Multi-state outbreaks are not particularly common, but they are particularly dangerous. A little more than half of all deaths associated with foodborne outbreaks come from multi-state outbreaks, according to a new report released Tuesday, Nov. 3, by the Centers for Disease Control and Prevention Tuesday as part of its latest Vital Signs issue. According to data from CDC’s Foodborne Disease Outbreak Surveillance System, there were 120 multi-state foodborne disease outbreaks reported in the U.S. between 2010 and 2014.

Although these outbreaks accounted for only 3 percent of all reported foodborne outbreaks, they were responsible for 11 percent of illnesses, 34 percent of hospitalizations, and 56 percent of deaths associated with foodborne outbreaks. Salmonella, Shiga toxin-producing E. coli (STEC), and Listeria monocytogenes were the leading culprits in multi-state outbreaks, and CDC notes that these more dangerous pathogens account for the disproportionate effect they have compared to localized outbreaks. Salmonella was responsible 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. The three most common Salmonella serotypes identified were Newport, Enteritidis, and Javiana. Among the 34 STEC outbreaks, almost half were linked to vegetable row crops, such as leafy greens, and another one-quarter of them were linked to beef. Dairy prod­ucts, sprouts, and fish were also reported. Of the STEC outbreaks, 20 were caused by serogroup O157, while serogroups O26 and O145 were responsible for three outbreaks each. Listeria was responsible for the most deaths, largely due to an outbreak caused by contaminated cantaloupe in 2011 that killed 33 people. Six deaths resulted from contaminated dairy products, three from con­taminated fruit, and one from sprouts. 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. During 2010-2014, investigators conducted product tracebacks for 87 of the multi-state outbreaks and, in 55 cases, food was ultimately recalled. An average of 24 multi-state outbreaks occurred per year. The median number of states involved in each outbreak was six. All states, the District of Columbia, and Puerto Rico were affected by one or more multi-state foodborne disease outbreaks during the five-year period. The median number of cases per outbreak was 22. CDC is using the findings from the report to emphasize that the government and the food industry need to do more to protect the public’s health and stop outbreaks from happening. “Americans shouldn’t have to worry about getting sick from the food they eat,” CDC Director Tom Frieden told reporters Tuesday. “We have done a lot to improve food safety, but we need to do more.” This report “comes at a time of increasing federal focus on ways to improve food safety and reduce foodborne disease,” Frieden said. “That includes the new Food Safety Modernization Act regulations from the Food and Drug Administration, and new USDA standards designed to reduce Salmonella and Campylobacter contamination in chicken and turkey.” The report also notes some of the things companies can do to improve food safety, such as maintaining records that enable the rapid tracing of foods and using only those suppliers who apply food safety best practices. Collaboration between industry and government can also speed up outbreak investigations and traceback processes and share lessons learned to reduce the likelihood of future outbreaks. (To sign up for a free subscription to Food Safety News, click here.)