Quick Detective Work & Cooperation Halt Foodborne Illness

The pooling of unique skills moves investigations forward

The clock is ticking. The stakes are high. No one has any clue what happened—except that 14 people are ill. How did a lighthearted lunch celebration result in a foodborne illness outbreak? In what looks like a detective whodunit, the Contra Costa Environmental Health team dives into yet another foodborne illness investigation.

Environmental Health is no stranger to investigative work, but this case presented a unique challenge. This wasn’t a routine restaurant inspection or health violation follow up. Foodborne illness outbreaks involve any number of factors and require immediate action. To make matters worse, concrete facts about the luncheon were few and far between. “At the start, we had no information,” remembers Supervising Environmental Health Specialist Michele DiMaggio. “We didn’t know what they ate. We didn’t know the symptomology. We didn’t have the infected people’s contact information.”

The obvious starting place was the burritos, all 1,200 of them. The Environmental Health Outbreak Response team—a team of specialists on call 24/7 year-round—wasted no time inspecting the scene of the crime. The burritos were reported suspiciously sour at the first lunch serving, so the dinner meals were consequently disposed of. A sigh of relief—the source was identified and the outbreak was controlled. Unfortunately, the partygoers had been too thorough in controlling the outbreak, throwing away all potential food samples. Led by Michele, the team found a few burritos stashed away in the recesses of a fridge— a break in the case. Samples were immediately sent to the California Department of Public Health laboratory for testing.

Next, the Environmental Health team turned to the food operator in question. After all, the outbreak at the celebration might have been controlled, but restaurant patrons could still be at risk. They learned that the restaurant was located in neighboring Alameda County, making this case cross-jurisdictional and inherently more complex. Michele looped in Alameda Environmental Health, dispatching Retail Food Supervisor Jackie Greenwood and her team to conduct multiple rounds of interviews at the restaurant. Nervous employees made for a complicated investigation, requiring persistent follow-up and no small amount of tact. “It wasn’t until the second visit that the interviews actually brought out information that we could work with,” said Jackie.

Simultaneously, the Contra Costa Environmental Health team worked to piece together a hypothesis. Contaminated meat seemed like the evident culprit, but interviews with those infected revealed that both the vegetarian and meat burritos had been contaminated.

This clue brought the rice and beans under investigation. Sure enough, the State laboratory soon reported that the food samples tested positive for the bacteria Clostridium perfringens, one of the most common causes of foodborne illness. Jackie’s team filled in the rest of the details, reporting that massive quantities of rice and beans were prepared the day before the celebration and left out at room temperature overnight. In short, the perfect storm.

With an eye on the big picture, the two teams dug deeper to understand how a mistake like this could have occurred. The small restaurant, they learned, was largely unequipped to handle a catering order of that magnitude. Fortunately, the restaurant closed to the public to focus on the order. Unfortunately, they brought in additional people who were not employees to help prepare the food, and who very likely had never received proper food preparation training. In Jackie’s words, “Just about everything that could go wrong did go wrong.” Her team followed up with the restaurant to temporarily halt operations while they administered comprehensive food handling training.

“With this fast-paced, high-stakes work, you just can’t afford to work in silos,” says Contra Costa Environmental Health Assistant Director Kristian Lucas. “Collaboration is key.” Relationships cultivated over many years allowed Contra Costa Environmental Health, Contra Costa Public Health Acute Communicable Disease, Contra Costa Public Health Laboratory, Alameda Environmental Health and the California Department of Public Health Food Emergency Response Team (FERT) to solve this case.

In the end, the outbreak was controlled and the investigation was concluded before the month’s end. Working as separate entities to meet a common goal, the various groups were able to get ahead of the outbreak and prevent more people from getting sick. The key to this rapid response? An integrated health system approach centered on communication and collaboration.

“Other systems might have been bogged down by the number of hands involved, but Contra Costa Health thrives on cooperation,” says Kristian. “The pooling of unique skills moved the investigation forward.”