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Why Does It Seem Like Everyone Is Getting Sick from Salad?

Romaine lettuce is the latest item subject to a CDC safety alert, just two days before Thanksgiving

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FDA Issues Warning After E. coli Outbreak Traced To Spinach Photo by Justin Sullivan/Getty Images

Maybe salads aren’t a healthy option after all: Romaine lettuce — as in, like all of it — is the latest leafy green subject to a food safety alert by the Centers for Disease Control, with a reported outbreak of E. coli stemming from the lettuce hitting just before Thanksgiving. Thus far, 32 illnesses have been reported in 11 states; 18 people have reportedly fallen ill in Canada.

The outbreak follows deadly ones that took place earlier this year: E. Coli in lettuce was linked to five deaths in the U.S. from February to June. In July, Cyclospora — a delicious little intestinal parasite — caused McDonald’s to halt selling salads in 14 states. In August, Trader Joe’s salads and wraps, along with those from Kroger and Walgreens, were flagged by the U.S. Department of Agriculture, also for possible cyclospora contamination.

Before this most recent romaine outbreak, the lettuce variety was responsible for the largest multi-state foodborne E. coli outbreak since 2006 — which sickened 172 people in 32 states and killed one person in California earlier this year. Add to this Chipotle’s latest public health scare in Ohio and it begins to feel like food poisoning is on the rise. But is it? Here’s the state of foodborne illness outbreaks in 2018.

Are foodborne illnesses occurring more frequently than ever before?

Not necessarily. “It is too early to tell whether foodborne illnesses or outbreaks are increasing” from previous years, according to Brittany Behm, a public affairs specialist with the CDC, which tracks multi-state outbreaks. FoodNet, a section of the CDC that monitors and surveils trends in foodborne illnesses has reported some increases over the past few years in rates of infection from things like Cyclospora and Yersinia, something the CDC attributes to the “increasing use of rapid diagnostic tests that are providing more positive results for certain germs than we saw in the past.”

That’s why, according to a preliminary FoodNet report looking at 2017’s incidents of foodborne illness, “the overall number of Campylobacter, Listeria, Salmonella, Shigella, Vibrio, and Yersinia infections diagnosed by CIDT increased 96% in 2017 compared with the 2014–2016 average.”

While the CDC tracks bigger interstate outbreaks, states usually investigate the majority of outbreaks. Those are reported to the National Outbreak Reporting System. “The number of outbreaks reported to us by state and local health departments has remained fairly stable over the last few years,” Behm told Eater in an email.

So why does it seem like foodborne illnesses are occurring more frequently?

Foodborne illnesses sicken millions each year in United States.” “Foodborne illnesses have nearly DOUBLED.” The speed of today’s news cycle amplifies serious outbreaks of foodborne illness. Still the FDA estimates that roughly 1 in 6 Americans contract a foodborne illness each year. Pregnant women, young children, older adults, and people with weakened immune systems are at particular risk for falling ill.

Are foodborne outbreaks happening on a bigger scale?

The CDC has noted an uptick in multi-state outbreaks this year so far, though as previously noted it’s too early to say if outbreaks are growing more frequent over time. Bill Marler, one of the nation’s leading food safety attorneys, tells Eater that even if outbreaks are in fact becoming more frequent, they appear to impact fewer people thanks to better tracking and detection. “I think we’re seeing more frequent outbreaks but they tend to be a bit smaller and that may be a function of how public health officials have a done better job of getting [contaminated items] off the shelves.”

Which foods are at the greatest risk for contamination?

Marler says that in the ‘90s and early 2000s the majority of his cases involved hamburgers, but following the Jack in the Box E. coli outbreak in 1993 — which sickened hundreds of people and killed four children — new, stricter policies regulating on the beef industry were introduced. “Now I have hardly any cases linked to hamburgers,” he says. These days, he sees more E. coli cases linked to fresh fruits and vegetables — also confirmed by a report in Vox — and a relatively steady rate of cases of Salmonella and Campylobacter, a bacteria associated with raw poultry.

Due to their enticing convenience, sales of pre-packaged salads are on the rise and, given trends in dining, Americans in general are gorging more on fresh produce. Raw foods always carry more risk, because people don’t cook them to kill off potentially harmful bacteria. “When you cut fresh fruits and vegetables you’re creating a really nice environment for bacteria to grow,” Marler says. Here are some other foods the FDA lists as risky.

Which foodborne illnesses are Americans most at risk for?

The CDC reported in 2011 that Norovirus was the number one foodborne pathogen that led to in foodborne illnesses, hospitalizations, and deaths in the U.S. It was followed by Salmonella, Clostridium perfringens, Campylobacter spp., and Staphylococcus aureus. Salmonella results in the highest number of hospitalizations and deaths.

“One thing we’re seeing more of is outbreaks linked to imported food products. It’s not because imported food products are necessarily dangerous — it’s because we’re importing more,” says Marler.

What is Cyclospora?

Cyclosporaisis is an infection of the intestines, caused by consuming food or water contaminated with the cyclospora parasite. It’s most common in tropical and subtropical regions. The parasite most commonly affects produce, and past outbreaks have been tied to raspberries, snow peas, basil, and mesclun lettuce.

Is Cyclospora common in the U.S.?

Cyclosporaisis is relatively uncommon in the United States compared to other varieties of foodborne illness. Some of the earliest cases were documented in the 1980s, but two highly publicized outbreaks resulting from the import of Guatemalan raspberries in 1996 and 1997 brought greater awareness to the parasite. So far in the U.S., most cases have been attributed to imported fresh produce, according to the CDC.

“As we import more food we’re going to get bugs in our food supply that we don’t normally see,” Marler says, such as Cyclospora and Hepatitis A, which surfaced following the importing of infected scallops from the Philippines in 2016.

Does this mean foodborne illnesses are shifting in spectrum from more bacterial to more parasite?

No. The rates of Norovirus, Salmonella, Clostridium perfringens, Campylobacter spp., and Staphylococcus aureus still far outpace Cyclospora — a relatively rare foodborne illness-causing parasite.

What can companies and restaurants do to reduce the risks of transmitting foodborne illnesses to consumers?

Francine Shaw, founder of Food Safety Training Solutions has worked in chains such as McDonald’s, KFC, and Domino’s to provide food safety training services and audits. She recommends that companies work down from the executive level to improve overall awareness of food safety in order to reduce the risk of foodborne illness. She also advocates for in-person training with supplemental online training for employees at restaurants.

“While online training is very convenient and it has its place, I am a believer that there needs to be some in-person training done because online training can’t provide real life experiences,” Shaw says. “When we provide training we can explain to people why things are important. Why it’s important that you wash your hands or why it’s important that the cold food to be held at 41 degrees or below. Online training can’t always get that information across is effectively as a live person can.” Shaw also recommends that companies implement third party inspections to make sure restaurants are following food safety protocols, something Chipotle executives promised to do following the burrito chain’s 2015-2016 foodborne illness outbreaks. Shaw also advises companies to vet their suppliers to make sure they’ve seen the processing facilities and know their food safety protocols.

Are millennials to blame for all these outbreaks?

Sure, why not? When in doubt, blame millennials. But perhaps there’s actually a grain of truth to this. Product research and trend forecaster NDP found that consumers under age 40 have increased the annual eatings per capita of fresh vegetables by 52 percent and frozen vegetables by 59 percent over the last decade, compared to boomers who have decreased their consumption of fresh and frozen vegetables. Higher income millennials also tend to spend a larger share of their food budget on fruits and vegetables, according to Meanwhile chains like Sweetgreen are growing like weeds in order to feed the younger generation’s hunger for bougie salads.

Perhaps fast casual chain restaurants’ desires to feed young consumers’ hunger for fresh foods is outpacing the competency of suppliers. Such appears to have been the case with Chipotle, which famously aimed to satisfy the tastes of the millennial demographic with more ethically grown and sourced foods compared to traditional fast food, like McDonald’s, which tends to source from one major commercial supplier.

During Chipotle’s widely publicized food poisoning outbreaks, these complicated supply chains turned against the company, making it more difficult to trace the cause of the illnesses. “The more complicated your supply chain is, the more opportunity you have to introduce problems,” Melinda Wilkins, an expert in food safety with Michigan State University told Wired in 2016. “[Chipotle’s] food sourcing is a laudable effort—and it’s what customers want. But they’re probably walking a fine line between offering fresh, local ingredients and decentralized food preparation and the risk of introducing foodborne pathogens because it is such a complicated food chain.” In short, as millennial tastes force companies to reshape their supply chains, there may also be increases in foodborne illnesses.