Multistate Foodborne Disease Outbreaks Sicken Thousands

Multistate outbreaks cause more than half of all deaths in foodborne disease outbreaks despite accounting for only a tiny fraction (three percent) of reported outbreaks in the United States, according to a November 3, 2015 CDC report. Multistate outbreaks can be hard to detect. Contaminated food grown or produced in a single place can wind up in kitchens across America. People in many states may get sick from a contaminated food, making it difficult to spot the outbreak.


The leading causes of multistate outbreaks – Salmonella, E. coli, and Listeria – are more dangerous than the leading causes of single-state outbreaks. These three germs, which cause 91 percent of multistate outbreaks, can contaminate widely distributed foods, such as vegetables, beef, chicken, and fresh fruits, and end up sickening people in many states. If the problem is a contaminated ingredient, people may unknowingly eat it in many different foods. Unexpected foods have been linked to recent multistate outbreaks, such as caramel apples and chia powder.


“Americans should not have to worry about getting sick from the food they eat,” said CDC Director Tom Frieden, M.D., M.P.H. “Top-notch epidemiology and new gene sequencing tools are helping us quickly track down the source of foodborne outbreaks – and together with our national partners we are working with the food industry to prevent them from happening in the first place.”


The CDC report analyzed data from the CDC’s Foodborne Disease Outbreak Surveillance System during 2010 to 2014. CDC scientists compared the number of illnesses, hospitalizations, and deaths from outbreaks in two or more states with those from outbreaks that occurred in a single state. They found that the 120 multistate outbreaks during the five-year study period were responsible for 11 percent of all foodborne outbreak illnesses, 34 percent of hospitalizations, and 56 percent of deaths. An average of 24 multistate outbreaks occurred each year, involving two to 37 states.


Other highlights from the report on multistate foodborne outbreaks during 2010-2014 include:


  • Salmonella accounted for the most illnesses and hospitalizations and was the cause of the three largest outbreaks, which were traced to eggs, chicken, and raw ground tuna.
  • Listeria caused the most deaths, largely due to an outbreak caused by contaminated cantaloupe in 2011 that killed 33 people.
  • Imported foods accounted for 18 of the 120 reported outbreaks. Food imported from Mexico was the leading source in these outbreaks, followed by food imported from Turkey.


The CDC report recommends that local, state, and national health agencies work closely with food industries to understand how their foods are produced and distributed to speed multistate outbreak investigations. These investigations can reveal fixable problems that resulted in food becoming contaminated and lessons learned that can help strengthen food safety. Contaminated food can be hard to trace to the source. Many different farms may produce the beef in a single burger or the fresh vegetables sold in a single crate.


The report highlights the need for food industries to play a larger role in improving food safety by following best practices for growing, processing, and shipping foods. In addition, food industries can help stop outbreaks and lessen their impact by keeping detailed records to allow faster tracing of foods from source to destination, by using store loyalty cards to help identify which foods made people sick, and by notifying customers of food recalls.


Under the 2011 FDA Food Safety Modernization Act, the FDA is developing new regulations that will not only require importers to verify that their suppliers are meeting U.S. food safety standards, but will hold both domestic and foreign companies accountable for preventing foodborne illness before it occurs. Final regulations for preventive controls were announced in September, and additional regulations covering produce, imported foods, intentional adulteration and sanitary transportation are expected in coming months.


“The continued partnership of FDA, CDC, USDA and our partners at the state and local levels is essential to responding to foodborne outbreaks. But consumers should be able to have confidence that steps are being taken from farm to table to minimize the risk of illness from the food they feed their families,” said FDA Deputy Commissioner for Foods and Veterinary Medicine, Michael R. Taylor. “By continuing to work with our government partners and industry, we can build a food safety system and culture focused on prevention.”


Over the past six years, the U.S. Department of Agriculture (USDA) has taken an increasingly science-based approach to preventing foodborne illness, relying heavily on available data, trends, and technological advances.


“The USDA Food Safety and Inspection Service’s top priority is preventing multistate foodborne illness outbreaks from occurring. As we look toward the future, USDA will continue to work with FDA, CDC, industry, and the states to advance our science-based approach to food safety,” said Phillip Derfler, USDA Deputy Administrator for the Food Safety and Inspection Service. “By focusing on collaboration and modernization, we are confident that there will be a decline in multistate outbreaks.”


See the CDC Announcement


See the CDC Report


See also Medical Law Perspectives, July 2012 Report: Foodborne Illness: When Grabbing a Bite Can Be Deadly