Emphasize the breadth and flexibility of this network. One good example of the inter-relationship is from the 1993 E.coli 0 157 outbreak in Washington State caused by undercooked hamburgers sold by a fast food chain. The outbreak was first suspected by pediatric emergency care providers and hospital laboratories, confirmed by state and local public health laboratories and epidemiologists. The fact that there were so few deaths was due to the outstanding performance of the care system, using the current best practices for aggressive disease management. The fact that there were so few second-generation cases (those caused by exposure to people who got the disease from the first source) was due to an outstanding effort to educate anyone providing child care services in the affected communities. The entire episode led to revision of food handling regulations for ground beef, and increased cooking time requirements to minimize chances of disease transmission. This episode also provided part of the impetus for the new USDA meat inspection rules.