CDC: 888 sick, 191 hospitalized, 6 dead from imported cucumbers

The U.S. Centers for Disease Control and Prevention reports that since the last update on November 19, 2015, 50 more ill people have been reported from 16 states.

cucumber.facialTwo additional deaths were reported from California, bringing the total number of deaths to 6. According to the California Department of Public Health, Salmonella infection was not considered to be a contributing factor in either of these 2 additional deaths.

Tennessee was added to the list of states with ill people, bringing the total number of states to 39.

The number of reported illnesses has declined substantially since the peak of illnesses in August and September; however, it has not returned to the number of reported illnesses that we would expect to see (about 1 every month during this time of year). The investigation into the source of these recent illnesses is ongoing.

CDC, multiple states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Salmonella Poona infections.

Epidemiologic, laboratory, and traceback investigations identified cucumbers imported from Mexico and distributed by Andrew & Williamson Fresh Produce as a likely source of the infections in this outbreak.

Two recalls of cucumbers that may be contaminated with Salmonella were announced in September 2015 as a result of this investigation: Andrew & Williamson Fresh Produce and Custom Produce Sales.

animal.house.cucumber888 people infected with the outbreak strains of Salmonella Poona have been reported from 39 states, an increase of 50 cases since the last update on November 19, 2015.

191 ill people have been hospitalized, and six deaths have been reported from Arizona (1), California (3), Oklahoma (1), and Texas (1). Salmonella infection was not considered to be a contributing factor in two of the three deaths in California.

Whole genome sequencing (WGS) showed that the strains of Salmonella Poona from ill persons and from contaminated cucumbers distributed by Andrew & Williamson Fresh Produce are closely related genetically.

WGS of isolates from people who became ill in October and November are also closely related genetically to isolates from people who became ill during the peak of the outbreak and to isolates from contaminated cucumbers.

The source of contamination for the cucumbers distributed by Andrew & Williamson Fresh Produce has not been identified.

The number of reported illnesses has declined substantially since the peak of illnesses in August and September; however, it has not returned to the number of reported illnesses that we would expect to see (about 1 every month this time of year). The investigation into the source of these recent illnesses is ongoing.

cucumber.spain,MEPWhole genome sequencing results from recent illnesses suggest it is likely that there is a common source of ongoing contamination.

Interviews of persons who became ill after the end of September have not identified an additional food item linked to illness.

Investigations are under way to determine if cross-contamination within the distribution chain for the recalled cucumbers could explain recent illnesses.

 

Chipotle’s processing changes: soundbite edition

I missed out on chatting with Jim-don’t-call-me-Louis-CK-Cramer but CNBC’s Closing Bell continues to cover the Chipotle outbreak anthology.

CNBC also has a decent breakdown of how outbreaks are investigated (good background for food company executives so they don’t say that CDC is picking on them).

Doctors and lab technicians are required to alert health authorities if a patient is diagnosed with any of a number of diseases, including many food borne illnesses. The reports made to state health departments help to collect data and determine disease trends.

The state health departments use techniques such as serotyping, which identifies more particular types of a given bacteria, like Salmonella. They also do DNA “fingerprinting,” which isolates variable elements in a string to be matched to other DNA found in a cluster.

They input their findings into a system called PulseNet.

One problem for the CDC in identifying fresh produce as the source of an outbreak is that by the time investigators find the food, the infected produce could be spoiled and no longer available for testing. Between physicians, state health authorities and CDC lab testing, the whole process can take weeks.

That means it’s likely that once you read about people taken ill in the news, they were infected a while ago. The illnesses that were reported the week of Dec. 21 started between Nov. 18 and 26, for example.

Don’t stand so close to me: Gastro events amongst US folks

I don’t like The Police, but I do like government surveillance systems that help us all know where people are barfing and why.

vomitAcute gastroenteritis (AGE) is a major cause of illness in the United States, with an estimated 179 million episodes annually. AGE outbreaks propagated through direct person-to-person contact, contaminated environmental surfaces, and unknown modes of transmission were not systematically captured at the national level before 2009 and thus were not well characterized.

Reporting Period: 2009–2013.

Description of System: The National Outbreak Reporting System (NORS) is a voluntary national reporting system that supports reporting of all waterborne and foodborne disease outbreaks and all AGE outbreaks resulting from transmission by contact with contaminated environmental sources, infected persons or animals, or unknown modes. Local, state, and territorial public health agencies within the 50 U.S. states, the District of Columbia (DC), five U.S. territories, and three Freely Associated States report outbreaks to CDC via NORS using a standard online data entry system.

Results: A total of 10,756 AGE outbreaks occurred during 2009–2013, for which the primary mode of transmission occurred through person-to-person contact, environmental contamination, and unknown modes of transmission. NORS received reports from public health agencies in 50 U.S. states, DC, and Puerto Rico. These outbreaks resulted in 356,532 reported illnesses, 5,394 hospitalizations, and 459 deaths. The median outbreak reporting rate for all sites in a given year increased from 2.7 outbreaks per million population in 2009 to 11.8 outbreaks in 2013. The etiology was unknown in 31% (N = 3,326) of outbreaks. Of the 7,430 outbreaks with a suspected or confirmed etiology reported, norovirus was the most common, reported in 6,223 (84%) of these outbreaks. Other reported suspected or confirmed etiologies included Shigella (n = 332) and Salmonella (n = 320). Outbreaks were more frequent during the winter, with 5,716 (53%) outbreaks occurring during December–February, and 70% of the 7,001 outbreaks with a reported setting of exposure occurred in long-term–care facilities (n = 4,894). In contrast, 59% (n = 143) of shigellosis outbreaks, 36% (n = 30) of salmonellosis outbreaks, and 32% (n = 84) of other or multiple etiology outbreaks were identified in child care facilities.

Interpretation: NORS is the first U.S. surveillance system that provides national data on AGE outbreaks spread through person-to-person contact, environmental contamination, and unknown modes of transmission. The increase in reporting rates during 2009–2013 indicates that reporting to NORS improved notably in the 5 years since its inception. Norovirus is the most commonly reported cause of these outbreaks and, on the basis of epidemiologic data, might account for a substantial proportion of outbreaks without a reported etiology. During 2009–2013, norovirus accounted for most deaths and health care visits in AGE outbreaks spread through person-to-person contact, environmental contamination, and unknown modes of transmission.

Public Health Action: Recommendations for prevention and control of AGE outbreaks transmitted through person-to-person contact, environmental contamination, and unknown modes of transmission depend primarily on appropriate hand hygiene, environmental disinfection, and isolation of ill persons. NORS surveillance data can help identify priority targets for the development of future control strategies, including hygiene interventions and vaccines, and help monitor the frequency and severity of AGE outbreaks in the United States. Ongoing study of these AGE outbreaks can provide a better understanding of certain pathogens and their modes of transmission. For example, certain reported outbreak etiologies (e.g., Salmonella) are considered primarily foodborne pathogens but can be transmitted through multiple routes. Similarly, further examination of outbreaks of unknown etiology could help identify barriers to making an etiologic determination, to analyze clinical and epidemiologic clues suggestive of a probable etiology, and to discover new and emerging etiologic agents. Outbreak reporting to NORS has improved substantially since its inception, and further outreach efforts and system improvements might facilitate additional increases in the number and completeness of reports to NORS.

Outbreaks of Acute Gastroenteritis Transmitted by Person-to-Person Contact, Environmental Contamination, and Unknown Modes of Transmission — United States, 2009–2013

Centers for Disease Control and PreventionMorbidity and Mortality Weekly Report; Surveillance Summaries; December 11, 2015 / 64(SS12);1-16

E. coli O157 in chicken salad: FDA can’t find it in celery-onion mix, but epi still counts (maybe it was an herb)

JoNel Aleccia of The Seattle Times writes that federal food-safety officials haven’t nabbed a culprit after all in an E. coli outbreak tied to Costco chicken salad that sickened 19 and led to the recall of 155,000 food products last month.

costco-rotisserie-chickenOfficials with the Food and Drug Administration said Tuesday that tests failed to identify E. coli O157: H7 from a sample of celery and onions from Taylor Farms Pacific Inc., of Tracy, Calif.

“The ongoing investigation has not identified a specific ingredient responsible for the illnesses,” the FDA wrote in a statement.

The celery-onion mixture was identified as the potential source of contamination in Costco rotisserie-chicken salad that was linked to 19 illnesses in seven states as of Nov. 23.

That was based on five preliminary tests by the Montana Department of Health, which indicated the presence of the bug in chicken-salad samples from a Montana Costco. In response, Taylor Farms voluntarily recalled multiple products that contained the celery mix on Nov. 26, followed by an expanded recall a week later.

Costco pulled the chicken salad from store shelves on Nov. 20 and stopped production.

Still, that doesn’t mean the bug wasn’t in the samples, only that later tests couldn’t find it, the FDA noted. The samples were analyzed with a rapid test to screen for bacteria. But later analysis may have failed to find the germ because other bacteria could have grown, too; there were too few of the bacteria in question to detect; they may have been hard to isolate; or they could have died off over time.

“This does not let celery off the hook,” said Craig Wilson, Costco’s vice president of food safety and quality assurance.

The salad was composed of chicken, high-acid salad dressing and the celery/onion mix. Only the vegetables have been known to be associated with E. coli outbreaks, Wilson noted.

The U.S. Centers for Disease Control said the ongoing investigation is working to identify which specific ingredient in the chicken salad is linked to illness. The celery and onion diced blend has not been ruled out as a source of the outbreak. Updates will be provided when more information is available.

52 sick with E. coli O26 linked to Chiptole; tightening suppliers

As the number of confirmed cases of E. coli O26 linked to Chipotle restaurants increased to 52 in nine states, the company says it’s revamping its food-supply standards.

portland-press-herald_3512878Chipotle will work with Seattle-based IEH Laboratories and Consulting Group, unveiled a new safety program that includes improving its supply chain and doing DNA testing of produce. Chipotle also is retooling its training to help employees handle food more carefully.

“While it is never possible to completely eliminate all risk, this program eliminates or mitigates risk to a level near zero, and will establish Chipotle as the industry leader in this area,” Mansour Samadpour, head of IEH Laboratories, said in a statement.

USA Today said Chipotle Mexican Grill will soon have stricter guidelines for its suppliers that will mean the chain will be using local produce less often.

Chris Arnold, a company spokesman, said in an e-mail Wednesday that the company plans on formally releasing some of its changes in the coming days, if not sooner.

“We do expect that some of the local suppliers we have used will not meet more stringent testing standards we have put in place,” Arnold said.

Goalies be goalies, and hockey rinks can be sources of CO

Maybe all that Zamboni CO got to me when I was a kid spending hours at the hockey arena.

mike.myers.zamboniI used to think I was fast enough to not worry too much about upper body padding.

I’m not fast enough anymore.

I played my first game in 10 years on Sunday, except for one in Guelph and one last year in which I let in 12 goals on what felt like 70 shots, and ripped my ACL.

We lost 3-1, but were outshot 22-10. I did OK. The team did great (I also coach this bunch of adults, and like any good coach, just want to see continuous improvement and having fun – and sweat).

In fortuitous timing, my fab partner Amy ordered me an early Xmas present which arrived today.

dp.chest.protectorThis is my 20-or 30-year-old chest protector, this is my new one.

And this is my happy face.

But public health takes place at the arena too.

The U.S. Centers for Disease Control reported last week that on December 13, 2014, the emergency management system in Lake Delton, Wisconsin, was notified when a male hockey player aged 20 years lost consciousness after participation in an indoor hockey tournament that included approximately 50 hockey players and 100 other attendees.

Elevated levels of carbon monoxide (CO) (range = 45 ppm–165 ppm) were detected by the fire department inside the arena. The emergency management system encouraged all players and attendees to seek medical evaluation for possible CO poisoning.

dp.chest.protector.22The Wisconsin Department of Health Services (WDHS) conducted an epidemiologic investigation to determine what caused the exposure and to recommend preventive strategies. Investigators abstracted medical records from area emergency departments (EDs) for patients who sought care for CO exposure during December 13–14, 2014, conducted a follow-up survey of ED patients approximately 2 months after the event, and conducted informant interviews. Ninety-two persons sought ED evaluation for possible CO exposure, all of whom were tested for CO poisoning. Seventy-four (80%) patients had blood carboxyhemoglobin (COHb) levels consistent with CO poisoning (1); 32 (43%) CO poisoning cases were among hockey players. On December 15, the CO emissions from the propane-fueled ice resurfacer were demonstrated to be 4.8% of total emissions when actively resurfacing and 2.3% when idling, both above the optimal range of 0.5%–1.0% (2,3). Incomplete fuel combustion by the ice resurfacer was the most likely source of elevated CO. CO poisonings in ice arenas can be prevented through regular maintenance of ice resurfacers, installation of CO detectors, and provision of adequate ventilation.

 

4 dead, 834 sick from Salmonella in cucumbers from Mexico

Who knew cucumbers could be so vile?

cucumber.spain,MEPThe U.S. Centers for Disease Control, multiple states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Salmonella Poona infections.

Epidemiologic, laboratory, and traceback investigations identified cucumbers imported from Mexico and distributed by Andrew & Williamson Fresh Produce as a likely source of the infections in this outbreak.

Two recalls of cucumbers that may be contaminated with Salmonella were announced as a result of this investigation: Andrew & Williamson Fresh Produce and Custom Produce Sales.

838 people infected with the outbreak strains of Salmonella Poona have been reported from 38 states, an increase of 71 cases since the last update on October 14.

165 ill people have been hospitalized, and four deaths have been reported from Arizona (1), California (1), Oklahoma (1), and Texas (1).

Safer food saves lives

That’s the view from the U.S. Centers for Disease Control and Prevention, and I agree.

powell.food.safety.aug.15Contaminated food sent to several states can make people sick with the same germ. These multistate outbreaks cause serious illness, and more of these outbreaks are being found. Multistate outbreaks caused 56% of deaths in all reported foodborne outbreaks, although they accounted for just 3% of all such outbreaks from 2010 to 2014. Foods that cause multistate outbreaks are contaminated before they reach a restaurant or home kitchen. Investigating these outbreaks often reveals problems on the farm, in processing or in distribution that resulted in contaminated food. Lessons learned from these outbreaks are helping make food safer. To protect the public’s health, government at all levels and food industries need to work together to stop outbreaks and keep them from happening in the first place.

Food industries can:

Keep records to trace foods from source to destination.

Use store loyalty card and distribution records to help investigators identify what made people sick.

Recall products linked to an outbreak and notify customers.

Choose only suppliers that use food safety best practices.

Share proven food safety solutions with others in industry.

Make food safety a core part of company culture.

Meet or exceed new food safety laws and regulations.

Problem

what.is.safe.food.09Multistate foodborne outbreaks are serious and hard to solve.

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.

Detecting that an outbreak is happening requires specialized testing of germs in laboratories across the country.

Multistate outbreaks can be hard to investigate.

Investigators depend on sick people to remember what they ate several weeks earlier.

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.

Contaminated food can be hard to trace to the source.

Companies may not have complete records of the source or destination of foods.

food.that.doesn't.make.you.barf.09Imported food can be even harder to trace to its source, and imports to the US are increasing.

Many different farms may produce the beef in a single burger or the fresh vegetables sold in a single crate.

Innovative methods are helping detect and solve more multistate outbreaks.

New DNA sequencing technology is improving public health’s ability to link germs found in sick people and in contaminated foods.

Information technology is helping investigators in many places work together.

Efforts by food industries are helping trace contaminated foods to their source.

What Can Be Done

The Federal government is

Implementing improved food safety laws and regulations.

Working with state and local health departments to use better methods, including DNA sequencing, to find, investigate and quickly stop multistate foodborne outbreaks.

Helping state and local health departments improve food safety inspections and guidelines.

State and local public health agencies can

Encourage clinical laboratories to quickly submit germs from sick people to the public health laboratory for advanced testing.

Test the germs from sick people quickly to find if others got sick from the same germ.

Interview sick people promptly about what they ate, using standard questions.

Family guy barfTest suspect foods, if available.

Participate in national networks to share improved methods for investigating multistate outbreaks.

Encourage industry actions that focus on preventing foodborne disease.

Health care providers can

Submit germs from sick people quickly to public health laboratories for advanced testing.

Report suspected outbreaks rapidly to the local or state health department.

Inform patients or caretakers of those in high-risk groups that they have an increased risk for food poisoning. These include pregnant women, adults over 65 years, children under 5, and people with weakened immune systems. Steps to prevent food poisoning can be found on: www.foodsafety.gov

Food industries can

Keep records to trace foods from source to destination.

Use store loyalty card and distribution records to help investigators identify what made people sick.

Recall products linked to an outbreak and notify customers.

Choose only suppliers that use food safety best practices.

Share proven food safety solutions with others in industry.

Make food safety a core part of company culture.

Meet or exceed new food safety laws and regulations.

Everyone can

Check for food recalls and information about how to handle and prepare food safely on: www.foodsafety.gov

food.safety.stickerTake action if you think you have a foodborne sickness:

Talk to your health care provider.

Write down what you ate in the week before you started to get sick.

Report your sickness to the health department if you think you are part of an outbreak.

Assist public health investigators by answering questions about your sickness.

Consider getting a loyalty card where you shop. If there is a recall, the store can use the card to notify you.

CDC researchers link cancer cells from parasite to human tumors

Scientists at the U.S. Centers for Disease Control and Prevention have discovered cancer cells originating in a common tapeworm may take root in people with weakened immune systems, causing cancer-like tumors. It is the first known case of a person becoming ill from cancer cells that arose in a parasite – in this case, Hymenolepis nana, the dwarf tapeworm.

dwarf.tapewormThe report, in the Nov. 5 issue of the New England Journal of Medicine, raises concern that other similar cases, if they occur, may be misdiagnosed as human cancer – especially in less developed countries where this tapeworm and immune-system-suppressing illnesses like HIV are widespread.

“We were amazed when we found this new type of disease – tapeworms growing inside a person essentially getting cancer that spreads to the person, causing tumors,” said Atis Muehlenbachs, M.D., Ph.D., staff pathologist in CDC’s Infectious Diseases Pathology Branch (IDPB) and lead author of the study. “We think this type of event is rare. However, this tapeworm is found worldwide and millions of people globally suffer from conditions like HIV that weaken their immune system. So there may be more cases that are unrecognized. It’s definitely an area that deserves more study.”

Puzzling case solved

In 2013, doctors in Colombia asked CDC to help diagnose bizarre biopsies from lung tumors and lymph nodes of a 41-year-old man who was HIV positive. The tumors looked similar to a human cancer, but initial CDC lab studies revealed the cancer-like cells were not human. That revelation kicked off a nearly three-year hunt for the cause of the man’s illness.

Researchers with IDPB, the CDC unit dedicated to investigating cases of unexplained illness and death, initially questioned whether it was an unusual cancer or an unknown infection. The growth pattern was decidedly cancer like, with too many cells crowded into small spaces and quickly multiplying. But the cells were tiny – about 10 times smaller than a normal human cancer cell. The researchers also noticed cells fusing together, which is rare for human cells.

  1. nanainfects up to 75 million people at any given time, making it the most common tapeworm infection in humans. People get the tapeworm by eating food contaminated with mouse droppings or insects or by ingesting feces from someone else who is infected. Children are most often affected. Most people show no symptoms. However, in people whose immune systems are weak, including people who have HIV or are taking steroids, the tapeworm thrives.

Some 3,000 kinds of tapeworms are known to infect animals. But H. nana is the only one that can complete its entire lifecycle from egg to adult tapeworm within an individual’s small intestine. This can lead to large numbers of H. nana in the intestine, especially in people with weakened immune systems whose bodies have a harder time fighting the parasite. Researchers theorize that the mechanism that allows parasites like H. nana to avoid human immune systems may also have allowed the tapeworm’s cells to proliferate unchecked in the Colombian man.

Food companies, step it up: US multistate foodborne outbreaks, 2010-2014

Multistate outbreaks cause more than half of all deaths in foodborne disease outbreaks despite accounting for only a tiny fraction (3 percent) of reported outbreaks in the United States, according to a new U.S Centers for Disease Control report.

fact-sheet-vs-final-thumbnail-page-3_cropRecent outbreaks of foodborne illness linked to tainted cucumbers, ice cream and soft cheeses show the devastating consequences when food is contaminated with dangerous germs before it reaches a restaurant or home kitchen.

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

• An average of 24 multistate outbreaks occurred each year, involving two to 37 states.

  • 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 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 what foods made people sick, and by notifying customers of food recalls.

“Reacting to problems isn’t sufficient in today’s food system, nor is it the best way to practice public health,” Dr. Kathleen Gensheimer, director of FDA’s Coordinated Outbreak Response & Evaluation Network, said in a teleconference.

TSA4Gensheimer stressed that in the past, food safety has been focused on reacting to outbreaks, but new regulations set to take effect in 2016 will require companies to take a science-based approach to building safety controls into food production.

“Industry is a very critical partner,” she said.

For example, although it is still not clear what caused the E. coli outbreak at Chipotle, Gensheimer said on the call that the company has shared “all of their records and is working with us in any way possible to give us information about their suppliers.”

Gensheimer also said after the current investigation ends, the company expressed interest in meeting with FDA and the CDC to work out ways to prevent future outbreaks.

CDC Director Dr. Tom Frieden said state-of-the-art disease tracking tools, and the introduction of gene tools, are helping to quickly track down the source of food-borne outbreaks in collaboration with state and national partners.

Frieden said disease detectives are “cracking the cases much more frequently than in past years because we have this new DNA fingerprinting tool being used increasingly,” but many cases still go unsolved.

He said companies are also stepping up to help, noting new requirements at Wal-Mart Stores Inc for food suppliers that set new control for suppliers to reduce contamination and the wholesaler’s Costco’s use of membership card lists to notify customers about recalled foods.

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. 

“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.”

Introduction: Millions of U.S. residents become ill from foodborne pathogens each year. Most foodborne outbreaks occur among small groups of persons in a localized area. However, because many foods are distributed widely and rapidly, and because detection methods have improved, outbreaks that occur in multiple states and that even span the entire country are being recognized with increasing frequency.

Methods: This report analyzes data from CDC’s Foodborne Disease Outbreak Surveillance System to describe multistate foodborne outbreaks that occurred in the United States during 2010–2014.

Results: During this 5-year period, 120 multistate foodborne disease outbreaks (with identified pathogen and food or common setting) were reported to CDC. These multistate outbreaks accounted for 3% (120 of 4,163) of all reported foodborne outbreaks, but were responsible for 11% (7,929 of 71,747) of illnesses, 34% (1,460 of 4,247) of hospitalizations, and 56% (66 of 118) of deaths associated with foodborne outbreaks. Salmonella (63 outbreaks), Shiga toxin-producing E. coli (34), and Listeria monocytogenes (12) were the leading pathogens. Fruits (17), vegetable row crops (15), beef (13), sprouts (10), and seeded vegetables (nine) were the most commonly implicated foods. Traceback investigations to identify the food origin were conducted for 87 outbreaks, of which 55 led to a product recall. Imported foods were linked to 18 multistate outbreaks.

Conclusions: Multistate foodborne disease outbreaks account for a disproportionate number of outbreak-associated illnesses, hospitalizations, and deaths relative to their occurrence. Working together, food industries and public health departments and agencies can develop and implement more effective ways to identify and to trace contaminated foods linked to multistate outbreaks. Lessons learned during outbreak investigations can help improve food safety practices and regulations, and might prevent future outbreaks.

MMWR November 3, 2015 / 64(Early Release);1-5

Samuel J. Crowe, PhD1,2; Barbara E. Mahon, MD2; Antonio R. Vieira, PhD2; L. Hannah Gould, PhD

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm64e1103a1.htm?s_cid=mm64e1103a1_w

vitalsigns-multistateoubreaks-lesscommon-moreseriou_crop