (CDC) was acquired from CDC for the years 2002-2011.  Outbreaks were sorted into two categories: (1) attributable (where both the food and pathogen were identified by epidemiologists), and (2) non-attributable (where data were missing).  Those data were sorted by state, and a comparative metric was created. 

Results: Our results identify and explore variation in state-level reporting that impact the quality of outbreak investigations and the evidence needed for food attribution.  States with successful and deficient systems are identified, based on 10 years of reporting data.  CSPI identifies best practices that might contribute to successful programs. 

Significance: This research demonstrates the importance of state-based public health reporting practices. By highlighting best performing states, we hope to identify policies that enable best practice operations for health departments.