Report Card Grades States on Reporting Outbreaks of Foodborne Illness

7 States Earn ‘A’s … and 14 States Get ‘F’s from CSPI


WASHINGTON—A nationwide report card grading the 50 states and the District of Columbia on how well they detect, investigate, and report outbreaks of foodborne illness finds great variability—indicating that many states are only reporting a small fraction of the number of outbreaks as states with better detection and reporting systems.

Using 10 years of data from the Centers for Disease Control and Prevention and the Center for Science in the Public Interest’s Outbreak Alert! database, CSPI assigned a letter grade and created an outbreak profile for each state. CSPI used two states that are widely recognized for having strong investigating and reporting systems as benchmarks. Those states, Oregon and Minnesota, have excellent laboratory facilities and public health departments that are quick to interview individuals who are suspected to have been outbreak “cases.” They report nine and eight outbreaks per million people per year, respectively. Those two states, and five states that reported equally high reporting rates for outbreaks, received ‘A’s: Florida, Hawaii, Maryland, Washington, and Wyoming.

In contrast, 14 states reported only one outbreak of foodborne illness per million people: Arizona, Arkansas, Indiana, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, Nevada, New Mexico, Oklahoma, South Carolina, Texas, and West Virginia.

“States that aggressively investigate outbreaks and report them to CDC can help nail down the foods that are responsible for making people sick,” said CSPI food safety director Caroline Smith DeWaal. “But when states aren’t detecting outbreaks, interviewing victims, identifying suspect food sources, or connecting with federal officials, outbreaks can grow larger and more frequent, putting more people at risk.”

In its report, All Over the Map, CSPI acknowledges that it may seem counter-intuitive to give higher grades to states with more outbreaks. But, in fact, those states are the most likely to have robust detection and reporting systems, according to the group. The report card suggests that states that received ‘D’s or ‘F’s may lack adequate funding for public health services, leading to health departments that are understaffed and overburdened.

CSPI also identified a troubling trend. The percentage of solved outbreaks—those with both an identified food and an identified pathogen—has declined over the 10-year period, from 1998 through 2007. The peak reporting year was 2001 when 44 percent of outbreaks reported to CDC were solved; the lowest year, when only 34 percent were reported, was 2007. But CSPI says that the FDA Food Safety Modernization Act, signed into law by President Obama earlier this month, requires the Food and Drug Administration and the CDC to enhance coordination between federal, state, and local surveillance systems and improve epidemiological tools available to the states. And within a year, the law directs the federal government to name five state health departments as regional Centers of Excellence to serve as resources for public health officials in response to outbreaks.

“Hopefully, this report will stimulate discussions among public health officials, food safety policy makers, legislators and the public about the value of surveillance,” said Craig Hedberg, Professor of Environmental Health Sciences at the University of Minnesota School of Public Health. “Ensuring that all states benefit from effective foodborne disease surveillance is a long range goal. A network of Regional Centers of Excellence can develop and demonstrate the best practices that have helped Minnesota and Oregon maintain their excellent records of foodborne disease surveillance and outbreak investigation.”

CSPI recommends that consumers and doctors do their parts, too. Consumers should notify their local health department when they suspect they have suffered a foodborne illness, and should seek medical treatment when needed, the group says. Physicians should likewise report suspected cases to health departments, and be more assertive about pursuing laboratory testing to detect and confirm foodborne illnesses.

Colorado, Illinois, Kansas, Maine, Michigan, Ohio, and Vermont received ‘B’s, with each state reporting 6 or 7 outbreaks per million people.

Alabama, Alaska, California, Connecticut, Iowa, New Hampshire, North Dakota, and Wisconsin received ‘C’s, with each state reporting 4 or 5 outbreaks per million people.

Delaware, the District of Columbia, Georgia, Idaho, Massachusetts, Montana, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah, and Virginia received ‘D’s. Those states and D.C. each only reported 2 or 3 outbreaks per million people.

In developing this report, CSPI used CDC data from OutbreakNet Foodborne Outbreak Online Database which became available on September 17, 2009. According to CDC, data available via the OutbreakNet Online Database originate from a dynamic outbreak surveillance database. Reporting agencies (state, local, territorial, and tribal health departments, and CDC) can modify their NORS reports at any time, even months or years after an outbreak. Therefore, specific results from Foodborne Outbreak Online Database are subject to change. 

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