Surveillance for Foodborne Disease Outbreaks — United States, 2009–2015

Abstract

Problem/ConditionKnown foodborne disease agents are estimated to cause approximately 9.4 million illnesses each year in the United States. Although only a small subset of illnesses are associated with recognized outbreaks, data from outbreak investigations provide insight into the foods and pathogens that cause illnesses and the settings and conditions in which they occur.Reporting Period2009–2015Description of SystemThe Foodborne Disease Outbreak Surveillance System (FDOSS) collects data on foodborne disease outbreaks, which are defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Since the early 1960s, foodborne outbreaks have been reported voluntarily to CDC by state, local, and territorial health departments using a standard form. Beginning in 2009, FDOSS reporting was made through the National Outbreak Reporting System, a web-based platform launched that year.ResultsDuring 2009–2015, FDOSS received reports of 5,760 outbreaks that resulted in 100,939 illnesses, 5,699 hospitalizations, and 145 deaths. All 50 states, the District of Columbia, Puerto Rico, and CDC reported outbreaks. Among 2,953 outbreaks with a single confirmed etiology, norovirus was the most common cause of outbreaks (1,130 outbreaks [38%]) and outbreak-associated illnesses (27,623 illnesses [41%]), followed by Salmonella with 896 outbreaks (30%) and 23,662 illnesses (35%). Outbreaks caused by Listeria, Salmonella, and Shiga toxin-producing Escherichia coli (STEC) were responsible for 82% of all hospitalizations and 82% of deaths reported. Among 1,281 outbreaks in which the food reported could be classified into a single food category, fish were the most commonly implicated category (222 outbreaks [17%]), followed by dairy (136 [11%]) and chicken (123 [10%]). The food categories responsible for the most outbreak-associated illnesses were chicken (3,114 illnesses [12%]), pork (2,670 [10%]), and seeded vegetables (2,572 [10%]). Multistate outbreaks comprised only 3% of all outbreaks reported but accounted for 11% of illnesses, 34% of hospitalizations, and 54% of deaths.InterpretationFoodborne disease outbreaks provide information about the pathogens and foods responsible for illness. Norovirus remains the leading cause of foodborne disease outbreaks, highlighting the continued need for food safety improvements targeting worker health and hygiene in food service settings. Outbreaks caused by Listeria, Salmonella, and STEC are important targets for public health intervention efforts, and improving the safety of chicken, pork, and seeded vegetables should be a priority.Public Health ActionThe causes of foodborne illness should continue to be tracked and analyzed to inform disease prevention policies and initiatives. Strengthening the capacity of state and local health departments to investigate and report outbreaks will assist with these efforts through identification of the foods, etiologies, and settings linked to these outbreaks.

Foodborne Illness Outbreaks at Retail Establishments — National Environmental Assessment Reporting System, 16 State and Local Health Departments, 2014–2016

“…Because ill workers are a frequent contributor to outbreaks ( 1 ), of particular interest are NEARS data on establishment characteristics that might be related to ill worker behavior, such as requiring gloves and excluding workers who are ill from work. Most establishments with outbreaks had policies requiring food workers to wear gloves when handling ready-to-eat foods and preventing those who are ill from working.…”

“…The majority of foodborne illness outbreaks occur in retail food establishments (i.e., places that prepare and serve food to consumers) ( 1 ). In 2014, NEARS was launched to collect data on outbreaks associated with such establishments ( 4 ).…”

“…During 2009–2015, state, local, and territorial health departments reported 5,760 foodborne illness outbreaks to CDC ( 1 ). Most of these outbreaks occurred in retail food establishments ( 1 ). …”

“…Data from these investigations provide insights into the epidemiology of foodborne illness, such as identifying the pathogens and foods that lead to illness ( 1 ). This information can be used to help prevent foodborne illness outbreaks and sporadic foodborne illnesses that can have the same epidemiologic profile as outbreaks.…”

Meeting Report: Key Outcomes from a Collaborative Summit on Agricultural Water Standards for Fresh Produce

“…In FDA's qualitative assessment of risk, commodity type was analyzed for the likelihood of attributing to foodborne illnesses. From 2009 to 2015, the CDC reports that there were 241 produce‐related outbreaks and illnesses associated with seeded vegetables (2572), fruits (2420), vegetable row crops (1972), herbs (476), root crops and underground vegetables (383), and nuts and seeds (245) (Dewey‐Mattia, Manikonda, Hall, Wise, & Crowe, ). The epidemiological data show that outbreaks associated with produce commodities change over time, though some commodities have a repeating pattern of association with outbreaks over multiple years, such as tomatoes and leafy greens.…”