The Long Road to Naming Restaurant X

By James Andrews | October 15, 2012 It started out like most other outbreaks. Late last April, 14 people in the Canadian province of New Brunswick checked into hospitals suffering from E. coli infections that turned out to be from matching strains. At least four others were sick, too, and provincial health investigators were working to pinpoint a common source. By mid-May, they had narrowed it down to a single restaurant in Miramichi: Jungle Jim's, a Canadian chain known for its lively, casual atmosphere. Almost all of the patients had eaten there, but exactly how E. coli O157:H7 infiltrated the establishment's kitchen remained unclear. The investigation appeared to dry up in the subsequent weeks, with no word on the specific source of contamination. It's not unusual for investigators to hit a wall at this point, unable to test ingredients that have all perished or been used up, left to abandon the outbreak as a question mark. Had the investigators in New Brunswick not pursued the case so persistently, however, the U.S. public likely never would have learned of a similar outbreak in a suburb of Orange County, California. Here's how. After six weeks of silence, New Brunswick health officials announced on June 29 that the cause of the outbreak was contaminated romaine lettuce served at Jungle Jim's in salads, wraps and hamburgers. But tucked near the bottom of their lettuce announcement was a tidbit of news more surprising to U.S. reporters: The Canadian infections genetically matched E. coli infections in California that occurred right around the same time in April. But that was the extent of the information provided. The public had not been told of any E. coli outbreaks in California around that time, and now more than two months had passed. It wasn't clear how many Californian illnesses there were, nor whether the Californians contracted their E. coli infections at home or while traveling to Canada. Food Safety News queried the California Department of Health for a week in search of more information, finally confirming that the illnesses were all tied to an unnamed restaurant in California. The genetic fingerprints of the bacteria isolated from Californian victims were indistinguishable from those isolated from sickened Canadians, meaning the contamination almost certainly traced back to the lettuce farm. Another week later, California finally said that 9 people had gotten sick, all in Orange County. A few days after that, on July 19, the health department identified the lettuce grower as Amazing Coachella, Inc. All contaminated lettuce had expired at this point. While Jungle Jim's had long been identified as the outbreak restaurant in Canada, California officials remained mum about their eatery's identity, and so Food Safety News sent a Freedom of Information Act (FOIA) request to the Orange County Health Department asking for the name of the restaurant. Like many other times Food Safety News has requested establishment names through FOIA requests, an Orange County records clerk informally stated that it was against policy to reveal the names of establishments associated with an outbreak if they no longer pose a public health threat. In this case, the restaurant did not cause the contamination and, either way, was no longer serving contaminated lettuce. The agency would mail a formal response to the request, she said. But why had the local public not heard of the Orange County outbreak back when it happened? Food Safety News asked Phyllis Entis, microbiologist and author of eFoodAlert, who relayed a perspective once imparted to her by the senior epidemiologist of a major state public health agency. "There are quite a few outbreaks that are looked into and investigated in which either the source is never determined or the investigation is taking place after the outbreak is clearly over, so there's no particular reason to notify the public," she said. "If every outbreak and every cluster was reported, perhaps there'd be an information overload." Health agencies simply can't report on each of the 48 million cases of foodborne illness estimated to occur in the U.S. each year, Entis went on. They have to prioritize. "There are always judgment calls being made at the county, state, provincial and national level over whether certain outbreak clusters even need to be reported to the public at all," she added. "Some of us might want them to report on more than they do, but those are the facts of the matter." University of Minnesota environmental health professor Craig Hedberg, Ph.D., said that while restaurants may just be an intermediary between consumers and food contaminated at the farm, they can amplify the number of people affected by an outbreak. Releasing restaurant names before completing an investigation can jeopardize the results, as case control interviews may become influenced by news reports. "However, once the investigation is over, there is no benefit to protecting what otherwise should be public," Hedberg said. "The main reason to alert people to the identity of a restaurant or other source would be to identify other cases or to alert people who may have been exposed, so they can take actions to seek care or prevent transmission to others." When Orange County did send the formal response to Food Safety News' request for the restaurant name, it included a surprising piece of information: the name of the restaurant. The agency also included reports of the establishment inspection that took place immediately following the outbreak. Now, six months following the outbreak, knowing the identity of the restaurant – Curry House Cypress – would seem to matter little. Whether the name would have made a difference if disclosed closer to the time of the outbreak remains unknown. © Food Safety News More Headlines from Foodborne Illness Investigations » Tags: E. coli, E. coli O157:H7, Jungle Jim's, New Brunswick, Orange County