Press Briefing Transcript

CDC-USDA Telebriefing on Salmonella Heidelberg Investigations

August 4, 2011- 11:30 a.m. ET

• Audio recording (MP3, 8.8MB)

Tom Skinner: Hi, thank you, Shirley, and thank you for joining us today for this update on the ongoing outbreak investigation of Salmonella Heidelberg.  Joining us today are Doctors Chris Braden, the Director of the Division of Foodborne, Waterborne and Environmental Diseases at CDC, and Dr. David Goldman, the Assistant Administrator for the Office of Public Health Science at the USDA’s Food Safety and Inspection Service.  We’re going to have both doctors provide some brief opening remarks, and then we’ll move to your questions.  So with that, I’ll turn it over to Dr. Braden. 

Chris Braden: Thank you, Tom.  And good morning, everybody.  Thank you for joining us today.  As you just heard, we’re here to update you on the latest in the investigation of the Salmonella Heidelberg outbreak linked to ground turkey.  We appreciate your interest in this investigation.  As you know, CDC has been collaborating with U.S. Department of Agriculture’s Food Safety and Inspection Service and state and local health officials on this investigation for several months.  I’d like to provide a brief update on the latest in CDC’s investigation, and the history of this outbreak.  I will then turn it over to my colleague, Dr. Goldman, from FSIS, to discuss the recall announcement last night and the FSIS investigation.  Finally, we’ll open the lines for questions. 

As of August 3rd, CDC has received reports of 78 cases from 26 states, including one death associated with this outbreak of Salmonella Heidelberg since March 1st of 2011.  The reported dates of illness on sets are March 9th through July 2nd.  It’s possible there are other cases that have not yet been reported.  Among the patients for whom we have information, 22 or 38 percent have been hospitalized, which is higher than the hospitalization rate typically seen with Salmonella infections.  We’re working to explore why this may be.  One possible reason is that the outbreak strain is resistant to several antibiotics, including ampicillin, tetracycline and streptomycin.  This antibiotic resistance may increase the risk of hospitalization and can sometimes lead to treatment failure, which is when a patient doesn’t respond to treatment.  I want to note that the samples do respond to several other common antibiotics that are used in clinical practice, such as ciprofloxacin, ceftriaxone and trimethoprim-Sulfamethoxazole, otherwise known as bactrium. 

I’d like to take a minute to explain about how this complex investigation evolved.  This was a slowly building outbreak in the beginning.  We had a few cases coming into our PulseNet surveillance system, but along the lines of what the baseline of cases we might expect.  Over time, it was clear that there was an unusual clustering of cases.  We began investigating that clustering on May 23rd.  These types of investigations can be tricky and initially interviews with patients didn’t support a link with ground turkey.  That is, it did not see a significant proportion of cases reporting that they had eaten ground turkey.  At the same time as some of these initial cases were being reported, four ground turkey packages purchased at four retail stores as part of routine surveillance in the National Antimicrobial Resistance Monitoring System or NARMS found the same strain of Salmonella Heidelberg.  These positive samples came in one per month, beginning in April through July.  This spurred a more intensive questioning of cases about ground turkey and other possible exposures.  This information eventually did lead to an association with ground turkey.  Meanwhile, investigators found information on ground turkey purchases, both the brand and where people bought the ground turkey, from three patients who had become ill with this outbreak strain.  Investigators used shopper card information to trace back these samples to the cargo plants in Arkansas. 

Around July 20th, state investigators found a sample of open turkey in one patient’s home, and on the 29th, got a positive test result for the outbreak strain.  That’s July 29th.  As you can see, CDC, USDA and our state health department partners in this investigation have had multiple lines of investigation.  There was an aggressive and thorough investigation with many types of evidence that came together over time to paint one picture of this outbreak.  Ground turkey has a long shelf life.  So contaminated ground turkey may be in grocery stores or in people’s freezers at home.  We’re urging people to check packaging on any ground turkey in their homes and not to eat ground turkey that was part of the recall announced yesterday, in which Dr. Goldman will give you some more information about.  I’d like to close by reminding people how they can protect themselves from Salmonella, and that’s to follow the simple rules of clean, separate, cook and chill.  More information on these important safety steps can be found at foodsafety.gov.  Also, more information about this outbreak can be found by visiting www.cdc.gov/salmonella.  I’d now like to turn the call over to Dr. Goldman from FSIS.  Thank you. 

David Goldman: Thank you very much, Dr. Braden.  As Dr. Braden said, I’m David Goldman, and I would first like to begin by thanking our colleagues at CDC and at the various state health departments who have provided information throughout this investigation.  Also I want to thank everyone for participating with us as we together, with CDC, provide you information about the investigation that, as you have heard, has been under way for a couple of months now.  FSIS has a historically strong partnership with CDC.  We were an original partner in FoodNet and other programs that CDC hosts, and, of course, again, we want to thank them for hosting the call today.  Last night, USDA’s FSIS was able to develop a link between some of the reported illnesses in the investigation that you just heard described and a particular plant- in this case, a Cargill plant in Arkansas.  After discussing these findings with the company, the plant agreed to implement a recall, and FSIS issued a recall notice, which we hope will have the effect of preventing additional illnesses. 

This investigation, as you heard from Dr. Braden, was a joint effort.  It required many partners.  It was a very thorough effort, and a good example of hard work being done by public servants across the country who are working to protect you and your families each day from foodborne illness.  In the weeks ahead, FSIS will continue to work with CDC and relevant state officials to complete a thorough, aggressive investigation into this outbreak to determine if there are any improvements that can be made in the food safety standards or in our recall processes.  I want to spend a couple minutes focusing primarily on the trace-back investigation, which is principally done by FSIS, although I should note that often state officials assist us with the beginnings of a trace-back investigation.  I also want to mention that we have—at FSIS, have benefited from having embedded a senior epidemiologist at CDC in the outbreak branch there so that we have a very close working relationship and liaison with CDC for investigations or clusters as they occur.  I will say that generally trace-back is, as I said, often a key in investigating and in making final determinations about the link between cases and products.  It is a very painstaking process.  Our folks at FSIS are tireless in their efforts to obtain information that will link illnesses to a particular manufacturing plant.  As was noted just a minute ago, by Dr. Braden, there was a particular focus on three cases, and I want to focus on that just for a couple of minutes here. 

FSIS began its trace-back activities on two of the cases from the same state on the 18th of July, and within two and three days respectively were able to confirm the purchases were related to this establishment, this Cargill establishment that was—is the subject of the recall last night.  The investigation or the trace-back investigation into the third case of the three was begun on July 26th, just last week, and a similar verification of the purchase of the product was made two days later.  I want to point out, too, that we depend on the state health officials and then CDC as well to endorse the—what’s called the epi link.  That is, confirm that the food history reveals this particular exposure as the cause of illnesses.  And so we felt we had that information in all three of these cases.  I also want to emphasize the—that in each of the three cases, shopper card information was very helpful to us in making these determinations. 

One of the things I want to point out about trace-back generally is that it is often helpful at determining the scope of a proposed recall, because if we can find that the purchase links back to a particular production date, which is always our effort, then we can determine which days of production in a plant ought to be subject to recall.  That can often be a difficult process, and in this particular case, there were, we believed at the time, based on the three cases, multiple days of production that may have contributed to contaminated product.  And then as was pointed out, I’ll go really to yesterday, FSIS took the facts that we had available to us at the time based on the information from both epidemiology and the trace-back to the company, and when we provided those facts to them, they came back to us within a matter of hours and agreed to the recall that you saw posted last night.  So with that, I think I’ll stop and provide time for questions. 

Tom Skinner: Okay, thanks, Dr. Goldman.  Here’s what we’re going to do.  Any questions we get from reporters about the epidemiological investigation, any kind of background on Salmonella, we’ll have Dr. Braden respond to those questions.  And any questions about the source, the trace-back and the recall we’ll have Dr. Goldman answer those questions.  So Shirley, I believe we’re ready to begin, please.

Operator: Thank you.  We will now begin the question and answer session.  If you would like to ask a question, please press star-1.  You will be prompted to record your name.  To withdraw your request, you may press star-2.  Again, press star-1 to ask a question.  And one moment for our first question.  Our first question comes from Elizabeth Weise with USA Today.  You may ask your question.

Elizabeth Weise: Hi.  Thanks for taking my call.  First I wanted to clarify something.  Dr. Braden, you said the last illness was in July, but I thought on the CDC report it said the last was August 1st or 2nd. 

Chris Braden: So I’m sorry for a little bit of confusion.  Actually, what we’re talking about, when I mentioned the—the dates, I was talking about the illness onset dates, and that is different from when those illnesses are actually reported to us. 

Elizabeth Weise: So we haven’t had any actual illness onset since the beginning of July in this outbreak. 

Chris Braden: Well, so we have—confirmed information for some people that go through July 2nd.  We estimate, based upon when we—they were reported, that we may have cases as of July 24th. 

Elizabeth Weise: Okay.  And then let me ask my question.  I just wanted to confirm that.  So if FSIS had trace-back information on July 26th that led them back to this Cargill plant in Arkansas, why did they not go and talk to Cargill until yesterday? 

David Goldman.  Okay.  This is Dr. Goldman.  As I mentioned, we did confirm the trace-back information, as I pointed out, and as you have just said, in—last week, for the most part.  We—there are other things that we need to do as part of the investigation.  There is, of course, the trace-back, I pointed out, is highly essential to this.  We need to correlate the findings on trace-back with findings in the plant, and we have, you know—we get information provided to us from our inspection force in the field, and as well we need to ensure that everything has lined up in a way that we are convinced.  The other factor in this case, and I will—I do think this is important, there are two other things.  One is that there are always other considerations in terms of production facilities that may have—or may be contributing to the outbreak.  And in this case, we were provided a line listing of cases who reported ground turkey exposure.  And there were quite a few non-Cargill exposures.  So that’s another factor in sort of making this determination.  And so that was part of our consideration, as well.  Let me stop there and see if you have a follow-up. 

Elizabeth Weise: Well, I guess my question—I mean, there’s clearly going to Cargill and saying “you need to do a recall” and that’s an official statement.  But seeing as you had a sense that something was going on, why was FSIS not able to just call Cargill and say, “hey, guys, what’s up?  Let’s talk about this."  It seems a week was lost there that Cargill might have been doing something. 

David Goldman: Let me answer that in part by saying the other issue that I mentioned, we’re focusing on three cases at the time out of 77.  And that is—that’s a difficult issue to weigh.  We have three cases of 77.  We have to make a determination that we have enough information to take forward to the company, even though we can’t explain the vast majority of the cases through our trace-back activities.  So that’s another factor in this determination.  So I’ll just leave it at that, I think. 

Tom Skinner: Let’s go to the next question, Shirley. 

Operator: Thank you.  The next question comes from Miriam Falco from CNN Medical News in Atlanta.  You may ask your question. 

Miriam Falco: Thanks for the call.  I’ve got two questions.  Number one, I’m a little concerned about hearing that you had—I mean, I guess it’s good, but as a shopper I’m concerned to hear that you were able to use the shopping cart information to corroborate information.  So as a consumer, should I be worried about touching shopping carts?  And second question is for Dr. Goldman.  In this environment of no money for the government, how much is FSIS affected now and likely to be affected in the near future by efforts in Washington to trim the fat, no pun intended, and how will it affect the inspection efforts the next time we have an outbreak like this? 

Chris Braden: This is Dr. Braden.  I will take your first question about the shopper cards.  And we are sensitive to the fact that shopper cards can be considered to have private information, and not everybody would like to know.  Or would—not everybody would like the public to know what they’re buying.  But we try to address that by getting the permission from the individuals to use their shopper card information, and also working through the retail stores involved to make sure that they are comfortable with providing that information, given the person’s permission.  So we go through that process in order to use the shopper card information, but we do pursue it, because it can really provide definitive links or data to a particular products that a person can’t recall off the top of their head. 

Miriam Falco: Okay.  I thought you were talking about the actual cart, not the card. 

Chris Braden: Oh, I’m sorry, yes. 

Miriam Falco: That’s important, I’m sorry.  I can’t get Salmonella from the electronic data you have.  I understand.  I thank you for that clarification.  Maybe I’m the only one who didn’t get that.  Sorry.  And Dr. Goldman? 

David Goldman: Yes, Dr. Goldman here.  I don’t want to comment on the budget.  I don’t think that’s pertinent to this investigation that we’re undertaking.  I’ll just say that our statutes require us to be in the plants every day, and so we will continue to do that.

Tom Skinner: Next question, Shirley. 

Operator: Next question comes from Mary Clare Jalonick from AP. 

Mary Clare Jalonick: Yes, responding to another question, you mentioned you were looking in the plant, as well.  So I guess I’m wondering if you had findings in the plant.  And continuing on the plant, I guess my question is, I know you guys have inspectors in all of these plants.  Did inspectors find anything as this was going on?  And is testing for Salmonella part of the normal meat inspection process? 

David Goldman: Thank you for the question.  We are still in the midst of investigating and analyzing the data from the plant.  I will take the last part of your question and say that our processing plants are subject to periodic testing by FSIS, and so this plant would have been tested in that same way. 

Tom Skinner: Next question, Shirley? 

Operator: Thank you.  Next question comes from Brian Hartman with ABC.  You may ask your question. 

Brian Hartman: Hi, thanks for taking my question.  Can you go back to the NARMS surveillance that you were doing and tell me if the facility that you traced those packages back to is the same as the Springdale, Arkansas facility we’re talking about in this outbreak, and as a follow-up to that, what happens to that information from NARMS?  I know why you’re doing it, but if you find something potentially dangerous, what happens with that information?  Thank you. 

Chris Braden: Yes, thank you.  This is Dr. Braden at CDC.  So, yes, all four of the samples that we had information on were traced to the Cargill plant in Arkansas.  So the other part of the question about what happens to the information.  Well, we’re—our efforts are to integrate as much information as we can to inform these investigations.  It is true that the National Antimicrobial Resistance Monitoring System or NARMS is a separate surveillance system.  It’s not meant for outbreak investigation.  But nonetheless, the data may be helpful in these investigations as we have seen in this particular circumstance.  So we are engaged in trying to integrate a lot of these data in many of our questions that we ask in public health across surveillance systems. 

Brian Hartman: Well, if I could ask a follow-up to USDA, is that information used in any way for preventative measures?  You have one part of the government finding antibiotic resistant Salmonella on a product that’s in a store.  Does that then- does someone from USDA then get that information and contact Cargill and is there any consideration given to some preventative measures at that point? 

David Goldman: This is Dr. Goldman.  Thanks for the question.  As Dr. Braden pointed out, NARMS is a separate surveillance system.  We certainly have a NARMS liaison that is someone within FSIS who is responsible for maintaining a relationship with the NARMS program, and its findings.  But NARMS is principally designed to examine trends or changes in antimicrobial resistance among a variety of products over time.  And in fact, if you were to go to their website, you can see an example of those reports.  And there’s a bit of a lag both in the annual reports as well as in the current sample data.  I think that was mentioned earlier, as well.  There’s a bit of a lag in terms of the—it’s reporting in—near real-time.  So yes, we do look at that data.  Right now we are not reporting antimicrobial resistance data to the plants that we regulate.  But it is part of a policy consideration here at FSIS. 

Tom Skinner: Next question, please? 

Operator: Thank you.  The next question comes from Daniel DeNoon with WebMD.  You may ask your question. 

Dan DeNoon: Thank you for taking the question. I would like to ask about the extent of the contamination.  I understand this plant in Arkansas produces more than ground turkey and other ground turkey parts or other turkey products.  Where are those not subject to the recall, or at least has there been heightened suspicion and checking of those other products?  And clearly, you mentioned that there were other manufacturers, not Cargill, whose turkey had been implicated by some of the cases.  Are those plants being investigated and possibly considered as being included in the recall? 

David Goldman: Okay, this is Dr. Goldman at FSIS again.  I mentioned earlier we have an ongoing evaluation in the plant right now, and I believe that we will get to the first part of your question which is examining their entire process while we’re engaged there.  But remember, this was an emergent situation that immediately focused our attention on ground turkey, and as regards to the other plants, we don’t have the same level of evidence available to us now to do more intensive evaluations, as is happening in the Cargill plant.  But as I also mentioned earlier, this investigation is ongoing, and will continue.  And so we will be open to findings that may change that. 

Dan DeNoon: Is there any sense of urgency about checking these plants?  Have you redoubled your searches, your investigations, both at the Arkansas plant and at other manufacturers of ground turkey? 

David Goldman: Certainly at the Arkansas plant, we are actively evaluating the data there, and we will, as I just mentioned, once there is further information that suggests other plants may have contributed to this outbreak, then we would do the same in other plants. 

Dan DeNoon: Thank you. 

Tom Skinner: Next question, please. 

Operator: Thank you, Rob Stein with the Washington Post. You may ask your question. 

Rob Stein: Yes, hi, thank you for taking my question.  First, I see this is being called one of the largest recalls.  I was wondering if you could put that in some sort of context.  Is it one of the largest, and is it the largest?  Or what are some of the other—how does it fit into—

Female Speaker: Shirley?  This is FSIS.  We’re having a hard time hearing the question.  I don’t know if you can adjust our speaker line somehow. 

Operator: I did adjust—I’m sorry, I did adjust the participant’s line.  Go ahead and speak again, Rob. 

Rob Stein: Sure.  Can you hear me better now? 

Female Speaker: So much better. 

Rob Stein: Great.  I was wondering if you could put the size of this recall into some kind of context.  Is it the largest, and how does it compare to previous recalls?  And also wanted to clarify, you’re saying that you’ve traced three cases back to the Cargill plant, but basically you don’t know yet whether for sure it occurred in that plant or how it occurred in that plant? 

David Goldman: Yes, Dr. Goldman here at FSIS.  This was one of the largest, we believe.  It’s probably the third largest recall that we have on record.  And so that, I think, should answer that question.  The second part of your question had to do with—could you repeat that part, please? 

Rob Stein: I just was trying to clarify exactly what you know about the role the Cargill plant played in the outbreak.  Do you know that it—the contamination did occur in that plant, or are you unsure about that yet?  And do you have any idea how it occurred in that plant? 

David Goldman: We are still investigating, as I mentioned earlier.  What we have is the trace-back.  I’ll go back to that.  That’s essential.  We can, through our trace-back confirm that product that a patient purchased that made them sick with Salmonella Heidelberg originated in that plant.  So that’s the—that’s the key fact that we are—that our evaluation in the plant is built around. 

Rob Stein: Okay.  And just getting back to the size of the recall.  Any chance, what are the other two?  The two larger recalls? 

David Goldman: We could get that information to you. 

Rob Stein: That would be great. 

Tom Skinner: Next question, Shirley. 

Operator: The next question comes from William Neuman from New York Times. You may ask your question. 

William Neuman: Hi.  I first wanted to clarify a couple things and then I have a question.  Do I understand that your first contact with Cargill in this investigation occurred yesterday?  And then the other clarification is, you talk about these three trace-back cases.  What states were those in?  If you could answer that, and then I’ll ask my question. 

David Goldman: Yes, thank you for the question.  Dr. Goldman again at FSIS.  We had preliminary discussion with their legal representative last Friday.  And so we have—you know, we have been in communications with them since that time.  But it was only yesterday where we presented the full set of facts that we had available to us to not only their legal representative, but their corporate management as well. 

William Neuman: Okay.  And the states? 

Chris Braden: Yeah, this is Dr. Braden at CDC. Those trace-backs were conducted to cases who reside in Ohio and Michigan. 

William Neuman: Oh Ohio and Michigan.  Great.  Here’s the question I have.  May 23rd is the date you give for identifying the cluster.  And if I understood right, already at that time in PulseNet you had, I believe, two of the NARMS samples showing that there was a PFGE match between the outbreak strain and a particular plant’s production.  So it seems to me that we shouldn’t—it seems to me there’s a gap there of nearly two months between your initial discovery that there was an outbreak, and production from a plant matching the strain, and your going to the company to discuss what was going on there.  That seems to me like a very long time.  So is it correct to say that your first indication of a connection occurred back in May? 

Chris Braden: This is Dr. Braden at CDC.  You’re correct that in early on we had some information from isolates from retail meat testing in NARMS that we could link to some patients in PulseNet.  Two things we need to understand about those pieces of data.  One is that the—the retail meat that was tested was not linked to illness that we know of in any way.  And it is true that if you test poultry meat, you may find Salmonella.  And that is something that we know as being the case.  The second is that when we tried to look at the cases in PulseNet that were matching up to the turkey meat isolates, we obviously took that as a primary hypothesis in what we were asking patients about their exposures.  When we did that at the beginning of this investigation, we actually were not finding a significant proportion of those cases that had turkey meat exposure.  So we were finding dissonant types of information that I think prevented us from acting at that point.  And we then had to go on to collect additional information to bring it all together. 

Tom Skinner: Next question, Shirley. 

Operator: Next question comes from Amy Burkholder with CBS Evening News.  You may ask your question. 

Amy Burkholder: Thank you so much.  My first questions are for Dr.  Braden quoted yesterday as saying you think that health authorities are closing in now on a suspect.  Knowing what we know from this call, can you tell us, Dr.  Braden, how close?  I’d also like to ask, what is the proper message we should be telling people about ground poultry products.  Are they, in fact, more susceptible to contamination?  And lastly please for Dr. Goldman.  In the midst of this latest outbreak, your thought on the role of food irradiation and keeping the food supply safe.  Thank you. 

Chris Braden: Thank you for the question.  This is Chris Braden at CDC.  As I mentioned in response to the previous questioner, Salmonella can be found in raw poultry products.  We know that.  Can we do better as far as the amount of Salmonella that may be there?  I think FSIS would agree that we might.  And there are policies that are in place and in consideration in that regard.  But given that Salmonella is—can be a natural—naturally occurring organism in chickens and turkeys and other poultry, it always behooves the consumer to handle, prepare, cook poultry products carefully and safely. 

Tom Skinner: Dr. Goldman, do you want to respond to the second question? 

David Goldman: Yes, the other question having to do with the role of irradiation.  FSIS has approved the use of irradiation, and it really is up to individual plants or processing facilities to decide to use it. 

Tom Skinner: Next question, Shirley. 

Operator: Thank you, our next question comes from April Fulton with National Public Radio.  You may ask your question. 

April Fulton: Yes, hi.  I was just wondering what the implications of this third largest outbreak are for doing more to prevent Salmonella getting into the food supply and particularly in turkeys and chickens in the first place. 

Tom Skinner: Dr. Goldman, do you want to respond to that? 

David Goldman: Sure, I can respond to that.  As I have mentioned before in this discussion, we are in the plant now evaluating that plant’s operations.  And we are collecting as much data around this investigation as possible that we might be able to use to evaluate the overall industry that produces ground turkey products.  And that’s part of what we always do.  We always want to learn from the unfortunate circumstance of an outbreak to try to prevent similar situations from occurring in the future. 

April Fulton: Are the FSIS inspectors in the plant required to test for Salmonella as part of their daily routine? 

David Goldman: Thank you.  This is Dr. Goldman again.  FSIS conducts periodic—what we call verification testing.  The plants operate under HYSSOP, the food safety system that we use here at FSIS.  And so the plants set up a food safety system, and they’re required to demonstrate to us that the food safety system is effective.  And then part of our verification activities is this periodic testing of a plant’s products for Salmonella.  So it’s not a daily occurrence, but it’s a periodic occurrence. 

Tom Skinner: Shirley, we’ll take questions from two more callers, please. 

Operator: Thank you.  Next from Lisa Baertlein with Reuters.  You may ask your question. 

Lisa Baertlein: Hi.  Thanks for taking my question.  I am wondering if the plant or the USDA inspectors are testing for—or were testing for Salmonella Heidelberg, and if so, when was the last time that happened? 

David Goldman: Okay, this is Dr. Goldman again.  We—as part of our testing program, we test on—as mentioned, periodic basis for a consecutive number of days of production.  The last—and we call them sets, because it’s a group of tests that conducted over a period of time that we do as part of our verification activities.  The last set in that plant was from 2010.  And what we do is we isolate Salmonella, and then we conduct serotype testing, antimicrobial resistance testing as well as PFGE analysis on those isolates, and all of that gets fed into a database that communicates with PulseNet.  So as I mentioned, the last set was done in that plant in 2010.  And at that time there were three positive Salmonella Heidelberg isolates among the positives in that set. 

Tom Skinner: All right, Shirley, last question, please. 

Operator: Thank you.  That comes from Alan Bjerga with Bloomberg News.  You may ask your question. 

Alan Bjerga: Yes, this is a little bit different from a budget question, but it is a resources question.  You have been doing this investigation over the course of months.  What kind of resources were you able to throw on to this, and if you had had more resources, do you think you would have come to a resolution more quickly? 

Chris Braden: This is Dr.  Braden of the CDC, and I can address part of that issue.  David may want to say more.  But you know, one thing to understand is that over these months that we’re investigating this outbreak, for instance, there may be at any one time 20 or 30 or 40 other clusters that we’re following that may or may not be outbreaks.  These are clusters identified in some of our surveillance systems, including PulseNet.  And it is labor-intensive on the part of local, state and federal investigators.  I would say that probably the area of that spectrum where I have the most concern is at the local and state level.  Given what’s happening to state budgets out there.  We depend on these people to do the primary data collection and work with us in these investigations.  You know, we could always expand the resources at CDC to potentially tackle more of these better, but we do what we can, and we feel like this was a successfully and intensively investigated outbreak. 

David Goldman: I’ll just add to that, we have a public health and epidemiology liaison with each of the state health departments who are our eyes and ears when it comes to investigations, as well as the senior epidemiologist I mentioned at CDC.  So we have resources in place to alert us as soon as possible, although often we don’t—excuse me, as you’ve heard, we don’t know what the food vehicle is.  We would rather know sooner than later about possible clusters that could involve FSIS-regulated products.  The other point is that the trace-back I mentioned is key in most investigations.  We have a coterie of field investigators, and they have daily regular surveillance activities, but when an investigation occurs, it becomes their highest priority, and we’re able to shift those resources to that effort.  And in this particular case, as I mentioned, it’s often a matter of a single person going, driving miles to a retail outlet and confirming the label.  So having more people wouldn’t have particularly made a difference in this case. 

Tom Skinner: Okay.  Thank you, Shirley, for helping moderate.  That concludes our call, and thank you all to the reporters for joining us.  We’ll make sure we keep you posted via updates on our website, as well as having any additional telebriefings as warranted.  Thank you.

Operator: Thank you.  That does conclude today’s conference.  We thank you for your participation.  At this point, you may disconnect your line.