About

Melanie Firestone, PhD, MPH, is an Assistant Professor in the Division of Environmental Health Sciences at the University of Minnesota School of Public Health. Her educational background includes a PhD in Environmental Health Sciences from the University of Minnesota, an MPH in Epidemiology from Columbia University, and a BS in Health & Exercise Science from Wake Forest University. Her research interests focus on the intersection of infectious diseases and environmental health, with particular emphasis on improving public health surveillance to reduce enteric infections. She is especially interested in the role restaurants play in foodborne illness transmission and prevention, as well as how food safety messages are communicated. Prior to joining the School of Public Health, Dr. Firestone served as the CDC Epidemic Intelligence Officer assigned to the Minnesota Department of Health. Her expertise encompasses public health surveillance, infectious disease, foodborne disease, food safety, epidemiology, outbreak investigation, and public health practice. She has contributed to research on infectious disease surveillance, foodborne illness outbreaks, and the impact of restaurant inspection data on understanding foodborne illnesses. Dr. Firestone is actively involved in teaching courses related to foodborne diseases, outbreak detection, and global food systems, and she participates in community engagement through her role as a member representative on the City of Minneapolis Public Health Advisory Committee.

Research topics

• Internal medicine
• Immunology
• Medicine

Selected publications

• Effect of Salmonella Cluster Detection and Investigation Methods on Outbreak Reporting in the United States, 2013–2017

  Journal of Food Protection · 2026-05-07

  articleOpen access

  Cluster detection and outbreak investigation practices and resources vary across states. There is a lack of evidence to evaluate the effectiveness of Salmonella cluster detection and investigation practices on outbreak detection and reporting by states. We conducted an online survey of all 50 U.S. state health departments (HDs) in 2015 to assess how pulsed-field gel electrophoresis (PFGE) cluster detection and outbreak investigation practices and resources at the state affected reporting single-state Salmonella outbreaks to CDC's Foodborne Disease Outbreak Surveillance System (FDOSS) from 2013 to 2017. Increased rates of Salmonella outbreak reporting were observed for states that used a standard hypothesis-generating questionnaire (HGQ) for conducting hypothesis-generating interviews (HGIs) (155% increase), conducted routine HGIs for all cases (85% increase), and used a standard PFGE cluster definition (40% increase) compared to states that did not use these practices. Multivariable regression models demonstrated that participation in the Foodborne Diseases Center for Outbreak Response Effectiveness (FoodCORE) or OutbreakNet Enhanced (OBNE) and per capita funding through Epidemiology and Laboratory Capacity (ELC) grants explained more of the variability in outbreak reporting than individual surveillance practices. Results suggest that the combination of practices promoted by FoodCORE and OBNE enhances the potential effectiveness of the individual practices used in isolation. While PFGE is no longer the standard method for subtyping, these findings demonstrate how surveillance activities relate to outbreak reporting and provide a framework for evaluating the impact of current surveillance practices. With the shift from PFGE to whole genome sequencing (WGS), ongoing evaluation of surveillance practices at state and local levels will be critical to maintaining the evidence base for effective surveillance and reducing the public health burden of Salmonella infections.

  PublisherDOI

• CDC Directed Funding Improves Foodborne Outbreak Reporting in U.S. States, 2009–2022

  Journal of Food Protection · 2025-07-17 · 2 citations

  articleOpen access

  Through Epidemiology and Laboratory Capacity (ELC) cooperative agreements, the US Centers for Disease Control and Prevention (CDC) has funded three programs focused on enhancing foodborne illness outbreak detection and response at the state level-the Foodborne Diseases Centers for Outbreak Response Enhancement (FoodCORE), the Integrated Food Safety Centers of Excellence (Food Safety CoE), and OutbreakNet Enhanced (OBNE). Data from the CDC's Foodborne Disease Outbreak Surveillance System (FDOSS) were used to assess the effect of ELC-funded foodborne programs on single-state foodborne illness outbreak reporting from 2009 to 2022. Based on 2022 program status, participation in these programs was associated with higher rates of reporting compared to states not enrolled in any ELC programs. Average foodborne outbreak reporting rates per million population were 1.54 for states enrolled in No Programs, 2.40 for OBNE states, 3.75 for FoodCORE states, and 4.16 for Food Safety CoE states. For Salmonella, Shiga toxin-producing E. coli, and Listeria (SSL) outbreaks, average reporting rates per million population were 0.37 for states enrolled in No Programs, 0.46 for OBNE states, and 0.69 for FoodCORE and 0.67 for Food Safety CoE states. Overall ELC funding was associated with increased outbreak reporting rates. A one-dollar increase in average ELC funding was associated with an estimated 0.88 (95% CI 0.69, 1.07) unit increase in the single-state foodborne outbreak reporting rate and an estimated 0.14 (95% CI 0.09, 0.19) unit increase in the SSL outbreak reporting rate. Federal support for public health surveillance improves the detection and reporting of foodborne illness.

  PublisherDOI

• Factors Influencing Foodborne Illness Self-Identification From User-Generated Data – Minnesota, 2024

  Journal of Food Protection · 2025-09-02

  articleOpen accessSenior author

  Foodborne illness outbreaks are a serious public health concern; faster identification enables the implementation of control measures to prevent others from becoming ill. User-generated data and artificial intelligence can be used to develop outbreak signals that could be disclosed to the public before they are associated with an actual outbreak of foodborne illness. We employed a vignette-based discrete choice experiment survey to examine when and why individuals would self-identify as ill during a publicized foodborne illness outbreak. Scenarios presented to participants included four attributes describing the event which were publicized in the headlines: the number of people (i.e., 20, 200, 8,500) stated as ill; symptoms (i.e., nausea, vomiting, and diarrhea) included or excluded; a statement that FDA is investigating included or excluded; and a call to action asking readers to report their symptoms included or excluded. The research found that people will self-identify from a publicized foodborne illness event, with a positive association for all attributes. The odds of self-identifying as ill from a publicized foodborne illness event more than doubled when the number of people publicized as ill is 8,500 (OR = 2.42, CI [2.16, 2.71], p < 0.001) or symptoms (OR = 2.21, CI [2.02, 2.42], p < 0.001) are included. This study highlights factors that influence a person to self-identify as ill from a publicized foodborne illness event, regardless of whether an actual outbreak exists, demonstrating a limitation of novel data streams in detecting foodborne illness outbreaks in the absence of public health authority confirmation.

  PublisherDOI

• Recurring bacterial strains, subclusters, and the importance of practising lessons learned

  Epidemiology and Infection · 2024-01-01

  articleOpen access
  PublisherOA PDFDOI

• Surveillance for Unexplained Deaths of Possible Infectious Etiologies During the COVID-19 Pandemic—Minnesota, 2020-2021

  Public Health Reports · 2024-01-11 · 3 citations

  articleOpen access1st authorCorresponding

  OBJECTIVES: Surveillance systems for unexplained deaths that might have an infectious etiology are rare. We examined the Minnesota Department of Health Unexplained Deaths and Critical Illnesses of Possible Infectious Etiology and Medical Examiner Infectious Deaths (UNEX/MED-X) surveillance system,-a system that expanded postmortem surveillance for infectious diseases during the COVID-19 pandemic by leveraging standard (medical examiner [ME]) and expanded (mortuary) surveillance to identify COVID-19-related deaths. METHODS: MEs, coroners, or morticians collected postmortem swabs from decedents with an infectious prodrome or with SARS-CoV-2 exposure before death but with no known recent infectious disease testing. The Minnesota Department of Health Public Health Laboratory used nucleic acid amplification, viral culture, and standard algorithms to test specimens collected postmortem for SARS-CoV-2, influenza virus, and other infectious pathogens. We reviewed UNEX/MED-X data from March 2, 2020, through December 31, 2021, and characterized decedents by location of swab collection (ie, ME or mortuary). RESULTS: From March 2, 2020, through December 31, 2021, the UNEX/MED-X surveillance system received samples from 182 decedents from mortuaries and 955 decedents from MEs. Mortuary decedents were older than ME decedents (median age, 78 vs 46 y). Seventy-three mortuary decedents (40.1%) and 197 ME decedents (20.6%) had SARS-CoV-2 detections. The UNEX/MED-X system identified 212 COVID-19-related deaths, representing 2.0% of total COVID-19-related deaths in Minnesota. Eighty-nine decedents (42.0%) were from racial and ethnic minority populations, representing 6.1% more COVID-19-related deaths among people from racial and ethnic minority populations than would have been detected without this surveillance system. PRACTICE IMPLICATIONS: Expanded and standard UNEX/MED-X surveillance builds capacity and flexibility for responding to emerging public health threats. Similar programs should be considered elsewhere as resources allow.

  PublisherOA PDFDOI

• Unexplained Illnesses Associated With a Subscription Meal Service, 2022

  Journal of Food Protection · 2024-11-21

  articleOpen access1st authorCorresponding

  In recent years, shifting consumer demands have led to changes in the types of foods produced and how consumers obtain them. A growing demand for non-meat-based proteins has led to the development of new plant-based protein products. Simultaneously, there has been an increase in subscription-based meal services. In 2022, a subscription-based meal service, Daily Harvest, launched a new plant-based protein line of products called Crumbles. Shortly, thereafter, consumer complaints of gastrointestinal symptoms were heard, and Daily Harvest recalled the French Lentil and Leek Crumbles, which contained a unique ingredient, tara flour. We obtained case data from the Marler Clark law firm and conducted an epidemiologic investigation of the relationship between illness and consumption of food products distributed by Daily Harvest. We independently reviewed data on 338 people, including 264 people with supplemental food exposure information, and calculated minimal attack rates. Of 264 people who completed the supplemental survey, all (100%) consumed the Lentil and Leek Crumbles. Minimal attack rates were highest for the Lentil and Leek Crumbles (1.4%) followed by the Walnut and Thyme Crumbles (0.45%). Among 213 subscribers, the minimal attack rate was highest for those who purchased three or more units of Lentil and Leek Crumbles (3.72%) compared to those who purchased two units (2.28%) or one unit (1.50%). The strength of the association and the increased risk of illness among persons who consumed Lentil and Leek Crumbles, but not other products that shared ingredients (other than tara flour) with Lentil and Leek Crumbles, suggests that tara flour was likely the source of illness, although a specific etiology remains unknown. This study highlights the value of using nontraditional data to identify sources of illness. Further research is needed to understand the safety of tara flour for human consumption.

  PublisherDOI

• Estimating Underdetection of Foodborne Disease Outbreaks

  Emerging infectious diseases · 2024-10-23 · 1 citations

  letterOpen access
  PublisherDOI

• Reply to Willoughby

  Clinical Infectious Diseases · 2023-05-18

  letterOpen access
  PublisherOA PDFDOI

• Patient Characteristics During Early Transmission of SARS-CoV-2, Palau, January 13–February 24, 2022

  Emerging infectious diseases · 2023-08-24 · 1 citations

  letterOpen access

  Palau had no reported evidence of COVID-19 community spread until January 2022. We chart reviewed hospitalized patients who had a positive SARS-CoV-2 test result during early community transmission. Booster vaccinations and early outpatient treatment decreased hospitalizations. Inadequate hospital infection control practices contributed to iatrogenic COVID-19 and preventable deaths.

  PublisherOA PDFDOI

• Rapid onset of functional tic-like behaviors among adolescent girls—Minnesota, September–November 2021

  Frontiers in Neurology · 2023-01-19 · 4 citations

  articleOpen access1st authorCorresponding

  Background: On October 15, 2021, the Minnesota Department of Health began investigating a school cluster of students experiencing tic-like behaviors thought to be related to recent COVID-19. The objective of this report is to describe the investigation, key findings, and public health recommendations. Methods: Affected students and proxies were interviewed with a standardized questionnaire including validated depression and anxiety screens. Results: Eight students had tic-like behaviors lasting >24 h after initial report with onset during September 26-October 30, 2021. All eight students were females aged 15-17 years. All students either had a history of depression or anxiety or scored as having more than minimal anxiety or depression on validated screens. Four students previously had confirmed COVID-19: the interval between prior COVID-19 and tic symptom onset varied from more than a year prior to tic symptom onset to at the time of tic symptom onset. Conclusion: The onset of tic-like behaviors at one school in Minnesota appeared to be related more to underlying mental health conditions than recent COVID-19. These findings highlight the need to better understand functional tic-like behaviors and adolescent mental health.

  PublisherOA PDFDOI

Frequent coauthors

• Stacy Holzbauer

  37 shared

• Ruth Lynfield

  Minnesota Department of Health

  16 shared

• Craig W. Hedberg

  University of Minnesota

  14 shared

• Joseph T. Hicks

  Imperial College London

  13 shared

• Richard Danila

  Minnesota Department of Health

  13 shared

• Stella S. Yi

  New York University

  12 shared

• Hannah E. Segaloff

  11 shared

• Matthew Donahue

  Nebraska Department of Health and Human Services

  11 shared

Education

• Ph.D., Public Health

  University of Minnesota

  2005

• Other, Public Health

  University of Minnesota

  2001

• B.A., Environmental Science

  University of California, Berkeley

  1997