The Top 10 most important outbreaks of 2016, according to the editors of Food Safety News, are presented here. Outbreaks were chosen for the list on a subjective basis, ranked by the number of fatalities and then the number of illnesses for outbreaks involving more than a single state.

The 2016 Top 10 outbreaks include a total of 10 deaths. Four of the outbreaks involved salmonella, three listeria, two Hepatitis A, and one E. coli. Interestingly, salmonella resistant to antibiotics came into play in one of the Top 10 and the single E. coli outbreak did not involve beef, but flour.

1. Live poultry and backyard flocks
Deadly and widespread, the were actually eight multi-state outbreaks of human Salmonella infections linked to live poultry and backyard flocks. They received barely a moment’s notice when the casualties were announced on Oct. 2, 2016. The report said three people died among the 895 confirmed cases of Salmonella, of which 209 required hospitalization. The cases were spread across 48 states. Salmonella serotypes  in the outbreaks included Enteritidis, Muenster, Hada, Indiana, Mbandaka, Infantis, Braenderup and topten2016_406x250Infantis. The Centers for Disease Control and Prevention found the victims had contact with live poultry and chicks from multiple hatcheries in the week before becoming ill. CDC cautioned people with backyard flocks on how to lower the risk of infections.

2. Frozen vegetables linked to outbreak of Listeria
More than 350 consumer products sold under 42 brand names and at lesst 100 other products prepared with ingredients from CRF Frozen Foods were recalled, but not before nine people in four states were put in hospitals with Listeria. Three died. CRF began recalling products April 23, 2016, and then on May 2, 2016, expanded its recall to included all organic and traditional frozen vegetable and fruit products produced at its Pasco, WA facility since May 1, 2014.

3. Hepatitis A from raw scallops
Two Hawaiians are dead and at least 292 were infected with Hepatitis A in 2016’s No. 3 outbreak. Raw scallops, which were harvested in the Philippines and served at Genki Sushi restaurants on Oahu and Kauai, were the likely source of the outbreak, according to the Hawaii Department of Health (HDOH). On Aug. 18, 2016, Sea Port Products Corp. recalled three lots of frozen bay scallops produced Nov. 23-24, 2015, in the Philippines and distributed to California, Nevada and Hawaii. CDC reports no Hepatitis A infections sourced to scallops outside of Hawaii. HDOH ordered the scallops embargoed and the temporarily closed the restaurants. Many Hawaii residents and visitors sought vaccinations, and all were on lookout for symptoms, which include yellow eyes or skin, abdominal pain, pale stools and dark urine. Except for 11 residents of Hawaii, Kauai, and Maui, and seven visitors who returned to the mainland or overseas, all the Hepatitis A victims were from Oahu.

4. Listeria linked to Dole packaged salads
One death was confirmed among 19 Listeria cases in nine states that were linked to packaged salads produced at the Dole processing plant in Springfield, OH. First reported on Jan. 22, 2016, all 19 Listeria victims required hospitalization. Dole recalled all salad mixes produced at its Springfield, OH, processing facility that were still on the market or in people’s homes. Isolates in the U.S. outbreak were also closely related to Listeria isolates from ill people in Canada. The fatality attributed to the outbreak was from Michigan and one of the illnesses was a pregnant woman.

5. Listeria outbreak linked to raw milk from Miller’s Organic Farm
On March 17, 2016, CDC issued one of its most controversial reports of the year. It had been unable to name the source of two Listeria illnesses that occurred in 2014 until whole genome sequencing of Listeria bacteria from raw milk produced by Miller’s Organic Farm showed it was “closely related” genetically — the phrase scientists use when regular people would say “matches” — to Listeria bacteria from cases investigated two years earlier. Raw milk advocates cried foul over the report, which led to a federal court ordering Miller’s Farm in Bird-in-Hand, PA, to submit to USDA’s inspection. CDC stuck to its science that the two cases, including a death in Florida, were linked to unpasteurized raw milk from Miller’s.

6. Hepatitis A linked to frozen strawberries
The second largest Hepatitis A outbreak of 2016 did not involve any deaths, but did result in 134 illnesses in nine states. Of those, 129 people reported eating a smoothie containing strawberries from a Tropical Smoothie Café. And 52 people with Hepatitis A symptoms, including yellow eyes or skin, abdominal pain, pale stools and dark urine, required hospitalization. On Oct. 30, 2016, The International Company for Agricultural Production and Processing (ICAPP) recalled strawberries imported from Egypt going back to Jan. 1, 2016. The frozen strawberries were imported for use by foodservice operations across the country, including restaurants, schools, hospitals, hotels and a wide variety of other entities.

7. E. coli infections linked to flour
On Sept. 29, 2016, CDC said the outbreak involving Shiga-toxin producing Escherichia coli (STEC) infections from flour was over, but illnesses might continue for “some time.” That’s because flour and other dry products with flour as an ingredient typically remain in people’s homes for a long time because of long shelve lives. That’s why consumers who are unaware of all the recalls associated with the seventh most important outbreak of 2016 might continue to get sick. When it was declared “over,” the flour outbreak had seen 63 confirmed illnesses in 24 states. No deaths were reported, but 17 victims required hospitalization. One victim developed the sometimes fatal hemolytic uremic syndrome or HUS. The epidemiologic, laboratory and traceback evidence all pointed at the General Mills facility in Kansas City, MO, as the source of the outbreak. On May 31, 2016, General Mills recalled several sizes and varieties of Gold Medal, Gold Medal Wondra  and Signature Kitchens flour because of possible E. coli contamination. In June and July, respectively, FDA isolated STEC O121 and STEC O26 in open samples of General Mills flour collected from homes of ill people in multiple states. The outbreak also caused FDA and CDC to repeat warnings not to eat raw dough or batter. Numerous products made with the recalled flour were also recalled.

8. Salmonella Virchow linked to Garden of Life organic product
Six of the 33 Salmonella Virchow cases linked to Garden of Life Raw Meal Organic Shake & Meal Products from 23 states required hospitalization. No deaths resulted. All the epidemiologic and laboratory evidence indicated Raw Meal Organic Shake & Meal products made by Garden Life LLC was the likely source of outbreak. Garden of Life recalled several lots of the product in chocolate, original, vanilla, and vanilla chai on Jan. 29, 2016.

9. Salmonella linked to sprouts from contaminated seed lot
One seed lot was found responsible for alfalfa sprouts that were contaminated with Salmonella Muenchen and Salmonella Kentucky. The final CDC report on the outbreak came out on May 13, 2016, and said there were 26 confirmed cases across 12 states. There were no deaths, but eight people required hospitalization. Investigations by FDA and state health departments traced all the contaminated sprouts back to Sweetwater Farms in Inman, KS. Kansas officials warned the public not to eat alfalfa sprouts produced by Sweetwater Farms on Feb. 19, 2016, and a week later Sweetwater withdrew all its products from the market. FDA worked to keep any additional contaminated seed from reaching the market.

10. Multi-drug resistant Salmonella Heidelberg infections linked to bull calves
Late in the year, on Nov. 28, 2016, the CDC announced 21 confirmed cases of Salmonella Heidelberg in eight states that were notable for being resistant to multiple drugs and involving contact with bull calves. Eight of 21 sick people required hospitalization. Epidemiologic, traceback and laboratory findings identified dairy bull calves from livestock markets in Wisconsin as the likely source of the infections. The dairy bull calves involved in the outbreak were also purchased for 4-H projects. In interviews, health officials found 79 percent of the ill people reported contact with bull calves or other cattle before they become sick. CDC has concluded the human illnesses are linked to ill calves as labotratory testing identified Salmonella Heidelberg in the calves. More troubling, isolates from ill people were found to be resistant to antibiotics, which limits treatment options.

(To sign up for a free subscription to Food Safety News, click here.)