Cochise County officials outline how epidemiology and environmental health track and prevent foodborne illness

Cochise County public health officials on Friday described how the county uses epidemiology, environmental inspections and laboratory testing to detect and investigate possible foodborne and other environmental illnesses.

Epidemiologist Axel Lopez and Environmental Health Division Director Natalie Johnson told the Board of Health that the county relies on three surveillance approaches — passive reporting by clinicians and labs, active case finding and syndromic surveillance of emergency‑room visits — and coordinates with state and federal partners when outbreaks cross jurisdictions. "Epidemiology analyzes the patterns or exposures and we come up with hypotheses on what the cause or agent for disease might be," Lopez said.

The overview is intended to explain how county staff detect problems early and how environmental health supports regulated businesses and temporary vendors so residents can safely buy and eat food. The presentation covered staffing levels, inspection schedules, legal delegations and partnerships with state agencies and cross‑border epidemiologists.

Lopez described three surveillance types: passive surveillance (lab and provider reporting of specific conditions), active surveillance (health department outreach to find additional cases after an exposure is identified) and syndromic surveillance (tracking coded emergency‑room visits for patterns). He said 21 of 83 reportable laboratory‑identified conditions are potentially foodborne or waterborne — roughly 25 percent of reportable conditions — and that the county most commonly sees campylobacter, salmonella, norovirus and E. coli.

Natalie Johnson said the Environmental Health Division has eight field staff, including five registered sanitarians, one sanitarian assigned to on‑site wastewater and two environmental health aides who focus on pools, lodging and lower‑risk inspections. The division has adopted the 2022 FDA Food Code and uses a risk‑based inspection frequency: annual inspections for low‑risk retail (Risk 1), two inspections for limited‑service operations (Risk 2), a minimum of three for full‑service restaurants (Risk 3) and quarterly inspections for high‑risk establishments such as long‑term care facilities and child care (Risk 4).

Johnson said the county emphasizes technical assistance and bilingual outreach for mobile vendors and start‑up food businesses. "We do a lot of technical assistance, help them be successful," she said, noting staff work with vendors before and after opening to reduce risk and keep operations in compliance.

Officials also described cross‑agency work: Arizona Department of Health Services and the county have a delegation agreement that defines local authority for inspections and nuisance complaints; the county works with the Arizona Department of Agriculture and USDA when products fall under their inspection authority; and county epidemiologists participate in binational meetings with Mexican counterparts and state partners to share surveillance data for border communities.

Board members asked about graywater use and the county's role with opt‑out communities. Johnson said the state provides guidance on residential graywater for irrigation and the county uses that pamphlet when education or enforcement is necessary to prevent nuisance conditions.

The presentation closed with an invitation to community partners: public‑information materials and a pamphlet for people considering starting a food business have been distributed to cities and community lenders to encourage early outreach to health staff.