Minnesota is widely considered the nation’s leader in outbreak investigations. The state’s Department of Health has earned the admiration of epidemiologists around the nation with its rapid and accurate identification of and response to foodborne illnesses.
“I would bet that Minnesota has cracked more national outbreaks than any other state, simply because they’re good and they’re fast,” said Dr. David Acheson.
Acheson, former chief medical officer for the U.S. Food and Drug Administration, was closely involved in the 2008 hot pepper salmonella outbreak investigation. Minnesota helped solve the outbreak that left two people dead and sickened more than 1,500 in 43 states.
State health departments generally lie somewhere between centralized and home rule systems. State investigators do it all in centralized systems: receive reports of suspected illnesses, test isolate samples and interview victims. In a home rule system, as in Texas, a county-level health department usually gets the initial report about an illness and sends that information to the state department of health.
Minnesota has among the most centralized systems and that, says Kirk Smith, the Minnesota Department of Health’s Foodborne Diseases Unit supervisor, is a big part of what makes it so effective.
“We’re able to follow up and if we need to re-interview we’re able to do that right away,” Smith said. “And so taking the counties out just kind of takes out a step and some lag time.”
Acheson says that lag time is critical to effective disease surveillance.
“The key thing that’s much more related to human intervention is the time gap between the potential exposure date and when the questionnaires [interviews] happen from the local health authority, simply because it’s really hard for folks to remember what they ate a week, two weeks, three weeks ago,” he said.
Another oft-praised component of the state’s Foodborne Disease Unit is what’s known as Team Diarrhea. This group of University of Minnesota public health graduate students helps the Department of Health process illness reports and interviews those sickened by foodborne pathogens.
Dr. Tim Jones, Tennessee’s state epidemiologist, lauds the model, saying that one team operating as a unit can more easily piece together disparate incidents of illnesses together to get a better notion of the whole picture than can a patchwork of local health departments.
“…One of the advantages to that is you can sort of instantly tell there are commonalities,” said Jones, who is looking to create Tennessee’s own version of “Team D.”