CDC: Multistate Outbreaks Account for Fraction of Total Outbreaks, but Cause the Most Deaths

CDC: Multistate Outbreaks Account for Fraction of Total Outbreaks, but Cause the Most Deaths
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November 3, 2015

Multistate outbreaks cause more than half of all deaths in foodborne disease outbreaks despite accounting for only 3 percent of reported outbreaks in the United States, according to a new Vital Signs report released today by the Centers for Disease Control and Prevention (CDC).

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.

The Vital Signs report analyzed data from CDC's Foodborne Disease Outbreak Surveillance System during 2010-2014. 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.

Of the three, E. coli seems to have caused the fewest problems. Salmonella accounted for the most illnesses and hospitalizations, but listeria caused the most deaths, largely due to a 2011 outbreak traced back to contaminated cantaloupe in which 33 people died. Salmonella caused the three largest outbreaks, which were traced to eggs, chicken and raw ground tuna.

The majority of the outbreaks were linked back to domestically sourced food with only 18 of the 120 reported outbreaks including imported foods. Foods imported from Mexico was the leading source of these outbreaks, followed by Turkey.

The Vital Signs 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.

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 Food and Drug Administration (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.

"Americans should not have to worry about getting sick from the food they eat," CDC Director Tom Frieden said in a statement.

For information on food recalls and to learn more about how to safely handle and prepare food, consumers can check They can also consider getting and using store loyalty cards so stores can contact them if they purchase a recalled product.