Food for thought: How to make food safer across state lines

 About 24 multistate foodborne outbreaks involving 2-37 states are reported every year, accounting for only 3% of all such outbreaks during the 2010-2014 period and yet responsible for 56% of all foodborne-related deaths – according to the November CDC Vital Signs Monthly Report. Multistate outbreaks occur when already-contaminated food reaches kitchens in homes and restaurants in several states, causing people in very different locations to become sick with the same germ. Investigating these outbreaks is like tracking down the killer in Fallen, but the experienced gained by investigators plus technology innovations have led to the discovery of problems at farms – though not in the Orwellian sense – as well as issues with processing and distribution. Where problems are detected, solutions can be offered to make food safer and save lives.

What can be done – and by whom – to prevent multistate foodborne outbreaks

Federal government

·         Implement improved food safety legislation and regulations.

·         Work with state and local health departments to use improved to find, investigate and quickly stop multistate foodborne outbreaks.

·         Help said departments improve inspections and guidelines.

State and local health agencies

·         Promote quick submission of germs from sick people from clinical labs to public health labs.

·         Test these germs quickly to determine if others are sick from the same germ.

·         Use standard questions to interview sick people about what they ate.

·         Test suspect foods.

·         Take part in nationwide networks to share improved investigational methods.

·         Promote industry actions focusing on the prevention of foodborne disease.

Healthcare providers

·         Submit germs from sick people quickly to public health labs.

·         Report suspected outbreaks a.s.a.p. to the local or state health department.

·         Educate patients and caregivers of people in high-risk groups - including pregnant women, adults over 65 years, children under 5, and people with weakened immune systems – on their increased risk for food poisoning.

Food industry

·         Keep records to track 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 inform customers.    

·         Choose only suppliers that use best food safety practices.    

·         Share food safety solutions with others in the industry.    

·         Make food safety an integral part of company culture.    

·         Comply with or surpass new food safety laws and regulations.

General public

·         Check for food recalls and information on how to handle and prepare food safely on:

·         Talk to your doctor if you think you have a foodborne sickness.         Write down what you ate in the week prior to getting 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 so as to be notified if there is a recall.


In addition to all of the above, outbreak investigation is arguably the most important tool to ensure food safety. Unfortunately, there are more obstacles for investigation than there are shortcuts.

Foodborne outbreak investigation





·         Contaminated food from a single place can find its way to kitchens all over the U.S.

·         People in many different states can get sick.

·         Specialized testing of germs in laboratories across the country is required to detect an outbreak.



·         Sick people have to remember what they ate in the previous several weeks.

·         They may have unwittingly eaten a contaminated ingredient in several different foods.

·         Caramel apples, chia powder, and other unlikely foods have been associated to recent multistate outbreaks. 


Tracking sources

·         Food companies may not have complete records of the source and/or destination of foods.

·         Food imports – which are increasing in the U.S. – are more difficult to trace.

·         The beef in a single burger may be produced in different farms.

·         Similarly, a single crate may contain fresh vegetables from different farms.




·         New DNA sequencing has improved the ability of public health agencies to link germs from sick people and from contaminated foods.

·         Information technology has helped to gap the distance between investigators from different places.

·         Food industries are putting in efforts to track contaminated foods to their source.


In spite of the many setbacks, the number of multistate outbreaks detected has steadily increased – from 34 in 95-99 to 120 in 2010-2014. Here’s how a routine outbreak investigation may play out:

1.       Food produced at company is contaminated and distributed to stores all across the country.

2.       A customer buys the food and uses a store loyalty card when checking out.

3.       The customer experiences diarrhea, fever, and abdominal cramps a couple of days after consuming the food.

4.       The customer sees his doctor, who collects a stool sample to test for germs.

5.       The clinical laboratory finds Salmonella germs and submits a sample to the state public health lab for advanced testing.

6.       The state lab finds the DNA fingerprint of the Salmonella germ and enters the results into the CDC’s PulseNet database.

7.       The database finds people sick from Salmonella in other states with the same DNA fingerprint.

8.       The CDC contacts state health agencies and begins a multistate outbreak investigation. Either the FDA or USDA track suspect foods back to their source.

9.       The public health agency interviews the consumer about what he ate before getting sick and requests that he use his store loyalty card to see what he bought.

10.   The results of the interview, loyalty card data, and source tracing reveal that many people got sick after eating food from the original company.

11.   The company issues a recall after discussing with public health officials and regulators.

12.   Food regulators and companies use the lessons learned to prevent future illnesses and outbreaks.

 Related: Early symptoms of food poisoning