Mary Selecky and Washington State's Salmonella Outbreak of June 1999

Three months into her job as secretary of health for Washington State in 1999-a position which had been vacant for nearly a year following the previous secretary's resignation-Mary Selecky read a newspaper story that the state's largest and most influential health jurisdiction, Public Health Seattle King County, reported three unconnected people in the county had been infected with salmonella, a common foodborne bacteria that makes people sick and can lead to severe illness and even death in some instances if untreated. While Department of Health epidemiologists had already serotyped the bacteria, which they traced to fruit smoothies from a Seattle chain, this was the first time that Selecky had heard anything about the outbreak. Clearly, she mused, no one in the state working on the matter thought the state secretary of health needed to know about it. Selecky, who had previously run a poorly resourced, rural county health district in Washington State, did not yet understand how state-level public health laboratories and other resources interacted with Public Health Seattle King County, health labs in other states, or federal agencies and resources. She was not even sure of her role vis à vis the State Department of Health's own epidemiology team when it came to routine foodborne outbreaks. However, Selecky did know that foodborne pathogens could sicken and kill, and had no respect for man-made borders. What if anything should Selecky do? What does she need to know? What is her role in what staff consider routine communicable disease investigations. How should she go about discovering it? How does one decide what is and what is not routine?

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