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Pulsenet: a Critical Food Safety Surveillance System Association of Public Health Laboratories April 2010

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Pulsenet: a Critical Food Safety Surveillance System Association of Public Health Laboratories April 2010 ISSUES IN BRIEF PULSENET: A CRITICAL FOOD SAFETY SURVEILLANCE SYSTEM ASSOCIatION OF PUBLIC HEALTH LABORatORIES APRIL 2010 PULSENET A CRITICAL FOOD SAFETY SURVEILLANCE SYSTEM Public health laboratorians are critical to the detection and prevention of foodborne illnesses. Through a national laboratory-based foodborne disease surveillance network known as PulseNet, public health and agricultural laboratories have detected high-profile outbreaks such as those from imported produce, peanut butter and peanut butter-containing products and raw cookie dough.1-3 In 2008 alone, PulseNet laboratorians DNA fingerprinting. Established detected more than 1,500 local clusters in 1996 by the Centers for Disease of foodborne illnesses and increased Control and Prevention (CDC), four the number of foodborne bacterial public health laboratories, the US isolates tested. Additional resources and Department of Agriculture (USDA) support are needed for public health and the Association of Public Health laboratories to test and investigate all Laboratories (APHL), PulseNet has since cases of foodborne illness. It is critical grown to more than 70 laboratories for the nation to recognize the impact nationwide, including state and that public health and agricultural local public health laboratories, state laboratories have on the overall agricultural laboratories and regulatory foodborne disease surveillance system laboratories within the US Food and to ensure a safer food supply. Drug Administration (FDA) and USDA. Molecular subtyping and computer The PulseNet network links public analysis are performed to generate health laboratories nationwide, and analyze the DNA fingerprint monitoring pathogens such as Shiga- patterns. These patterns generated toxin producing Escherichia coli or from isolates of ill persons and/or food STEC (including E. coli O157:H7), and environmental samples are then Listeria monocytogenes, Salmonella compared to national databases at CDC, species (sp.), Shigella species and allowing for the early identification Campylobacter species using a molecular of foodborne disease clusters. Such subtyping method called pulsed- information assists epidemiologists with field gel electrophoresis (PFGE) or their investigations and may potentially lead to the identification of the source conducted in 2006 to assess activities of an outbreak. for the 2005 calendar year. Some comparisons are included in this APHL, which represents state and report for questions that were largely local public health and agricultural unchanged between 2005 and 2008. laboratories, supports its members by providing various training opportunities, The survey was administered through disseminating information relevant to MR Interview, a web-based repository the public health laboratory community, and survey tool. Descriptive analyses facilitating the transfer of new were conducted, and responses were technology nationwide, and conducting grouped into three main categories: assessments of laboratory capacity and surveillance, communication, and capabilities. In 2009, APHL administered laboratory management. a survey to assess the capability and capacity of the PulseNet network and SURVEILLANCE to determine the challenges that face The PulseNet network has proven to be public health laboratories in achieving an essential component to the national the goals and objectives of the network. foodborne disease surveillance system. This issue brief presents the findings of Through active participation by local that survey. and state laboratories, this network has ensured improvements to the METHODS nation’s food safety system by detecting In April 2009, APHL conducted a survey numerous outbreaks and preventing to assess participating laboratories’ many illnesses. In recent years, capacities and capabilities for laboratories have continued to increase conducting molecular subtyping the number of isolates tested by this through the PulseNet network for the molecular subtyping method. 2008 calendar year. The survey was sent to 64 public In 2008, the PulseNet network In 2008, the PulseNet network health laboratories collectively subtyped a total of 48,194 and agricultural isolates of STEC, Salmonella, Shigella, L. collectively subtyped a laboratories— monocytogenes and Campylobacter. This total of 48,194 isolates of which included is a 47% increase from 2005 in which 50 state and 32,830 isolates of the same pathogens STEC, Salmonella, Shigella, territorial were subtyped. In 2008, PulseNet L. monocytogenes and public health laboratories were able to subtype 70% laboratories, 10 of the aforementioned foodborne Campylobacter. local public health pathogens received from clinical laboratories and 4 laboratory partners, as compared to 61% state agricultural in 2005. laboratories. Of those surveyed, APHL received 57 responses—comprised of Although PulseNet has increased 46 state and territorial public health the percentage of foodborne isolates laboratories, 9 local public health subtyped, all pathogens under PulseNet laboratories and 2 state agricultural surveillance that are submitted to laboratories—for an overall response public health laboratories should ideally rate of 89%. A similar survey was be subtyped. A significant delay or lack 2 APHL PUBLIc HEaLTh LaBORaTORY IssUEs IN BRIEf of outbreak recognition may occur very similar PFGE patterns.4-6 Currently, when laboratories do not subtype all E. coli O157:H7 isolates that are part of foodborne isolates. In 2008, only 61% a multi-state outbreak are sent to the of laboratories were able to subtype CDC for MLVA testing and analysis. In all STEC, Shigella, L. monocytogenes and 2008, only 12% of PulseNet laboratories Salmonella isolates received in their performed supplemental or additional laboratories. Laboratories did not subtyping methods (a 3% increase subtype all isolates due to inadequate funding for supplies, staff shortages and Figure 1. Comparison of Isolates PFGE Subtyped increased workload in all areas of public Comparison of Isolates PFGE Subtyped by PulseNet Laboratories in by2005 PulseNet and 2008 Laboratories in 2005 and 2008 health laboratory testing. Currently, the bulk of isolates 70,000 received and subtyped in PulseNet 69,074 laboratories are of clinical origin; 50,000 Isolates received in however, environmental samples 53,494 laboratories and food samples are also important Isolates subtyped in potentially identifying the source 30,000 Number of isolates 48,194 of foodborne outbreaks. Sixty- seven percent (67%) of PulseNet 32,830 laboratories subtyped isolates from environmental and food origins. This 2005 2008 is an increase from 2005, where 45% Source: APHL PulseNet Survey, 2008. Note: Comparison of of PulseNet laboratories subtyped isolates PFGE subtyped as share of the total amount food and environmental isolates. from 2005). With additional funding of isolates received in The importance of subtyping isolates and personnel, PulseNet laboratories PulseNet laboratories in of food and environmental origins would have the capability to perform 2005 and 2008. was demonstrated in the 2008-2009 these new subtyping techniques in their Salmonella Typhimurium multi-state own laboratories, thus eliminating the outbreak associated with peanut butter additional time needed for specimen and peanut butter-containing products. transport to CDC and potentially A match in DNA fingerprint profiles reducing the amount of time it takes to from the food source to the human identify an outbreak. outbreak strain prompted public health officials to issue consumer warnings Among the more than 1,500 foodborne and product recalls. disease clusters that were identified through PulseNet in 2008, three of PFGE has proven to be a powerful every four local clusters detected were tool for the detection of foodborne followed-up by an epidemiologist. The disease clusters. Additionally, newer detection of small clusters by local molecular subtyping methods, such public health laboratories can aid as multiple-locus variable number in the identification of larger multi- tandem repeats analysis (MLVA), can state outbreaks. This demonstrates greatly contribute to some foodborne the important role that state and outbreak investigations. In some cases, local agricultural and public health MLVA can further discriminate between laboratories contribute to the overall bacterial strains that have identical or foodborne investigation process. PULsENET: A CRITIcaL FOOD SafETY SURVEILLaNcE SYsTEM ApRiL 2010 3 COMMUNICATION notification of new clusters or “matches” Communication and data sharing to an existing national cluster. In 2008, among PulseNet laboratories is critical available resources allowed for 72% of to detecting and identifying multi-state laboratories to respond to web-board postings within two working days. This Figure 2. Comparison of Isolates PFGE Subtyped is an increase from 2005, in which 49% by PulseNet Laboratories in 2008 of laboratories were able to respond Comparison of Isolates PFGE Subtyped by PulseNet Laboratories in 2008 within two working days. 50,000 47,030 Communication between laboratory and epidemiology partners is another key factor in promptly identifying foodborne outbreaks. Seventy-five percent (75%) of PulseNet laboratories in 2008 reported Isolates received in communicating with their state or local laboratories 36,206 foodborne epidemiologists on a weekly Isolates subtyped basis or more. This is a significant solates I 30,000 improvement over 2005, in which 59% of laboratories reported communicating with their
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