For weeks now, public health epidemiologists in Hawaii have been working overtime to determine the source of an E. coli O157:H7 outbreak that has resulted in as many as nine – perhaps 10 – illnesses among residents of Oahu and one Canadian tourist. Four of those have been hospitalized with three developing potentially life-threatening acute kidney failure caused by hemolytic uremic syndrome (HUS).

These public health epidemiologists have interviewed the E. coli victims, asking about foods they ate in the 5 days before becoming ill, whether they visited petting zoos, or if they were all exposed to another potential environmental source of E. coli bacteria. Their goal is to protect us—to make sure they stop the outbreak and hope to figure out why it happened in the first place.

What’s going on in Hawaii is epidemiology at its finest.

Dr. John Snow, the so-called “Father of Epidemiology” would be proud. In 1854, he conducted interviews with residents of So-Ho, a London neighborhood hard-hit by a cholera outbreak, and through those interviews determined that a public water pump was the source of the outbreak. The pump handle was removed and the outbreak stopped. Dr. Snow later used statistics to illustrate the connection between the quality of the water source and cholera cases. (Read the full story, “Ghost Map.”) His work demonstrated what we know today: Numbers do not lie, but data cannot tell the whole story. They can only flesh-out what is known empirically—the really important work is in patient interviews and connections made by the discerning minds of the epidemiologists.

In December of 1992, E. coli O157:H7 was not a reportable disease in California, which meant that when multiple children ended up in emergency rooms, the State of California epidemiologists were not notified of these children’s illnesses. Epidemiologists were not dispatched to interview E. coli case-patients and the source of their illnesses went unknown until months later, when hundreds of Washington residents also fell ill with the same E. coli O157:H7 infections.

You see, E. coli O157:H7 had become a reportable illness in Washington state in 1987, so when people started falling ill with bloody diarrhea that tested positive for E. coli O157:H7 in Washington, the Washington Department of Health coordinated with city and county public health agencies to conduct an epidemiologic investigation into the source of the outbreak. Epidemiologists were sent to interview E. coli patients and quickly learned through interviews that the common source of the outbreak was hamburgers served at Jack in the Box restaurants. Data and statistical analysis confirmed the epidemiologists’ findings. The outbreak was stopped after over 600 were sickened and three children died. However, it could have been much, much worse. Several tons of hamburger were recalled, saving the lives of countless others.

As Hawaii epidemiologists are scrambling to determine the source of the E. coli outbreak on Oahu, remember this: doing this work is time-consuming and expensive. However, it is an expense that we as taxpayers should gladly pay. The cost of one HUS case is in the millions of dollars, whether paid by insurance or not. The potential for business losses due to fear by tourists can be in the millions as well.

Epidemiologists are cheap considering the alternatives.


About the author: Bill Marler has dedicated his law practice to representing victims of E. coli outbreaks and hemolytic uremic syndrome (HUS). He and E. coli lawyers at the Marler Clark law firm have represented thousands of victims of E. coli and other foodborne illness infections and have recovered over $600 million for clients. The law firm has brought E. coli lawsuits against such companies as Jack in the Box, Dole, ConAgra, Cargill, and Jimmy John’s.


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