1. Communicating Science with Integrity: A CDC Foodborne Outbreak Case Study
Laura Burnworth, MPH
Health Communication Specialist
Outbreak Response and Prevention Branch
Centers for Disease Control and Prevention
2017 International Crisis and Risk Communication Conference
March 15, 2017

2. Objectives
Understand CDC’s scenario-based framework for deciding to communicate about foodborne outbreaks
Use the framework to highlight various investigation and communication decision points during a recent outbreak
Demonstrate the success of following an established process to communicate clearly, despite challenges

3. Framework for Communication Decisions

4. Why CDC Communicates about Foodborne Outbreaks
#1 REASON:
Specific source identified & public can take action
Other reasons CDC may communicate include:
State health department(s) communicate
High risk group involved
Deaths, high hospitalization rate
Intense media interest
Misinformation being circulated

5. CDC’s Role in Foodborne Outbreak Communication
CDC’s role in taking actions to stop a foodborne outbreak is usually limited to issuing public warnings
Since 2006, CDC has posted over 100 multistate foodborne outbreak warnings on its website
Postings include recommendations to the public, retailers, and other stakeholders
As the nation’s public health agency, CDC serves as the unofficial “spokesperson” for the multistate epidemiologic outbreak investigation

6. Timing for Public Communication
Communication to the public may be needed at any point, or it may never be needed
In 2016, CDC investigated over 220 multistate clusters; 17 outbreaks were communicated about publicly
Posting a notice on the CDC website involves balancing many priorities:
Being “fast and right”
Input from partners
Science and plain language

7. 5 Common Communication Scenarios
The decision about “when” to communicate occurs quickly
During an investigation, knowledge about what the food source is accumulates and changes, as does the need to communicate
A working document was developed to assist federal agencies during multistate outbreak investigations
Describes 5 common scenarios encountered during investigations
Outlines reasons why or why not communication is needed
Acts as a guide when discussing the need for public communication between federal agencies

8. 5 Common Communication Scenarios
Examples
20 people infected with one strain of E. coli
Signal for ground beef
Brand X ground beef is likely vehicle
Outbreak of E. coli infections in Ohio
Ground beef recalled for E. coli contamination
Scenario 1
Cluster of illnesses with no specific source identified
Scenario 2
Generic food type identified as likely vehicle
Scenario 3
Specific food product, brand identified as likely vehicle
Scenario 4
Local outbreak, locals and/or state release press
Scenario 5
Pathogen identified in food independent of any human illness

9. Questions to Consider Is the outbreak ongoing?
Is there a clear action step for people to take?
Does the food item have a long shelf life?
Is the food item widely distributed/available for purchase?
Is a vulnerable group at higher risk?
Is there sufficient evidence linking illness to the food item?
Is the pathogen causing the outbreak causing severe illness?

10. Food with Integrity vs. Science with Integrity

11. Chipotle 101 Pronunciation: “Chi-pote-lay” Opened in 1993
Dramatic success and growth through the 2000s
Customers looking for healthy fast-food alternative
Many items used in multiple dishes: lettuce, cilantro, tomatoes, red onions, lime juice, beans, rice

12. Outbreak Overview
In late October 2015, an outbreak of a rare strain of E. coli O26 infections was detected in Washington and Oregon; people reported eating at Chipotle restaurants
By November 2015, cases in states outside of the Pacific Northwest had been identified; these people also reported eating at Chipotle restaurants
When the outbreaks were declared over in February 2016, 60 ill people had been identified in 14 U.S. states; almost all reported eating at Chipotle
Many communication decisions were made, but this presentation will focus on three decisions and their challenges:
Announcing the multistate investigation
Announcing a second, smaller outbreak linked to Chipotle
Declaring the outbreaks over

13. Decision Point 1: The Multistate Investigation
In mid-November, we began to see illnesses reported from states outside of the Pacific Northwest
Same rare strain of E. coli O26
Questions to consider:
Is this outbreak ongoing?
Is the pathogen causing severe illness?
Do we have sufficient evidence linking illness to Chipotle?
Can we provide specific advice to people?

15. Challenges to CDC’s Scientific Integrity

16. Decision Point 2: Another Outbreak?
In December, we identified a second outbreak of different, but still rare, E. coli O26 infections
Five infections in 3 new states: Kansas (1), Oklahoma (3), and North Dakota (1)
All five people ate at Chipotle
All three OK cases at a single location
ND case traveled to KS and ate at the same location as the KS case
Questions to consider:
Is this outbreak ongoing?
Is the pathogen causing severe illness?
Do we have sufficient evidence linking illness to Chipotle?
Can we provide specific advice to people?
AND: Is this linked to the larger outbreak?

18. More Challenges to CDC’s Scientific Integrity
CDC received an “Information Quality Challenge” from Chipotle legal counsel
Document questions the utility and accuracy of CDC’s public communication about the outbreaks, claiming:
CDC did not adhere to guidelines on dissemination of information
CDC inappropriately included cases in the case count
CDC staff made unnecessary statements to the media

19. So, why did CDC communicate about the outbreaks?
Infections with the rare strains of E. coli O26 continued to be reported to CDC and the outbreaks were causing severe illness
Additionally, CDC sought to:
Encourage sick people with exposure to Chipotle to seek medical attention and get information to prevent transmission of infection to close contacts
Assist in identifying additional outbreak cases who might provide clues to solve the outbreak
Give the public information to protect themselves by choosing to avoid certain food exposures associated with the outbreaks
Government transparency and trust
Applying the established framework, we decided to communicate

20. Decision Point 3: Declaring the Outbreaks Over
CDC was cautious about declaring the outbreaks over for several reasons:
Contaminated ingredient was never identified, so investigators weren’t sure if the food linked to illness was no longer available at restaurants
Winter holidays likely increased the illness reporting delay

22. Challenges and Successes

23. Unique Communication Challenges
Chipotle’s “Food with Integrity” tagline
Publicly traded company = public financial losses
Beloved brand among teens and young adults
Massive social media following and internet presence

24. Communication Successes
Increasing demands for government agencies to be transparent
Transparency, trust, and credibility intrinsically linked
Throughout the investigation, CDC applied its established framework for communications decision-making
CDC could defend the decisions it made to communicate during the investigation
Could demonstrate a consistent pattern of communicating
Ultimately, Chipotle made substantial changes to their food safety program, hopefully leading to safer food for their customers

25. Contact:
Laura Burnworth