PulseNet, which consists of public health laboratories networked across the United States to track foodborne illness outbreaks, helps prevent an estimated 270,000 illnesses and saves half a billion dollars each year, according to a study published in the American Journal of Preventive Medicine. Physicians play a key role in the success of PulseNet and its protection of patients nationwide.1
The 83 labs in the national PulseNet network enter information into a database accessible to local and state health officials. By comparing bacterial DNA fingerprints from infected patients, PulseNet helps match outbreaks that have the same source. The system has been in place since 1996 and has resulted in changes in the way food is handled and processed. It has also resulted in new or improved policy, guidance, and regulations, according to data on the Centers for Disease Control and Prevention (CDC) website.
CDC researchers examined data from 1994-2009 and noted the program costs $7 million to run, which amounts to about $70 saved per dollar used, according to a prepared statement about the study. “PulseNet has provided an incredible return on investment with hundreds of thousands of people able to stay healthy as a result of this early warning system,” CDC Director Tom Frieden, MD, MPH, noted in a press release.2
PulseNet enables researchers to identify outbreaks even when there are only a few infected people across several states. “Advanced molecular detection technology, such as whole genome sequencing, is enhancing CDC PulseNet’s ability to save lives right now – and promises to save more American lives in the future,” Dr Frieden noted, adding that PulseNet is able to identify 1500 illness clusters of E coli, Listeria, and Salmonella every year. This includes 25 multistate outbreaks caused by foodborne illness.
In an interview with Infectious Disease Advisor, Peter Gerner-Smidt, MD, DSc, and Chief of the Enteric Diseases Laboratory Branch at the CDC, discussed the important role physicians play for PulseNet’s effectiveness.
“Physicians play a critical role in providing the information needed to make PulseNet work by sending patient samples to the laboratory for culture,” Dr Gerner-Smit said. “The bacterial isolates that are identified by clinical laboratories are then usually forwarded to a PulseNet laboratory for further subtyping.”
He added, “When PulseNet sees a groups of isolates with indistinguishable fingerprints from patients that cluster in time and/or place, this could signal that an outbreak is occurring. [This] is forwarded to public health epidemiologists for follow-up, [who] may contact the physicians and ask them questions about a particular patient, or to serve as a liaison between the epidemiologists and the patient to gather information that may help solve the outbreak.” He also indicated that public health authorities give out important information related to outbreaks that help physicians manage their patients.
“For example, during the severe outbreak of E coli O104, infections originating in Germany in 2011 were associated with high rates of hemolytic uremic syndrome. Travel information in a patient with diarrhea and/or kidney failure was critically important in identifying those that could be part of the outbreak and who needed prompt and specific treatment,” Dr Gerner-Smit said.
PulseNet depends on patient cultures or isolates. “Clinical laboratories are increasingly using molecular diagnostic tests that do not produce a culture. These tests produce results that are actionable for physicians faster than culture- based tests, although they do not provide as much information about the pathogens involved, such as antimicrobial susceptibility. The increasing use of these tests needs to be accompanied by requests to culture those specimens with positive results to preserve the access to isolates critical to public health ability to detect and respond to outbreaks,” he said.
Scharf RL, Besser J, Sharp D, et al. An economic evaluation of PulseNet. Am J Prev Med. 2016;doi: http://dx.doi.org/10.1016/j.amepre.2015.09.018.