Foodborne illnesses should not be a major medical problem in the developed world. The United States has one of the most sophisticated health care systems in the world and several federal agencies, including the Food and Drug Administration, that work to keep the food supply free from contamination. The system does not always work as well as expected. The records for reporting foodborne illnesses among the 50 states are uneven. Obviously, health care problems cannot be mitigated or eliminated if they cannot be systematically analyzed.
The Center for Science in the Public Interest reviewed ten years of records from the Centers for Disease Control and Prevention to determine which states do a good job of detecting outbreaks of foodborne illness in a study titled All Over the Map: A 10-Year Review of State Outbreak Reporting. The study looked at the track records of each state based on its ability to detect outbreaks. That does not mean a state has more or fewer outbreaks than other states.
The Center for Science in the Public Interest rated all 50 states and the District of Columbia, with grades of “A” through “F.” The states with better records for reporting problems are, by the study’s definition, those with better health care resources. That may not be the only interpretation of the data, but it is the one the CSPI has elected to take. Unfortunately, the study is flawed at its foundation because the methodology and data gathering do not include state budgets for contaminated food detection and does not take into account that there is no really accurate measurement of total foodborne illness outbreaks. There is no way to analyze something which has not been reported but could have been. The CSPI study is the best of its kind, but is still flawed.
Among the mitigating factors of the survey’s results are that states with hotter climates tend to have more outbreaks because of the heat. These same states usually do poorly in the study. Several do a bad job, it seems, of detecting a problem which effects them more frequently than it does colder states.
The study also indicates that the ability to identify foodborne problems fluxuates significantly from states to other states which share common borders. Florida and Georgia get much different ratings, as do Maryland and West Virginia. Does that mean the successful states have more well-trained or more well-funded disease control bureaucrats? That seems to be the case.
This 24/7 Wall St. analysis creates a State Food Poising Index. We have used the CSPI’s survey to rank the states based on how well each detects foodborne problems and then “solves” the outbreaks by identifying the pathogens and the source of the illnesses:
The Seven ‘A’ States
1) Minnesota
> Outbreaks Per Million: 10
> Total Illnesses: 7,952
> Total Hospitalizations: 208
> Total Deaths: 3
Minnesota, while having a generally good record of reporting outbreaks, has faced repeated food-related outbreaks involving norovirus. There have been 146 outbreaks of the gastrointestinal bug, also known as the Norwalk Virus, in the state. The virus is most often spread through food and drink that has come into contact with fecal matter, frequently the result of poor hygiene at restaurants, such as employees not washing hands.
2) Oregon
> Outbreaks Per Million: 9
> Total Illnesses: 6,248
> Total Hospitalizations: 88
> Total Deaths: 7
Oregon reported 341 outbreaks of food-related illnesses between 1998 and 2007. During its peak in 2003 and 2004, the state reported 51 and 52 outbreaks, with 53% of outbreaks only affecting between two and ten people. The pathogen which caused the greatest percentage of outbreaks was norovirus.
3) Florida
> Outbreaks Per Million: 11
> Total Illnesses: 6,248
> Total Hospitalizations: 68
> Total Deaths: 7
In 1998, Florida reported 278 outbreaks to the Centers for Disease Control and Prevention. For 2007 it only reported 104 outbreaks. The median number of reported outbreaks for the ten-year period, however, was 11 reports for every one million people, earning it an A rating. The most common type of outbreak was staphylococcus, which derived from many types of unhygienic prepared food, such as one case in which cooked ham was sliced on a dirty slicer.
4) Hawaii
> Outbreaks Per Million: 24
> Total Illnesses: 2,432
> Total Hospitalizations: 61
> Total Deaths: 1
Hawaii reported 24 outbreaks per one million people, the highest rate among all the states. Of 306 total reported outbreaks in Hawaii, 238 were solved, meaning that both a pathogen and a food source were identified. Solved outbreaks are a minority among cases for most states. The most widespread pathogen in Hawaii was ciguatoxin, found in fish. Data showed that 91% of outbreaks in Hawaii affected only between two and ten people.
5) Maryland
> Outbreaks Per Million: 10
> Total Illnesses: 6,826
> Total Hospitalizations: 141
> Total Deaths: 2
Maryland reported a median number of 10 food-illness related outbreaks from 1998 to 2007. The greatest number of reported outbreaks was 144 in 1999, with the lowest being 23 in 2007, or 4 reports per one million people. 31% of all Maryland outbreaks for this time period involved salmonella, often found in vegetables.
6) Washington
> Outbreaks Per Million: 9
> Total Illnesses: 6,880
> Total Hospitalizations: 138
> Total Deaths: 2
Washington reported a median number of 9 outbreaks per one million people between 1998 and 2007. The most prominent pathogen reported was norovirus, spread by unsanitary food service conditions. One outbreak of norovirus in 2006 resulted in the deaths of multiple people.
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7) Wyoming
> Outbreaks Per Million: 9
> Total Illnesses: 982
> Total Hospitalizations: 37
> Total Deaths: 0
Although Wyoming only reported 41 outbreaks to CDC from 1998 to 2007, its small population provided it with the ‘A’-earning score of nine reported outbreaks per one million people. The greatest percentage of solved outbreaks involved campylobacter. One such outbreak occurred at Grace Camp, a Bible camp in Wyoming, where fecal contamination of the site’s water supply was suspected to be the source. More than 88 camp attendees reported experiencing gastrointestinal illness.
The Fourteen ‘F’ States
1) Arizona
> Outbreaks Per Million: 1
> Total Illnesses: 2,161
> Total Hospitalizations: 78
> Total Deaths: 0
Of Arizona’s 106 reported outbreaks, 40 are considered to be “solved.” The most frequent pathogen involved in these outbreaks is norovirus. Many of these outbreaks occur among people using recreational waters, such as rafting on the Colorado River.
2) Arkansas
> Outbreaks Per Million: 1
> Total Illnesses: 1171
> Total Hospitalizations: 80
> Total Deaths: 0
Arkansas has only reported 32 foodborne illness outbreaks in the ten years between 1998 and 2007. The greatest amount reported in one year was eight reports in 2002. Seven of the total reported outbreaks involved salmonella, spread by food such as sushi.
3) Indiana
> Outbreaks Per Million: 1
> Total Illnesses: 2,756
> Total Hospitalizations: 99
> Total Deaths: 0
Indiana reported 88 outbreaks to the CDC, half of which were “solved.” The number of reported outbreaks varies greatly by year, with only three outbreaks reported in 2005 and 16 reported in 2000. The most common pathogen was norovirus, which affected 373 people during one outbreak in 2006 which originated at an Olive Garden restaurant outside of Indianapolis.
4) Kentucky
> Outbreaks Per Million: 1
> Total Illnesses: 193
> Total Hospitalizations: 20
> Total Deaths: 0
Over the ten-year period, Kentucky only reported 25 outbreaks of food illness. Sixteen of these reports were “solved,” and a quarter of those that were solved affected only residents of Kentucky. As with many other states, the most common pathogen in Kentucky was norovirus.
5) Louisiana
> Outbreaks Per Million: 1
> Total Illnesses: 2,584
> Total Hospitalizations: 95
> Total Deaths: 2
Louisiana reported 44 outbreaks from 1998 to 2007 and identified a pathogen and food source for 35 of these cases. The most commonly found pathogen was clostridium, often present in beef products.
6) Mississippi
> Outbreaks Per Million: 1
> Total Illnesses: 908
> Total Hospitalizations: 35
> Total Deaths: 0
Mississippi reported 35 outbreaks to the Centers for Disease Control and Prevention between 1998 and 2007. In 2007, the state only reported two outbreaks. The most commonly implicated pathogen among these outbreaks was salmonella. One report, published by the CDC in 2001, hypothesizes that many of the state’s salmonella cases are linked to contact with amphibians.
7) Missouri
> Outbreaks Per Million: 1
> Total Illnesses: 2,538
> Total Hospitalizations: 51
> Total Deaths: 0
Missouri reported 86 outbreaks, although only 31 of these were “solved.” The state’s peak year for reports was 2004, during which 24 outbreaks were reported. The most common pathogen was salmonella, frequently originating in restaurants.
8 ) Nebraska
> Outbreaks Per Million: 1
> Total Illnesses: 518
> Total Hospitalizations: 23
> Total Deaths: 0
Nebraska only reported 21 outbreaks of foodborne illnesses, however in 18 of these cases a pathogen and food source were identified. There was a fairly even distribution of active pathogens, with the same amount of reported outbreaks involving norovirus, clostridium, E. coli, and salmonella.
9) Nevada
> Outbreaks Per Million: 1
> Total Illnesses: 1,952
> Total Hospitalizations: 47
> Total Deaths: 1
Nevada reported 45 outbreaks between 1998 and 2007, but solved only 21 of these outbreaks, less than half. Salmonella was the most common illness-inducing pathogen. In 2007, three people became sick after eating salmonella-tainted hamburgers.
10) New Mexico
> Outbreaks Per Million: 1
> Total Illnesses: 885
> Total Hospitalizations: 48
> Total Deaths: 2
Between 1998 and 2007, New Mexico reported 24 outbreaks and solved 14. 40% of these outbreaks affected between 26 and 50 people. Clostridium, which was the most prominent pathogen identified, was often associated with fish and home-canned foods.
11) Oklahoma
> Outbreaks Per Million: 1
> Total Illnesses: 480
> Total Hospitalizations: 40
> Total Deaths: 2
Oklahoma reported 31 outbreaks over the ten-year period, with 21 being solved. 44% of the state’s outbreaks affected between 11 and 25 people. One outbreak in 2005 was traced back to a single restaurant serving lettuce that had been cross-contaminated with raw chicken.
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12) South Carolina
> Outbreaks Per Million: 1
> Total Illnesses: 2,663
> Total Hospitalizations: 116
> Total Deaths: 1
South Carolina reported a total of 76 outbreaks, and identified a pathogen and food source for 43 of these outbreaks. By 2007, the number of reports per million people had improved to four. The most common pathogens implicated were salmonella and staphylococcus, each of which was involved in a quarter of solved outbreaks.
13) Texas
> Outbreaks Per Million: 1
> Total Illnesses: 11,055
> Total Hospitalizations: 250
> Total Deaths: 8
Although Texas reported 201 foodborne illness outbreaks to the CDC, the state’s population dwarfed this number and caused the stated to receive a ranking of ‘F.’ 31% of the state’s 56 solved outbreaks involved salmonella, often associated with contaminated vegetables.
14) West Virginia
> Outbreaks Per Million: 1
> Total Illnesses: 766
> Total Hospitalizations: 33
> Total Deaths: 0
West Virginia only reported 27 outbreaks to the CDC, 17 of which were solved outbreaks. The most common pathogens implicated in these outbreaks were bacillus, salmonella, and norovirus, each of which was involved with three solved outbreaks.
Charles B. Stockdale, Douglas A. McIntyre
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