Your vomit and diarrhea is our bread and butter: Portland’s outbreak museum

I still miss Bill.

I never really knew him, but we all have our demons.

Everyone has problems, especially the ones who think they don’t.

He was awkward in a way I found familiar

Thing is, Bill could nail an outbreak in a heartbeat.

Emily Smith of Atlas Obscura writes about the home-canned beets killed someone.  The freezer-aisle pot pies (there’s about 50 in Phebus’ freezer from 2007). The cheese, breakfast cereal, frozen pizza, tampons, tattoo ink and plastic bags have victims of their own.

These are a handful of the exhibits on display at the International Outbreak Museum in Portland, Oregon, which curators say is the world’s only museum of its kind. It features objects collected from outbreaks of infectious diseases that took place in Oregon and around the globe.

The museum is a single windowless room in a state office building that’s home to the Oregon Health Authority. This room was once the office of Bill Keene, an internationally respected disease investigator for the State of Oregon who assisted on cases around the world. He officially began collecting the mementos for a museum in 1993, though he started holding onto items a decade or more earlier. After his unexpected death in 2013, his colleagues have continued his efforts.

The small room is crammed with more than 100 exhibits that fill tall glass-encased cabinets and cover every surface. The beets and the box of Rely tampons are authentic. Others, like the papier-mache cantaloupes in a net that hangs from the ceiling, are carefully handcrafted representations.

Not every item in the collection represents a fatal outbreak. But every item hints at ailment: stomach cramps, fevers, chills, rashes—the often-agonizing symptoms that accompany an outbreak. And each exhibit hints at investigators’ quiet, crucial work to unravel the mystery of their cause.

On a shelf along the back wall, some tarot cards and mugs bearing the image of cult leader Bhagwan Shree Rajneesh mark a dark chapter for disease detectives, when a cult in rural Antelope, Oregon, perpetrated the largest bioterrorism attack in U.S. history. The goal was to suppress voter turnout in Wasco County, ensuring that cult members, known as Rajneeshees, could overtake locals in the November 1984 elections. They slipped liquid tainted with salmonella into salad-bar offerings at 10 restaurants and several other public places. The attack sickened 751 people, who ranged in age from newborn to 87.

The plastic milk jugs contained in a red plastic crate recall a yearlong case that stumped investigators as they pondered 25 cases of salmonella spread across Oregon, over the course of 12 months, with no clear link. The only detail the cases had in common was milk, which perplexed investigators because the milk was pasteurized. However, a trip to a beloved local dairy in Roseburg, southern Oregon revealed that while the milk itself was fine, a crate-washing machine at the facility was contaminated with salmonella bacteria. So, as crates of milk cartons moved through the facility, they were doused with a salmonella-infused solution. A thorough cleaning of the facility ended the yearlong outbreak.

The Outbreak Museum’s peanut-laced products including granola bars, cookies, and crackers serve as a reminder of Stewart Parnell, a corporate peanut peddler who was sentenced to 28 years in prison for knowingly selling contaminated products. Parnell, the CEO of the Peanut Corporation of America, famously wrote in an email, “Just ship it,” when he learned a shipment had been delayed pending salmonella testing. The shipped peanut-butter paste was linked to a 2008 outbreak that killed nine people and sickened more than 700 others.

In isolation, the stuff that fills this one-room museum is the same ordinary stuff that fills trash and recycling bins. It’s waxy paper boxes printed with company slogans and plastic wrappers bearing logos and nutrition facts. In some cases it’s convincing reproductions of raw meat you’d find shrink-wrapped and refrigerated in the grocery store or fresh strawberries you’d buy from a farmer’s market.

But in Bill Keene’s world, each exhibit stands for a smoking gun. This museum is the evidence of real, everyday items that harmed or killed—and that could have gone on to hurt more, if not for the scientists who solved these mysteries. Even before it was a museum, this room was a place where other investigators drew inspiration.

“You could come in here when you needed a break from your work, sit here and ask him about anything,” epidemiologist Tasha Poissant says.

Keene wanted this museum to commemorate the successes, remember the failures and demonstrate the importance of this work, Poissant says. He understood that outbreaks affect people’s lives in intimate and powerful ways, which means they also have the power to educate, to influence public opinion and change policy.

“When Bill passed away, we all wondered what are we going to do with this museum?” epidemiologist Hillary Booth says. “He didn’t get a chance to make it into the proper museum he wanted to.”

So his colleagues and family stepped in to bring some order to the collection he’d amassed. They installed the display cabinets in his office and catalogued exhibits on the museum website. They continue to collect artifacts, from their own work as well as from cases around the world. While the museum isn’t open to the general public, the curators show it off whenever the opportunity arises—when a public health conference comes to town or guests visit the office.

Memorabilia from Keene’s work spills out of the museum and covers the walls leading to its door. Newspaper clippings, photos from his field work and quotes from Keene (Keene-isms) decorate the cubicle walls just outside.

“Your diarrhea is our bread and butter,” one quote reads.

Poissant offers a correction: What Keene actually said was, “Your vomit and diarrhea is our bread and butter.”

Either way, Keene’s words capture a genuine passion for this line of work that in some cases saves lives but almost always remains invisible.

I miss Bill Keene: Museum catalogues food poisoning in Oregon, elsewhere

Lynne Terry of The Oregonian writes that an unusual museum stocked with food packages including everything from ground beef to alfalfa sprouts has gone live on the internet.

The Outbreak Museum, physically located in Portland, showcases the culprits in food poisoning cases.

The museum was the brainchild of Oregon’s star epidemiologist William Keene, who died suddenly at the end of 2013. He cracked dozens, if not hundreds of outbreaks that sickened people from Portland, Oregon to Portland, Maine with food tainted by E. coli, salmonella, norovirus, campylobacter and listeria. He worked with manufacturers and health officials alike with one goal in mind: prevent consumers from getting sick.

He collected packages of tainted items in outbreaks he worked on and other public health officials sent him containers from their investigations. The museum includes items from the 1999 salmonella outbreak traced to alfalfa sprouts, the 2006 E. coli outbreak involving spinach and the 2012 E. coli outbreak traced to raw milk.

Dr. Paul Cieslak, medical director of Oregon’s immunization program, said the museum is designed to educate younger epidemiologists about the significance of past outbreaks and how they influenced public health decisions and epidemiological investigations.

“It’s mainly meant to be instructure,” Cieslak said.

The items are open to public health students and school groups by appointment. The website includes more extensive information on 12 outbreaks.

Food Safety Talk episode 52: A Keene epidemiologist

Food Safety Talk, a bi-weekly podcast for food safety nerds, by food safety nerds.  The podcast is hosted by Ben Chapman and barfblog contributor Don Schaffner, Extension Specialist in Food Science and Professor at Rutgers University.  Every two weeks or so, Ben and Don get together virtually and talk for about an hour.  They talk about what’s on their minds or in the news regarding food safety, and popular culture. They strive to be relevant, funny and informative — sometimes they succeed. You can download the audio recordings right from the website, or subscribe using iTunes.bill.keene_.portland

The guys started the show dreaming about a Red Mac Pro. They then turned to the passing of Bill Keene. Bill has been mentioned in various FST episodes and was a well respected epidemiologist as seen in the articles by the Oregonian and Doug Powell. The guys then turned to their beverages, Coffee Club, Napoleon Dynamite, Homeland, and Car Talk. Ben shared his preference for Aussie Rule football and Arcade Fire’s album Reflektor. The conversation then turned to Don’s limited iPhone music library, Privateering and Dire Straights, which reminded Ben of Money for Nothing and WWE Wrestling (not WWF Wrestling). To finish they talked about Christmas music, Bad Religion’s Christmas Songs, Coulton and Roderick’s One Christmas at a Time and Horrible Christmas songs.

Ben confused IAFP’s History with Bug Trivia and shared Julian Cox’s information about the 1960’s, and this evolved into a broader discussion about the IAFP and its membership.

The discussion then turned back to Bill Keene and some of the outbreaks he had been involved in. This included a Salmonella Panama outbreak (not to be confused with Van Halen’s Panama), which was the first outbreak that was solved through the innovative use of supermarket loyalty cards and that Bill and others were sued for (the lawsuit was eventually dropped.. The guys then discussed outbreak investigation in some detail and that public health officials are damned if they do and damned if they don’t name commodities and suppliers. There is of course always a risk of getting the epidemiology wrong, as was the case with Salmonella Saintpaul in peppers. Finally, Bill’s investigation of a Norovirus outbreak reminded Ben of a recent Norovirus outbreak in Las Vegas.

Then Ben commented on an exchange with Chris Gunter, who was presenting on traceability for small producers at the 2013 Strawberry Expo. Chris’ presentation is based on the investigation of an E. coli O157 outbreak related to strawberries, in which Bill Keene played a part.

In the after dark, the guys reflected on mortality and that we should all Enjoy Every Sandwich. And because they love him,  Rob Ford got a mention again and again.

Portland food detectives crack E. coli mystery, finger Sally Jackson cheese

The three weeks I spent in France in 2007 with my French-professor wife were memorable on many accounts. Like anywhere else, when I met people and they found out I was involved in food safety, they would tell me their worst barf stories. What was unique was the patriotic-like duty many of the sufferers felt about not reporting any foodborne illness to health-types.

Dr. Mathieu Tourdjman, a French physician who’s currently working at Oregon Public Health in Portland, helped investigate the Sally Jackson cheese mess under the supervision of Bill Keene.

As reported by Lynne Terry of The Oregonian, food is recalled in France but that country does not have a wealth of epidemiologists to investigate outbreaks.

"We don’t have such a developed public health system," said Tourdjman, "and all those epidemiologists know each other and are perfectly happy to cooperate."

To help identify the woman who made raw milk cheese while covered in cow poop, Keene (below, right, photo from The Oregonian) and colleagues at Oregon Public Health offered a unique case study in epidemiology 101.

To this day, no one sickened remembers consuming Sally Jackson cheese. But epidemiologists managed to pinpoint it anyway.

"I can’t recall another outbreak with so many cases and a multi-state outbreak with none of the cases remembering eating the food," said William Keene, senior epidemiologist with Oregon Public Health.

About two weeks ago, Keene found out about two cases of E. coli O157 in Roseburg. Both were women in their early 60s. They didn’t know each other but their demographic similarity sent up red flags, indicating a possible wider outbreak.

Tourdjman quickly caught on. Under Keene’s guidance, he discovered another E. coli case in Vancouver. Turns out that that woman and one of the women in Roseburg had dined one day apart at Clarklewis Restaurant in Southeast Portland.

Not only that, they had both ordered the artisan cheese plate as a starter.

Clarklewis officials could not identify the cheese they ate. But the restaurant’s invoices provided a list of suspects. They included Sally Jackson cheese.

"That was the start, and it turned out to be critical," Keene said. "We assumed that whatever was causing the outbreak was at the restaurant."

Then another Washington connection popped up with a woman who had shopped at Calf & Kid, an artisan cheese store in Seattle.

The shop’s website mentioned Sally Jackson cheese — yet another coincidence.

Then, Keene and Tourdjman discovered that Jackson, an artisan cheesemaker in Oroville near the Canadian border, was threatened with a possible shutdown by Washington state over sanitation concerns.

With Sally Jackson on their radar, the Oregon epidemiologists discovered more cases, including a man in Vermont and one in Seattle.

The Vermont man had visited his uncle in Seattle and eaten at Palace Kitchen, a high-end restaurant that serves Sally Jackson cheese. And the man in Seattle had attended a wedding in Tonasket, Wash., just south of Oroville. The wedding featured local cheese — probably from Sally Jackson.

The scientists had circumstantial evidence. Now, they needed proof. Keene sought Sally Jackson cheese from Oregon restaurants to test for E. coli. Very few had any. Tina’s Restaurant in Dundee had thrown some away. The owner retrieved it by diving into her Dumpster.

In the end, at least two samples of Sally Jackson’s cheese tested positive for E. coli O157:H7, confirming it was the source of the outbreak that sickened eight and involved investigators from four states and the Food and Drug Administration.

Last Friday, less than two weeks after Tourdjman started the investigation, Jackson pulled all her cheese off the market.