Fiction Reboot Presents: Nina Post and Epidemiology

FictionReboot2_posterWelcome back to the Fiction Reboot!

Today, we are joined once again by Nina Post, author of One Ghost Per Serving. Nina is a Seattle-based author who has also written Danger in Cat World, The Last Condo Board of the Apocalypse, and The Last Donut Shop of the Apocalypse. In her latest, however, Nina returns to the world of One Ghost–and the troubled and sometimes nefarious world of food safety. Humorous and witty, Nina’s writing looks at the incongruities of life–and also of health. In researching for this new release, she has crossed into the equally engaging world of science and medicine, and particularly epidemiology. Given the blog’s twin focus on fiction and medical humanities, I have asked Nina to elaborate on the interstices of fiction writing and research. It just goes to show: medical history is hiding behind every corner, and it enriches the texts of which it is part. Thank you, Nina, for joining us!

Don’t Even Think About Calling it the Stomach Flu: A Look at Epidemiology and Extra Credit Epidemic

Taffy Snackerge is the main character in my next book, Extra Credit Epidemic. Even at the age of twelve — when she made her first appearance in One Ghost Per Serving — Taffy was obsessed with zoonotic and emerging infectious diseases, and suspicious of restaurant workers, food that wasn’t boiled, and animals. If forced to eat at a restaurant, she would read the health inspector’s reports beforehand. As a votary of science, she did her science fair project on microbiota and found it fascinating that the girl she liked was impervious to foodborne pathogens (must’ve been a mutant gene).

In Extra Credit Epidemic, Taffy is a high school senior and remains fixated on infectious diseases. She’s considering a career in public health, despite her stunning lack of diplomacy when interacting with the public. In Epidemic, she falls for the detective, not just the scientific, aspects of outbreak investigation.

While researching some of the scientific topics that play a role in the book, I read several outbreak investigations and talked with a state epidemiologist via email. Though I had a pretty solid understanding of food safety and foodborne pathogens before writing Epidemic, working on the book raised my level of awareness and context. I found a few key resources of information and models for outbreak investigation in addition to the CDC. These included the Indiana State Department of Health’s Epidemiology Resource Center, and the Minnesota Department of Health’s Foodborne Diseases Unit. I used ProQuest to find the detailed accounts of outbreaks and some ancillary material.

As it turns out, the most common cause of foodborne-disease outbreaks in the U.S. — norovirus — is often referred to incorrectly as “stomach flu” (a phrase that Taffy hates). Norovirus isn’t related to influenza, which is a respiratory illness caused by influenza virus. I also refer to listeriosis and e. coli infections in the book, mainly as payoffs in a scene where Taffy has to prove herself by doing something she thought she’d never do. But as the epidemiologist I spoke with pointed out, it was more feasible that a salmonella outbreak would be under the radar and would allow my team in Epidemic the latitude of pursuing it on their own.

That’s not to say that salmonella isn’t a concern. According to the CDC, approximately 42,000 cases of salmonellosis are reported in the U.S. every year. Because milder cases aren’t diagnosed or reported, the actual number of infections may be considerably greater. In Epidemic, Taffy’s close watch on public health surveillance data turns up a salmonella outbreak she wants to investigate — although she’d rather not have to leave the lab. Her teacher — a former epidemiologist — says he’ll help her on one condition, which forces her way out of her comfort zone.

In Epidemic, I highlighted how health departments are often woefully underfunded. This helps create the circumstances in which a team of high-schoolers can accomplish what the authorities can’t. For example, public health departments reported 1,527 foodborne disease outbreaks during 2009 and 2010, resulting in 29,444 cases of illness, 1,184 hospitalizations, and 23 deaths. That’s a lot of ground to cover.

Extra Credit Epidemic is scheduled for release in July. Whether or not readers are approaching the book with any prior knowledge of food safety, I think the story will appeal to both YA and adult audiences alike.

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