Cochise County health staff outline how epidemiology and environmental health track and investigate foodborne illness

Cochise County epidemiologist Axel Lopez and Environmental Health Division Director Natalie Johnson told the Cochise County Board of Health on Friday that the county uses three primary methods to detect and investigate suspected foodborne and waterborne illnesses: passive, active and syndromic surveillance.

Lopez explained that passive surveillance depends on laboratory and provider reports, active surveillance involves outreach to find additional cases linked by common exposures, and syndromic surveillance looks at anonymized emergency-department visit data. "The three main ones are gonna be passive surveillance... active surveillance... and syndromic surveillance," he said.

The county's environmental health team inspects and investigates licensed food establishments, temporary food events, pools, lodging and on-site wastewater systems, Johnson said. Cochise County has eight environmental health staff, five of whom are registered sanitarians; one registered sanitarian handles septic complaints. Johnson said the county adopted the 2022 FDA Food Code and uses a risk-based inspection schedule: at least once a year for lower-risk retail, twice a year for quick-service establishments, three times a year for full-service restaurants and four times a year for high-risk settings such as hospitals, long-term care and child care.

The presentation also described how local, state and federal roles intersect during outbreaks. Local health departments lead investigations when all cases fall under a single county's jurisdiction; the Arizona Department of Health Services coordinates across counties; and the Centers for Disease Control and Prevention and, where relevant, the Food and Drug Administration coordinate multi-state responses.

Panelists noted constraints that affect detection and follow-up, including limited lab capacity at the county level, the long distances some residents must travel for care and the fact that many people with mild symptoms do not seek medical attention. Lopez said laboratory sequencing can link patient samples to implicated products when the same strain appears in both.

Board members asked about cross-border coordination and inspections at commercial ports of entry; Lopez and Johnson said Cochise County participates in binational meetings with neighboring Mexican epidemiologists and coordinates with state and federal partners when imported products or commercial shipments are involved.

Johnson and Lopez emphasized education as part of prevention. "We give them an opportunity to learn about what the requirements are here," Johnson said of food operators. Staff described outreach to bilingual vendors, technical assistance for new food businesses, and a pamphlet the department distributes to prospective vendors and community organizations.

The discussion included smaller program details such as vector trapping for mosquito-borne disease surveillance and partnerships with cities to inspect public pools monthly when in season. Lopez and Johnson said those activities are ongoing but constrained by staff time.

The presentation concluded with a reminder that surveillance and inspection are complementary functions: "Epidemiology itself analyzes the patterns or exposures... and environmental health conducts those inspections, investigations, and they follow-up on the complaints," Lopez said.