Connecticut had the highest total number of foodborne illness outbreaks in New England from 2005 to 2014, according to federal data -- a distinction that experts say is fueled by better reporting, while higher rates of certain pathogens also may contribute.
An analysis of data from the Centers for Disease Control and Prevention (CDC) shows that Connecticut had 2,259 cases of foodborne illness in 154 single-state outbreaks in that 10-year period. For five of those years, Connecticut reported more single-state outbreaks than any other New England state. For eight years, its outbreak count exceeded that of its more populous neighbor, Massachusetts. And for nine of those years, it topped New Jersey.
The data show that norovirus, salmonella, and E. coli were the top three illness-causing offenders in Connecticut, with outbreaks most commonly linked to contaminated foods prepared at restaurants and in private homes, and, to a lesser degree, at banquet facilities and caterers.
Less commonly, outbreaks occurred at colleges, camps, and nursing facilities, although those incidents often sickened larger numbers of people than the ones occurring in restaurants and homes.
The Center for Science in the Public Interest (CSPI), in a 2015 report, ranked Connecticut among the top one-third of states in reporting foodborne illness outbreaks. Its analysis found that Connecticut reported the same or more outbreaks per million people than 34 other states, including all other New England states and New Jersey. In CSPI’s view, this is a positive.
“A high per-capita outbreak reporting rate probably reflects a robust public health system,” the report says.
David Plunkett, a CSPI senior staff attorney, said that since most food manufacturing is regulated at the federal level, states will have largely similar underlying rates of illness-causing food contamination.
“If you’ve got a problem with an outbreak among tomatoes in Connecticut, you’ve probably got a problem with an outbreak among tomatoes in Florida and elsewhere at the same rate,” Plunkett said, suggesting that state-by-state variations are tied to how well public health officials detect and report outbreaks.
A foodborne disease ‘outbreak’ is defined as the occurrence of two or more similar illnesses resulting from the ingestion of a common food.
Connecticut participates in two federal foodborne disease surveillance programs -- FoodNet and FoodCORE -- which have helped to ensure “robust detection and reporting systems that are similar to the systems in Oregon and Minnesota,” said Dr. Matthew Cartter, state epidemiologist for the Connecticut Department of Public Health (DPH). Oregon and Minnesota have a history of high detection and reporting of illnesses.
FoodNet, in place in 10 states, is a program that actively surveils for nine disease-causing foodborne pathogens -- meaning that investigators try to count every person who visited a doctor, had a sample tested, and was diagnosed with one of the pathogens, whether or not the case came to the attention of state public health officials. FoodCORE, also in place in 10 states, is a collaborative effort to improve detection.
State-by-state differences in outbreak rates also may be influenced by factors other than reporting, such as geographic location, water sources, proximity to cattle, and food-handling practices, according to the CDC and recent epidemiological studies.
In 2014 and 2015, according to FoodNet data, Connecticut had a relatively high rate of Campylobacter, a common foodborne bacteria found in raw and uncooked poultry and unpasteurized dairy products. The number of reported cases rose in Connecticut from fewer than 500 in 2007, to more than 700 in 2015 -- higher than the counts in more populous states, such as Maryland and Tennessee. State DPH data show that Fairfield County had the most reported cases of Campylobacter in 2015 (245), followed by New Haven County (172) and Hartford County (153).
To combat Campylobacter, state health officials and other groups developed a strategic plan that includes educating consumers on food-safety practices and ensuring appropriate training of food-safety workers.
Over the 10-year period in which Connecticut reported 154 single-state outbreaks, Maine reported 133 outbreaks, Massachusetts reported 123, Rhode Island had 54, New Hampshire had 44, and Vermont had 17, according to the CDC data.
Food safety experts note that the vast majority of foodborne illness cases fly under the radar. With salmonella, for instance, the CDC estimates that for every case of infection detected by a lab, there are 29 others.
A report in June by the federal Office of Inspector General for the U.S. Department of Health and Human Services found that the Food and Drug Administration (FDA) did not have an “efficient and effective food recall initiation process that helps ensure the safety of the nation’s food supply.” The report cited several outbreaks of salmonella and listeria in which the FDA’s lapses left consumers “at risk of illness or death for several weeks after FDA knew of potentially hazardous food.”
Some food-safety advocates, including U.S. Representative Rosa DeLauro from Connecticut, have been pushing for more funding to improve the FDA’s ability to institute and oversee recalls. A 2011 law gave FDA power to order recalls in cases that have the potential for serious harm.
CDC spokesperson Brittany Behm said that in the case of E. coli, a foodborne pathogen that occurs in beef, actual differences in rates of illness “might depend on how close people are to cattle, water sources, and differences in how much E. coli the cattle carry and shed.”
Recent studies point to other factors. A 2014 study in the journal Epidemiology & Infection found that northern states experience more E. coli outbreaks than southern states. The authors noted that cattle tend to shed more bacteria during daylight hours, and that northern states have longer daylight hours in summer. The same study also suggested that lower rates of infection in cattle-dense areas could mean that residents in those areas are exposed to low levels of the bacteria and eventually develop immunity.
Behm said the CDC “cannot quantify how much each factor plays into the different reporting rates of foodborne illness, particularly in any given state.”
The CSPI report noted that over its 10-year examination period, through 2012, overall outbreak reporting went down nationwide, and fewer outbreaks were solved -- trends the authors said were related to public health budget cuts.
This report was originally published by Connecticut Health I-Team. C-HIT Senior Writer Lisa Chedekel contributed to this story.