Step 1: Gathering of Information
In May of 2008, the CDC along with public health officials from multiple states across the United States, along with the Food and Drug Administration (FDA) identified 28 infected people from 15 different states. These infected people have been all diagnosed to have been infected with Salmonella agona. Infected people were dispersed in the following states: Colorado, Delaware, Illinois, Maine, Massachusetts, Michigan, Minnesota, North Dakota, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. Through the mapping of these states, the pattern is unclear in regards to the cause of the infection. According to the CDC, the dates in which the symptoms of the infection ranged from January 1 to April 10, 2008. As far as the demographics of infected persons, patients ages ranged from 4 months old to 95 years old.
Through conducted interviews, public health officials determined the infections to have been caused by Salmonella agona found in a specific brand of puffed rice and wheat cereals. This product was from the Malt-O-Meal Company in which the presence of Salmonella has been determined through an issued recall on April 5, 2008. Although the pattern of infected persons (PFGE) was indistinguishable, the outbreak was confirmed to have been caused by eating the said Malt-O-Meal products. The specific manufacturing location of this product was a mill in Minnesota.
Step 2: Analysis
In this particular case, there are a lot of things to consider in order to take steps into designing a solution to this problem. Since a product was consumed, which then caused the outbreak, economic, cultural and social factors need to be addressed for the impacted population. Firstly, cereal is consumed by almost every American on a daily basis, which is why the issue of an outbreak being caused by this particular food product is unbelievably risky and unacceptable.
To elaborate, a SWOT analysis further analyzes the decision context. 1) A strength is that there are food safety handling guidelines regulated by the FDA, 2) a weakness is the fact that these outbreaks can still occur even if these guidelines are being enforced, 4) an opportunity, then, is to further educate about and prioritize the food safety issues in manufacturing cereal products, 4) a threat, then, becomes the imperfect cooperation of these companies.
There is no particular main organization involved in the case. However, the Institute of Environmental Science and Research Limited, along with New Zealand Food Safety Authority highlights this particular issue exceptionally. Their mission statement is similar of most countries goals, which is to protect the health and wellbeing of consumers whether it be in their own country and also across the globe. They also help protect the reputation of their country’s food products and regulate food standards internationally (Ministry & Industries, 2016).
Step 3: Highlighting Core Issues
There are many root causes of this particular outbreak. There may be a lack of sanitation in these manufacturing mills of the product, which can be caused by another root cause: lacking compliance in regards to health and safety regulations in place. This can be from lack of proper training of employees, or simply noncompliance. This also goes hand in hand with lack of regulation and monitoring/screening of both the manufacturing of products, and the products itself. However a root cause can also be the cereal grain supply of these manufacturing mills, which may have been contaminated. This is proven by a study in 2013, which claimed that the agona pathogen is a common contaminant of both livestock and vegetables in farms, which also includes prepared food from food factories (Zhou et al., 2013). In analysis, both details regarding how the product is manufactured and the supply of grain contribute to the contamination of this pathogen.
Step 4: Analyzing Alternatives
At the time of the outbreak, the CDC advises consumers to check “Best If Used By” dates printed on the product to avoid any more consuming of recalled cereals. However, this was merely a individual, secondary prevention. Although there is no perfect solution to completely eradicate contamination of cereal products, there are steps to make sure the outbreak does not happen again. The theory of the Health Belief Model can be applied to solutions. This theory hypothesizes the following: 1) There needs to be a concern for health to make health issues relevant, 2) one’s belief to being vulnerable to health issues is seen as a threat, and 3) believing that particular health recommendations help reduce threat, whether it has a cost, such as financial barriers (Rosenstock et al., 1988). For example, a solution can be updating procedure in the manufacturing of cereal products by all companies. This can be through retraining of all employees in regards to food handling guidelines. The HBM can be applied in a way that there is a concern for health, the company is subject to accountability, thus recommendations of better food handling reduces the concern for health.
There are numerous amounts of root causes of this issue, which is why there are also numerous alternatives and solutions that can be provided. According to a study involving a national outbreak of the similar pathogen, salmonella surveillance along with serotyping and molecular sub typing, which are also known as elaborate methods of screening products, are all important in detecting outbreaks like these (Sheth et al., 2011). This has been successful in preventing outbreaks from occurring again. This study also addressed the fact that the manufacturing plant lacked proper sanitation of processing and handling equipment and also of the plant as a whole. In response, the company installed new equipments and made necessary repairs and sanitation to ensure proper handling and processing of products. This has also been a successful approach given that the infections has not increased since the plant reopened.
Step 5: Recommendations
Based on the alternatives presented, recommendations to help reduce the chance of this particular outbreak from occurring again are crucial moving forward.
Recommendations include updating procedures of food handling and processing by retraining employees of manufacturing on sanitation and proper use of equipments. This is discussed the in a study on foodborne diseases which claims that food safety includes accountability on companies that manufacture these products (Rollin, 2006). Avoiding responsibility will only lead to more consequences. This can go hand in hand with addressing poor sanitation of these manufacturing mills: such as water leakage that can contaminate the product, etc. And finally, by utilizing advanced and timely screening methods as discussed in a previous study discussed (Sheth et al., 2011). Screening methods are important in detecting these pathogens which is why it’s important to execute this before products are sent out to different stores. Preventing contaminated products from being consumed should be a top priority.
Step 6: Action Plan
Moving forward, there are steps needed to be taken to achieve solutions:
Requiring companies to educate and retraining employees of proper health and safety procedures in both manufacturing and production of products at least every two years. This can be reinforced and supplemented by the FDA.
Maintain and monitor health and safety guidelines in manufacturing location. Random inspections by FDA or any Environmental Health and Safety administration, estimated 10 times a year.
Screen products before being sent out. This can be executed by the company and also the FDA. This can be done during an outbreak, but definitely with every product being sent out.
If and when an outbreak does occur, the company must be held accountable. This can also be regulated by the FDA.
During an outbreak, notify consumers as soon as cause has been determined.
Stop consumers from consuming product to reduce amount of infected people. This may be challenging to achieve, will take more than 24 hours.
Conclusion
Through proper education and reinforcement, outbreaks like of Salmonella agona in manufactured products such as cereal can be prevented. Of course it is one thing to deescalate an existing outbreak, however, it is also important to look at possible solutions or alternativees that will help reduce the risk of a particular outbreak from happening again.
An outbreak of poultry-bourns disease in the 1980s approached the case very similarly, in a way that manufacturers were also held accountable. However, the solution focused more on the eating habits of consumers and also emphasized public awareness on the consequences of eating poultry (OBOEGBULEM et al., 1993).