A foodborne outbreak occurs whenever two or more people get sick from the same contaminated food or beverage. If the illnesses occur in two or more states, the situation becomes a multistate foodborne disease outbreak.

The federal Centers for Disease Control in Atlanta is the lead coordinator for public health partners for all multistate foodborne disease outbreaks. The CDC detects the outbreak, defines its size and extent, and identifies the source. Sometimes the CDC does not name the specific company or companies involved.

The Food and Drug Administration, the USDA’s Food Safety and Inspection Service (FSIS), and state and local public health officials may also investigate outbreaks to control them so more people do not get sick and to learn how to prevent similar outbreaks from happening in the future.

The FDA’s Coordinated Outbreak Response and Evaluation (CORE) Network is available to manage not just outbreak response, but surveillance and post-response activities related to incidents involving multiple illnesses linked to FDA-regulated human and animal foods, and cosmetic products.

It’s a good year when the top multistate foodborne outbreaks can be ranked only by the number of illnesses involved. This year was looking like a good year because no outbreak had involved any known deaths.

That changed on Dec. 18 when the CDC reported bulk, fresh hard-boiled eggs produced by Almark Foods of Gainesville, GA, were contaminated with Listeria. Seven illnesses and one death were blamed on the contaminated eggs.

The peeled hard-boiled eggs are packaged in pails for sale to foodservice operators nationwide. Almark has not recalled the eggs. The CDC is warning against selling, serving, using or eating the hard-boiled eggs in other food products.

With that caveat for the one death caused by hard-boiled eggs, we rank the top foodborne diseases outbreaks by the number of illnesses.

241 — Cyclospora

There were multiple outbreaks of cyclosporiasis in 2019, with about 10 percent of the year’s cases tied to fresh imported basil. And that was enough to cause more illnesses than any other foodborne outbreak during 2019

The Cyclospora cayetanensis is a parasite that is so small it can only be seen under a microscope. The parasite invades the intestinal tract via contaminated food and beverages. The 241 illnesses occurred in 11 states without any deaths. Six were admitted to hospitals.

138 — E. coli O157: H7

Another E.coli outbreak involving Romaine lettuce, this one has caused illnesses in 25 states and sent 72 people to hospitals with more serious conditions. CDC says a “common grower” in the Salinas CA growing region is likely responsible, but they’ve not named the culprit.

CDC has warned consumers not to eat Romaine lettuce from the Salinas, CA growing region or any product where the growing region is not known. Growers sometimes voluntarily include the growing region on the label, and sometimes they do not.

The Wisconsin Department of Health Services has linked an unopened bag of Fresh Express leafy green romaine to this outbreak.

137– Salmonella Carrau

In April, CDC warned consumers about recalled pre-cut melon products that would go on to sicken 137 people in ten states and sending 38 to hospitals.

Caito Foods become associated with the outbreak through its Indianapolis facility.

It ceased producing and distributing the products while the FDA investigated.

81 — Salmonella Uganda

Imported Cavi Brand whole, fresh papayas sickened 81 people in nine states with Salmonella Uganda. One-third of those sickened ended up in hospitals.

Most notable was the refusal by Agrisib’s LLC, the exclusive distributor of the Cavi brand papayas, to initiate a recall to the imported fruit. Nor did FDA use its power to order a recall. The agency did, however, go directly to Agroson’s wholesale customers to make sure Cavi brand papayas were removed from the marketplace.

62 — E Coli O157: H7

The 17-state outbreak began in late 2018 but did not end until February 2019. Of 62 cases, it saw 25 or 40 percent require hospital treatment.

The contaminated Romaine blamed in this outbreak also came from California.

The investigation into this outbreak was extensive, causing FDA to “strongly recommend the entire leafy green supply chain adopt traceability best practices and state-of-the-art technology to assure quick, accurate and easy access to key data elements from farm-to-fork when leafy greens are involved in a potential recall or outbreak.”

47 — Scombrotoxin Fish Poisoning

Between August and October, 47 Americans in ten states were victims of scombrotoxin fish poisoning of yellowfin or Ahi Tuna. Only one went to the hospital, and nobody died, but the FDA made Truong Phu Xanh Co. initiate a voluntary recall of its yellowfin tuna.

FDA also said none of the Vietnamese company’s production for 2019 should be consumed. Scombrotoxin fish poisoning occurs when fish is not kept properly chilled or preserved, and it begins to spoil.

33 — E. coli 0121 & 0103

Ground bison supplied by Northfork Bison in Saint Leonard, Quebec, Canada was the likely source of E. coli 0121 and 0103 illnesses in the United States.   The ground bison meat and patties, produced between Feb. 22 and April 30, 2019, was believed to be responsible for the illnesses.

Eighteen of the 38 people or almost half with E. coli infections in eight states required hospitalization.

FDA  regulates bison in the United States because the authority has never been specifically assigned to the USDA’s Food Safety and Inspection Service (FSIS).   The ground bison was sold frozen and may remain in home freezers.

21 — E. coli 026

ADM Milling Co. flout was contaminated with E. coli 026,  causing 21 illnesses in nine states.

Brand Castle, ALDI, King  Arthur, and Pillsbury Best were among the brands quickly recalled.

Three people infected with O26 required hospitalization. The CDC declared the outbreak over in July. However, because of the long shelf life of flour, and consumers’ usual practice of using storage containers while throwing out original packaging, could easily result in more illnesses.

18 — Hepatitis A

Fresh conventional Blackberries from Fresh Thyme Farmers Market and Woodman’s Market are responsible for a six-state Hepatitis A outbreak that has infected 18 and sent ten to hospitals.

The Blackberries were traced back to the two grocery chains.

The FDA urged consumers to not consume fresh conventional Blackberries purchased last September from Fresh Tyme Farmers Markers in 11 states or from Woodman’s Markets in Wisconsin and Illinois.

13 — Salmonella Newport

Thirteen people in seven states were sickened by Salmonella Newport because they consumed frozen ground tuna that was contaminated with the pathogen.  Jensen Tuna recalled the product that it distributed to seven states, but that was also distributed further by others.

The outbreak also caused the FDA to add JK Fish of Vietnam to import alerts.

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