soiled clothes of the ill child; 2) touching sur- faces (e.g., sink faucet handles, door handles) in restroom A; 3) caring for or holding the child who had diarrhea; and 4) touching the serving utensils in the buffet line. To the relief of facility management, nei- ther food consumption nor ill food handlers were associated with the illness outbreak. The food safety team worked closely with the restaurant staff to implement extensive dis- infection and sanitization, and enhanced ill- ness monitoring and exclusion strategies. No additional illnesses were identified. Mystery at the Nice Hotel My administrative aide texted, “Call me,” our super-secret bat signal for “Call me, immedi- ately!” She did not use it very often. A state senator called. His story was similar to stories we often hear. He attended an annual celebra- tion event at the Nice Hotel for the end of the legislative session, and he and others became very sick 2 days later. The attendee list read like a who’s who of state senators, elected and appointed officials, and lobbyists. This out- break registered at about 8.7 on my internal “outbreak fear factor scale.” One of our outbreak investigation goals is to get at least three stool samples for labo- ratory testing. This task can be harder than it sounds, since the most effective way to “cure” diarrhea is to ask for a stool sample. The underlying physiology is not well under- stood, but the psychology of “That is so gross!” is clear. The epidemiology team, how- ever, convinced several attendees to provide the much-needed stool samples. I had the awkward privilege of going to a senator’s home to deliver a stool sample col- lection kit. She did not look well. I expressed my sincere sympathy and thanked her for her willingness to help. When I handed her the stool sample kit, her face said, “Why did I agree to this?” I tried to delicately explain how to collect a diarrheal stool sample. This
relief was unmistakable, and they thanked us repeatedly for our thorough investigation. The Other Reason! I served for many years on the Council to Improve Foodborne Outbreak Response (CIFOR). CIFOR has developed guidelines, tools, and trainings to help food safety agen- cies investigate and solve foodborne out- breaks. The overarching goal is to reduce the risk of foodborne illness and protect public health. But the CIFOR guidelines also stress that structured food complaint systems and thorough illness investigations are vital to “protect food establishments from unfounded allegations of foodborne illness.” As environ- mental public health professionals, we have a responsibility to advocate for this aspect of foodborne illness outbreak investigations and to develop robust complaint systems and team approaches to foodborne illness investigations. Would you like to improve your food- borne illness outbreak responses? You will soon have a fantastic opportunity to do just that. Once again, the National Environmen- tal Health Association (NEHA) and Food and Drug Administration (FDA) are part- nering to provide crucial funding to reduce foodborne illness and meet FDA’s Voluntary National Retail Food Regulatory Program Standards through the Retail Flexible Fund- ing Model (RFFM) Grant Program. Our team has worked hard to make it easy to submit for these grants. Don’t miss the chance to build a more robust foodborne illness response sys- tem by applying for this grant opportunity. The portal will open on December 9. Learn more at www.neha.org/retail-grants. And remember, as the poster image says, “Nobody Wants to Eat Your Poop!” Please take 20 seconds to wash your hands.
Poster courtesy of the Lincoln–Lancaster County Health Department.
moment became even more awkward when I said, “You can just drop it off at the health department.” Her look of dismay was unmis- takable, so I pivoted quickly and added, “Or I can pick it up tomorrow.” Laboratory analysis found norovirus in the stool samples. After analyzing data from doz- ens of interviews, we found no association between food and illness; staff had not been ill, and food preparation appeared safe. One attendee had diarrhea before the event. The epidemiology team reinterviewed attendees, and based on the additional data gathered— including contact with the person who was ill before the event, where each person sat, and who they greeted and interacted with—we concluded that this outbreak appeared to be spread person-to-person. We met with the hotel, events, and food managers to explain our conclusions. Their
sholmes@neha.org
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November 2026 • Journal of Environmental Health
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