Balancing Transparency and Integrity: How We Changed Public Notification of Potential Outbreaks

By Hilary Karasz, PhD., and Meredith Li-Vollmer, PhD., Public Health – Seattle & King County

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A Public Health – Seattle & King County inspector visits a Chipotle restaurant.

The second half of 2015 felt like all foodborne illness, all the time. In the summer, we dealt with a statewide salmonella outbreak resulting from contamination at a supplier of whole hogs who sold to small food establishments in our county, as well as to individuals for backyard pig roasts. At the same time, there was an E. coli outbreak stemming from a food truck that shared a communal kitchen with a dozen other food businesses. We scarcely had time to catch our breath before there was a multi-state E. coli outbreak connected to Chipotle restaurants in our jurisdiction—perhaps you heard about that one? In quick succession, we also had cases of E. coli from Costco chicken salad, listeria from ice cream, and a norovirus outbreak that gained momentum at a catered holiday party in a large office tower, affecting many hundreds of office workers and numerous food establishments.

With so much news about foodborne illness, we understandably heard from members of the public and local media that they wanted to know about every disease investigation. For those who work in this field, you know that it’s not so simple.

Why we have publicized some investigations, but not others

Like health departments across the country, in a typical week, we receive reports of enteric illnesses like campylobacteriosis, salmonellosis, shigellosis, and norovirus, in addition to other types of reportable conditions. When potential outbreaks are reported to us, we investigate but we don’t divulge the ill person’s identity, even if it’s a communicable disease. Not only are people’s identities protected by state and federal law, breaking confidentiality could discourage people from reporting diseases—putting us all at risk.

Similarly, if we learn from a food business or from its customers that people got sick from eating at the restaurant, we want that food business to work with us, confident that we will not prematurely place blame before we have done an investigation to evaluate all possible causes. No health department wants to unnecessarily stigmatize a business if we don’t have evidence about the source of the problem or a confirmed link to the business and there is no ongoing risk.

Of course, our top priority is to keep the public safe and healthy. If there is ongoing risk to the public, we have always made a public announcement, including names of implicated food businesses, so that people can protect their health. We post restaurant closures on our website and on Facebook and Twitter, and we provide information on how to avoid illness and what to do if you’ve been exposed. We have also made public health announcement if it will help solve an ongoing investigation.

Our dilemma

People want to know more about our outbreak investigations, above and beyond our public alerts when there’s an immediate health risk, and we respect that interest. This is part of a larger trend toward greater openness from government, which values the public’s right to know.

However, information about the causes of outbreaks is often unclear or inconclusive, such as when there is simply not enough epidemiologic and/or laboratory evidence available to draw reliable conclusions. In order to provide information about the circumstances and possible causes of outbreaks responsibly, we need to provide more context and background. We don’t want readers to confuse associations (which may not indicate cause and effect) with actual cases.

So how do we meet the public’s desire for timeliness and transparency in a way that maintains the scientific integrity of our foodborne illness investigations?

A change in public notification

We continue to issue news releases and social media alerts related to outbreaks that present a risk to the public. But we’ve added something new: an outbreak website where we routinely post information about likely or confirmed foodborne illness outbreaks, even if there is no ongoing risk or if there is not a recommended action for the public to take. By putting it on a website, it allows us to include context that will help readers avoid drawing inaccurate or premature conclusions. We also update the information as the investigation progresses. Members of the public or journalists with an interest in foodborne illness outbreaks can sign up to get email alerts when there is something new on the website. For those outbreaks that we consider particularly noteworthy, we will also write about them on our blog.

A website hardly seems revolutionary, but in terms of our approach to public information, it is a big step. We’ve had this new website up since February, and we promoted it on our social media platforms and through our blog. So far, the feedback from media and food safety advocates has been positive, but some impacted food establishments have said that they felt singled out. Our workload has increased because disease investigators, restaurant inspectors, and communications staff now meet regularly to share information and finalize content for the website. But we hope that the benefit of increased transparency, and a population that is better informed about both foodborne illness and the work that public health does will be well worth the added effort.

Hilary Karasz is a public information officer at Public Health – Seattle & King County and faculty at the University of Washington School of Public Health. Meredith Li-Vollmer is the risk communication specialist at Public Health – Seattle & King County and chairs the NACCHO Risk Communication and Information Sharing Work Group.

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