Foodborne Illnesses: When Do I Need to Call the Health Department?

No one wants to call the health department to report a foodborne illness outbreak, but sometimes, you may have to step up to get ahead of the issue. As you know, it only takes two people reporting foodborne illness symptoms after eating the same food to be considered an outbreak.

While prevention is key, it is also necessary to have a plan in place for dealing with potential health risks. If it turns out that an investigation is necessary, the sooner it begins, the better. Limiting the spread of an outbreak will help save the entire food industry from losing public trust–and ensure affected customers can receive any necessary treatment as soon as possible.

So, how do you know when it is time to call the health department? Not calling them soon enough can result in widespread illness–not to mention criminal investigation, lawsuits, or even closure of your business.

In this article, we’ll talk about what you need to know to help you make the right decision! We’ll cover:

How do I learn about a potential outbreak?

What illnesses need to be reported?

Should I contact local, state, or federal agencies about a potential outbreak?

What do I do when I suspect a foodborne illness outbreak?

How should I manage Illnesses at work?

What should consumers do about food poisoning?

What types of contamination do I need to look for?

How do I learn about a potential outbreak?

You might find out about a potential outbreak in several ways, and one source may even be related to another. For example, a comment on Instagram could be associated with a customer complaint over the phone. What may appear insignificant at first could become the missing puzzle piece down the line.

Let’s break down different sources for information gathering.

Customer complaints

Where do your clients provide feedback? Whether it’s phone calls, emails, or face-to-face interactions, make sure to have a system in place to properly track all feedback. Stick with the basics: Who (contact info), what (food items consumed), when (date and time).

Social Media

Word of mouth spreads on social media just as much as in real life (if not more!). Similarly to direct complaints, set up a system to document all social media interactions. Not just comments on your direct page, but note where your establishment is tagged. And don’t forget direct messages, too.

Remember, as long as you have a plan, there’s no need to fear a bad review!

Employee illnesses

Employees coming into work sick is the leading cause of foodborne illness. It is important to track who is on the schedule and who calls out sick. If someone calls in sick, consider checking in with the teammates they recently worked with to try and get ahead of a spreading illness.

Health Department

Get in the habit of regularly checking for alerts from your local health department to stay current on any recent outbreak. You may also want to check the Centers for Disease Control for updates on multistate outbreaks to see if there are any ongoing outbreaks you should be keeping an eye on.

Setting up systems and procedures to track feedback and other reports will not only create a habit for your establishment, it will prove indispensable should an outbreak occur and you need to work with the health department to gather evidence. The systems you’ve set up have already gathered much of the evidence!

What illnesses need to be reported?

The top six pathogens–plus botulism–are listed below that the CDC requires food establishments to report to the health department. All are largely preventable by following good food safety practices.¹ Note that some jurisdictions, like the State of Ohio, require food workers to know about even more foodborne illnesses.

Norovirus	Norovirus is the most common foodborne illness in the United States. Symptoms include vomiting and diarrhea.
Hepatitis A	Hepatitis A causes inflammation of the liver. Symptoms include fatigue, nausea, abdominal pain, loss of appetite, and low-grade fever.
Shigella spp	Shigella spp has a very low mortality rate but can easily spread from one person to another. Symptoms include diarrhea and fever.
Shiga toxin	Shiga toxin Shiga toxin, better known as E. coli, causes bloody diarrhea, Hemolytic Uremic Syndrome, and other symptoms.
Salmonella Typhi	Only found in humans, Salmonella Typhi symptoms include headache, high fever, belly pain, and either constipation or diarrhea.
Nontyphoidal Salmonella	Many animals carry Nontyphoidal Salmonella in their digestive tract. When transferred to humans, symptoms include fever and gastrointestinal upset.
Botulism	While it is rare, Botulism affects the body’s nerves and any suspected case needs to be reported immediately due to the severity of the illness. Symptoms include difficulty swallowing or speaking, facial weakness, and paralysis.

Common signs and symptoms of foodborne illness are nausea, vomiting, cramps, diarrhea, dehydration, headache, or fever. Depending on the bacterial, viral, or chemical agent responsible for the illness, symptoms may begin anywhere from 30 minutes to several weeks after consumption.²

Should I contact the local, state, or federal agencies about a potential outbreak?

The short answer is, it depends. In most cases, you should call the local health department because they oversee food safety in retail food establishments. Local jurisdictions are responsible for tracking reports of foodborne illnesses and taking steps to contain and prevent outbreaks.

Health departments are also responsible for tracking certain conditions, known as notifiable diseases, to help the CDC track these diseases nationally. In extreme cases, your local authority may instruct you to contact another authority. For example, if botulism is suspected, you should bypass your local health department and report your suspicions directly to the state health department.

On a local level, outbreak investigations typically begin after a high number of reports of the same illness have been documented. If a notifiable condition is reported to a local authority, the state health department will contact the CDC and add it to the National Notifiable Diseases Surveillance System (NNDSS).

The NNDSS allows the CDC to gather and analyze data from 3,000 health departments nationwide.³ The CDC also uses PulseNet, the national laboratory network that tracks intestinal disease outbreaks, to help track and combat foodborne illness outbreaks.

PulseNet is a critical tool in identifying groups of people who get sick from similar bacterial strains, also known as clusters. If those clusters have something in common, indicating they got sick from the same source, that group is redefined as an outbreak.⁴

What do I do when I suspect a foodborne illness outbreak?

If you manage a restaurant or retail food business and suspect an outbreak, there is more to do than simply making a call. These are the five steps to the process:

Detect the outbreak

There are several ways you can detect an outbreak:

Your tracking systems reveal several people got sick after eating at your establishment.
A physician reports a sick patient to the local health department, linking your establishment to the illness.
A supplier issues a recall of food used at your establishment.

Contact your local health department

Your local health department will provide steps and tools to guide you through the next phase of the process. Stop all operations until the issue is resolved. And while in the process, keep lines of communication open–between you and the health department, as well as you and your team.

Gather Info

Begin to gather information according to your health department's guidance. You will need things like customer feedback, employee work schedules, purchase invoices, and ingredient lists.

This is where your Food Safety Management System (FSMS) and/or Hazard Control Program become important! If your establishment has documented a thorough FSMS and has implemented the action steps it contains, then most of the information gathering should have already been done.

Please note: as you gather data, do NOT discard any food associated with the outbreak. If it’s been recalled, label it and store it away from other food.

Work with authorities

When inspectors from the health department arrive, follow their instructions. Be ready to answer many questions. You may need to contact suppliers at this point, too. Remember, if you have laid the groundwork with an FSMS, you will already have answers to their questions, reinforcing your credibility while working with authorities.

Re-open for business

The health department will tell you when you can re-open for business, and they will probably issue a re-opening inspection. Were new procedures recommended as a result of the outbreak? Make sure to implement them at this time (and moving forward). After all, who wants to have to repeat this process if you don’t have to?!

How should I manage illnesses at work?

According to the CDC, employee sickness is the leading cause of foodborne illness in customers.¹ Creating a culture of food safety includes ensuring everyone is on the same page when it comes to the company’s sick policy. Be prepared to send people home if they are too ill to work, and make sure to document any diagnoses of the major foodborne illnesses.

Good personal hygiene cannot prevent the spread of an illness. Track the schedule patterns, be willing to send people home if they are too sick to handle food, and ensure everyone on staff knows what to do when they fall victim to an illness.

What should consumers do about food poisoning?

If an individual suspects they have become a victim of a foodborne illness, they should schedule a doctor’s appointment as soon as possible. The doctor may report the illness to the local authorities, or the individual can reach out to their local health department.

According to the Mayo Clinic, symptoms will improve without treatment within 48 hours (in most cases).⁶ Doctors typically advise waiting to eat until the stomach settles and keeping hydrated with sports drinks, juice, or broths. Adequate rest is also essential to recovering from a foodborne illness.

If someone with a foodborne illness does not improve within a day or two, consult with a doctor as soon as possible.

What types of contamination do I need to look for?

Preventing an outbreak from ever happening is always the better option. Knowing what to look for will help keep you from even needing to call the health department at all. It is important to regularly assess your kitchen and service areas for the four major types of food contamination.

Let’s review the major risks to food safety and public health.

Biological

Biological hazards are caused by bacteria, mold, fungi, parasites, or viruses. This type of contamination is believed to be the most common form of foodborne illness.

Chemical

Chemical contamination is caused by some chemical substance–think cleaners, sanitizers, or pesticides–all of which are toxic to humans. Always be sure to follow chemical storage best practices to protect customers and staff alike.

Cross-contact, a subset of chemical contamination, occurs when proteins from an allergen transfer from one food to another (i.e. peanut dust from a dessert preparation gets mixed in with someone’s entree dish).

While biological contamination is not typically fatal, chemical contamination (from toxic substances or allergens) can immediately cause serious and deadly reactions.

Physical

Physical contamination is caused by a foreign object in food, like plastic, steel wool, glass, or even bones. Thankfully, this type of contamination is very easy to prevent.

Intentional

Unfortunately, you must also be aware that sometimes contamination is done intentionally. The FDA created the A.L.E.R.T. initiative to help decrease the risk of deliberate food contamination.

The A.L.E.R.T. initiative identifies five areas you can track to avoid intentional contamination. It stands for assure, look, employees, reports, and threats.⁵

Assure: Ensure supplies and ingredients come from safe resources by having someone oversee deliveries.

Look: Check the security of the products, limit access to preparation and storage areas, and create systems for handling damaged products.

Employees: Get to know your team! Conduct background checks and control visitor access to food areas of your establishment.

Reports: Be prepared to provide reports and records of what you do to secure and protect food products in your establishment.

Threats: Have a plan in place for potential threats. Make sure you have a secure place to hold a contaminated product for testing and have law enforcement’s contact information on hand should you need to make the call.

As a manager, know the best practices for preventing intentional contamination. It is your job to create and implement tracking systems, policies, and procedures that alert you to potential hazards in the establishment.

The Takeaway

It only takes two people reporting symptoms of a foodborne illness to be considered an outbreak. Remember, lives are at stake when food safety is called into question. So, if you suspect a potential outbreak, you must call the local health department, gather data, and work with the authorities to ensure a swift end to the outbreak and the ability to get back to business as usual.

Sources