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Case Study: E. Coli

What Would You Do?

You’re the state epidemiologist for infectious diseases. More than forty children in county X contracted what appears to be E. coli 0157. When the state health department announces to the press that there is an E. coli outbreak and that the source is a famous restaurant chain, media interest skyrockets. The public information officer for the state health department asks you to continue fielding questions from reporters, but lab tests aren’t telling you anything new.

What They Did

In January 1993, the Washington State Health Department investigated a suspected E. coli 0157 H7, which made more than forty children in the Puget Sound region ill. Initially, the press paid little attention. But when the department announced to the press that it was dealing with an E. coli outbreak—and that the source of the outbreak was the restaurant chain Jack in the Box—the media interest skyrocketed. This case involved a potentially fatal disease, children, and a national restaurant chain. Suddenly, the department was dealing with a national news story.

John Kobayashi, then the State Epidemiologist for Infectious Diseases, found that his time was consumed with responding to the press during the week following the announcement. In this video, Dr. Kobayashi describes his experience with crisis emergency risk communication.

At the end of the week I was pretty tired because we made the public announcement, as I recall it was on the beginning of the week, about Jack in the Box being related to the outbreak, and that the food was being quarantined, and so on, and so on. It was really, really big news at that time. And so we were very, very busy that week investigating the outbreak and also responding to media questions.

So I was ready to have a rest at the end of that week. But my public affairs officer, Dean Owen, talked to me and he said, “Don’t stop talking to the media. And it’s really important to continue your message.” And I didn’t really understand that because I thought we had said everything we were going to say. And we were waiting for culture results and the data to be finalized and so on.

And he said, “No, you need to keep talking to the media. This is a very big issue. It’s a national story and people need more information, even if it’s the same information.” And he said that if I stop talking to the media, then the media would be looking for other people to talk to and that information might not be as up-to-date and accurate as it ought to be.

And as chance would have happened, we were dealing with another problem by that weekend. There were about 60 children who had the infection and these children had been in day care centers. And E. coli 0157 can be transmitted in many ways, one of which is through contaminated food, but also it can be passed from person to person very easily, especially in situations like day care centers. So that became a big concern of ours.

So that weekend I had about four interviews with the media talking about the importance of hand washing all of the time, but especially when you're ill with something, especially when your ill with something like E. coli 0157. So I talked about hand washing, hand washing, hand washing during that weekend to the media. And that was actually a very good thing. There were three children who died of E. coli 0157 in that outbreak. And actually, two of the children who died were not direct consumers of the hamburgers. They were contacts of people who had consumed the hamburgers. So secondary transmission was very important.

So that message was carried through the weekend. And although “secondary transmission” is more an epidemiological term, it became a household word in Washington state. And everybody knew what it was.

And I am convinced to this day that we probably reduced the number of secondary cases because of the messaging we did that weekend.