Foodborne Disease Outbreaks

September is National Food Safety Month. To impact on food safety we need to consider the causes for food borne illness. Addressing those causes will pay dividends in reducing risk.

Every year the Centers for Disease Control (CDC) reports on the latest food borne disease outbreak statistics. That report is 24 pages long. I spent a few hours reviewing it so you didn’t have to. Here are my key conclusions:

  • Nearly 2/3 of the outbreaks and nearly half of the illnesses are traced to restaurants.

  • Over half of these outbreaks are from sit down restaurants.

  • Fish and chicken have become the most common and severe meat risks.

  • Unpasteurized dairy and seeded vegetables are the most common non meat risks.

Why are restaurants apparently at greater risk?

It would be easy to blame restaurant management or their food handling processes. But there are potential compounding variables that may skew statistics. It may not be black and white.

The most recent data compiled by the USDA shows that over 40% of our food is eaten away from home. Quick service restaurants account for over 50% of restaurant sales. So statistically we would expect that at least 40% of all of our illness and outbreak associated food borne illness would be from restaurants anyway. That doesn’t account for the remaining 25%.

Let’s also consider that most people would not report to the health department if there was a small bout of a suspected food poisoning in the home or workplace or community center such as a church, unless there were a large number who became profoundly sick. Hence the statistics presented may unfairly misrepresent the percentages against restaurants.

Why are certain foods riskier than others?

Fish is particularly sensitive to how it is transported and prepared. If this is not put on ice nearly immediately after the catch, it begins to decompose. Fish typically does not taste as good if it is overcooked so there is a tendency to undercook. Use a meat thermometer.

Most of the chicken consumed today comes from feedlots. The density of the chickens in those feedlots and the inability for those chickens to stay clean increases their risk of being contaminated by bacteria. Chicken should not be served pink. Use a meat thermometer.

There has been a movement toward natural and organic foods. One extension of that is consuming unpasteurized milk and juices. The pasteurization process kills bacteria. Without pasteurization, without optimal refrigeration, and with consumption that might be beyond a reasonable shelf life those juices become a source of infection.

Commercial vegetables are often picked by immigrant laborers under less than sanitary conditions. Immigrant laborers can carry bacteria from other parts of the world that the American population may not be immune to. All fruits and vegetables need to be thoroughly washed and damaged parts need to be removed. Consider that typically fruits and vegetables are not cooked so there is no way to destroy harmful bacteria other than washing.

What foods should be avoided or eaten with caution?

In a blog posted by Bill Marler, a noted personal injury and product liability attorney, with a specialty in food borne illness, he cited six foods that he would avoid based on his professional experience: unpasteurized (raw) milk and packaged juices; raw sprouts; meat that isn’t well done; pre-washed or pre-cut fruits and vegetables; raw or undercooked eggs; raw oysters and other raw shellfish.

I heard of his list, and without biasing my opinions I published a list as a medical doctor food poisoning specialist. The foods that I would avoid include: raw, red or pink ground meats or chicken; oysters and raw fish; runny, slimy eggs; alfalfa sprouts; creamy salads at a picnic potluck; and snacks from a community serving bowl.

It is interesting that our lists share four major classes of foods. I certainly would not disagree with his opinion on unpasteurized milk or juices and/or precut fruits and vegetables.

The data from the CDC strongly supports our collective professional opinions.

For your reading pleasure, I have abridged the referenced report.

The Centers for Disease Control (CDC) monitors illnesses and when 2 or more people get the same illness it is called an outbreak. The CDC released it’s most recent comprehensive analysis in March 2016. Some key findings were:

2014 report

In 2014 (most recent compiled data):

  • 864 food borne disease outbreaks were reported,
  • 13,246 illnesses,
  • 712 hospitalizations,
  • 21 deaths,
  • 21 food recalls.

Location source of outbreaks:

  • 65% were from a single restaurant.
  • 53% were from restaurants with sit-down dining.
  • 12% were in a catering or banquet facility.
  • 12% were in a private home.

Single food categories associated with the most outbreak ILLNESSES:

  • Seeded vegetables, such as cucumbers or tomatoes (428 illnesses)
  • Chicken (354 illnesses)
  • Dairy (267 illnesses)

Single food categories associated with the most OUTBREAKS:

  • Fish (43 outbreaks)
  • Chicken (23 outbreaks)
  • Dairy (19 outbreaks, especially unpasteurized dairy products)

A single, confirmed agent caused 461 outbreaks:

  • Norovirus (34%)
  • Salmonella (30%)

The agents that cause the most outbreak-related hospitalizations were:

  • Salmonella (59%)
  • Shiga toxin-producing Escherichia coli (9%)
  • Listeria (8%)

The agents that caused the most outbreak-related deaths were:

  • Listeria (13 deaths)
  • Norovirus (4 deaths)
  • One each: Shiga toxin-producing Escherichia coli O157, Campylobacter, Clostridium botulinum, Salmonellas

A single, confirmed germ caused 8,810 outbreak-related illnesses and hospitalizations ( about 1 of every 13 illnesses)

  • Norovirus (34% of the outbreaks and 43% of the illnesses)
  • Salmonella (30% of the outbreaks and 27% of the illnesses)
  • Shiga toxin Escherichia coli (5% of the outbreaks and 2% of the illnesses.


Author: Dr. Harlan Stueven, MD

Harlan Stueven M.D. is a Board-Certified Emergency physician with sub-specialization in Environmental Toxicology and Board Certification in Medical Toxicology. Starting his career in the USAF, he served as a Flight Surgeon and Environmental Health Consultant Physician where one of his duties was monitoring food safety. In his nearly 40-year practice, he treated a range of medical, surgical and poisoning emergencies. He has been a Medical Director and/or Chairman of several hospital-based Emergency Medicine Departments, served as the President of Emergency and Environmental Medicine consulting group, a physician group Chief Financial Officer and sat on many national, state and local committees. Dr. Stueven founded Dining Grades and the Dining Safety Alliance to improve food safety by increasing awareness of food borne illness and the formation of partnerships within the food industry. He is a consultant to the Wisconsin Retail Food Establishment Grading Work Group; a Co-investigator in a CDC funded “Evaluation of Health Department Restaurant Inspection Programs” project. He has presented at several National, State and Regional conferences on restaurant grading and food safety. He is an accomplished leader, medical researcher, a champion of process improvement, author, and national and international speaker.

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