Fast Facts of CDC: Surveillance for Foodborne Disease Outbreaks — United States, 2009–2015 Surveillance Summaries / July 27, 2018 / 67(10);1–11:

2009–2015: 5,760 outbreaks that resulted in 100,939 illnesses, 5,699 hospitalizations, and 145 deaths.

Among 2,953 outbreaks with a single confirmed etiology:

  1. Norovirus was the most common cause of outbreaks (1,130 outbreaks [38%]) and outbreak-associated illnesses (27,623 illnesses [41%]).
  2. Salmonella with 896 outbreaks (30%) and 23,662 illnesses (35%).
  3. Outbreaks caused by ListeriaSalmonella, and Shiga toxin-producing Escherichia coli (STEC) were responsible for 82% of all hospitalizations and 82% of deaths reported.

Among 1,281 outbreaks in which the food reported could be classified into a single food category:

  1. Fish were the most commonly implicated category (222 outbreaks [17%]).
  2. Dairy (136 [11%]).
  3. Chicken (123 [10%]).

The food categories responsible for the most outbreak-associated illnesses were:

  1. Chicken (3,114 illnesses [12%]).
  2. Pork (2,670 [10%]).
  3. Seeded vegetables (2,572 [10%]).

Multistate outbreaks comprised only 3% of all outbreaks reported but accounted for 11% of illnesses, 34% of hospitalizations, and 54% of deaths.

Problem/Condition: Known foodborne disease agents are estimated to cause approximately 9.4 million illnesses each year in the United States. Although only a small subset of illnesses are associated with recognized outbreaks, data from outbreak investigations provide insight into the foods and pathogens that cause illnesses and the settings and conditions in which they occur.

Description of System: The Foodborne Disease Outbreak Surveillance System (FDOSS) collects data on foodborne disease outbreaks, which are defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Since the early 1960s, foodborne outbreaks have been reported voluntarily to CDC by state, local, and territorial health departments using a standard form. Beginning in 2009, FDOSS reporting was made through the National Outbreak Reporting System, a web-based platform launched that year.

Results: During 2009–2015, FDOSS received reports of 5,760 outbreaks that resulted in 100,939 illnesses, 5,699 hospitalizations, and 145 deaths. All 50 states, the District of Columbia, Puerto Rico, and CDC reported outbreaks. Among 2,953 outbreaks with a single confirmed etiology, norovirus was the most common cause of outbreaks (1,130 outbreaks [38%]) and outbreak-associated illnesses (27,623 illnesses [41%]), followed by Salmonella with 896 outbreaks (30%) and 23,662 illnesses (35%). Outbreaks caused by ListeriaSalmonella, and Shiga toxin-producing Escherichia coli (STEC) were responsible for 82% of all hospitalizations and 82% of deaths reported. Among 1,281 outbreaks in which the food reported could be classified into a single food category, fish were the most commonly implicated category (222 outbreaks [17%]), followed by dairy (136 [11%]) and chicken (123 [10%]). The food categories responsible for the most outbreak-associated illnesses were chicken (3,114 illnesses [12%]), pork (2,670 [10%]), and seeded vegetables (2,572 [10%]). Multistate outbreaks comprised only 3% of all outbreaks reported but accounted for 11% of illnesses, 34% of hospitalizations, and 54% of deaths.

Location: A location of preparation was provided for 5,022 outbreak reports (87%), with 4,696 (94%) indicating a single location. Among outbreaks reporting a single location of preparation, restaurants were the most common location (2,880 outbreaks [61%]), followed by catering or banquet facilities (636 [14%]) and private homes (561 [12%]). Sit-down dining style restaurants (2,239 [48%]) were the most commonly reported type of restaurant. The locations of food preparation with the most outbreak-associated illnesses were restaurants (33,465 illnesses [43%]), catering or banquet facilities (18,141 [24%]), and institutions, such as schools (9,806 [13%]). The preparation location with the largest average number of illnesses per outbreak was institutions (46.5), whereas restaurants had the smallest (11.6).

Outbreaks: Outbreak investigators identified a food in 2,442 outbreaks (42%). These outbreaks resulted in 51,341 illnesses (51%). The food reported belonged to a single food category in 1,281 outbreaks (22%). The food category most commonly implicated was fish (222 outbreaks [17%]), followed by dairy (136 [11%]) and chicken (123 [10%]). The food categories responsible for the most outbreak-associated illnesses were chicken (3,114 illnesses [12%]), pork (2,670 [10%]), and seeded vegetables (2,572 [10%]). Scombroid toxin in fish was the single confirmed etiology and food category pair responsible for the most outbreaks (85), followed by ciguatoxin in fish (72) and Campylobacter in dairy (60). The pathogen-food category pairs that caused the most outbreak-associated illnesses were Salmonella in eggs (2,422 illnesses), Salmonella in seeded vegetables (2,203), and Salmonella in chicken (1,941). In comparison, scombroid toxin and ciguatoxin outbreaks from fish resulted in 519 outbreak-associated illnesses, an average of three illnesses per outbreak. Outbreaks of Salmonella infections from seeded vegetables resulted in an average of 88 illnesses per outbreak, and outbreaks of Salmonella infections from eggs resulted in an average of 78 illnesses per outbreak.

Food Implicated: Several novel food vehicles caused outbreaks during the study period. In 2011, an outbreak of Salmonella serotype Enteritidis infections linked to pine nuts imported from Turkey resulted in 53 illnesses and two hospitalizations. In 2014, an outbreak of Salmonella serotypes Gaminara, Hartford, and Oranienburg in chia seed powder imported from Canada caused 45 illnesses and seven hospitalizations. An outbreak of STEC serogroups O26 and O121 infections that began in 2015 was linked to raw wheat flour produced in the United States; it resulted in 56 illnesses and 16 hospitalizations in 24 states. An outbreak of Salmonella serotype Virchow infections attributable to moringa leaf powder imported from South Africa began in 2015 and caused 35 illnesses and six hospitalizations in 24 states. It was an ingredient of an organic powdered shake mix branded to be used as a meal replacement.

Multistate Outbreaks: Multistate outbreaks comprised only 3% of outbreaks but were responsible for 11% of illnesses, 34% of hospitalizations, and 54% of deaths. Multistate outbreaks involved a median of seven states with a range of two to 45 states in which exposure occurred. The largest of the 177 multistate outbreaks was caused by Salmonella serotype Enteritidis and due to contaminated shell eggs. An estimated 1,939 persons were infected in 10 states beginning in 2010. An outbreak of Salmonella serotype Poona infections attributed to cucumbers in 2015 had the second highest number of illnesses (907 illnesses in 40 states). This outbreak also had the most outbreak-associated hospitalizations (204 [22% of cases]). An outbreak of Salmonella serotype Heidelberg infections attributed to chicken during 2013–2014 had the second most hospitalizations (200 [32% of cases]) and involved persons from 29 states and Puerto Rico. An outbreak of Listeria monocytogenes infections attributed to cantaloupes in 28 states in 2011 had the most deaths (33 [22% of cases]), followed in 2014 by an outbreak in 12 states of Listeria monocytogenes infections attributed to caramel apples, another novel food vehicle (9), in which seven persons (20% of cases) died.

Daniel Dewey-Mattia, MPH; Karunya Manikonda, MPH; Aron J. Hall, DVM; Matthew E. Wise, PhD; Samuel J. Crowe, PhD.

  1. CDC Annual summaries of foodborne outbreaks. Atlanta, GA: US Department of Health and Human Services, CDC; 2018.
  2. Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States—major pathogens. Emerg Infect Dis 2011;17:7–15. CrossRefPubMed
  3. National Notifiable Diseases Surveillance System (NNDSS). Foodborne disease outbreak 2011 case definition. Atlanta, GA: US Department of Health and Human Services, CDC; 2013.
  4. PulseNet. Atlanta, GA: US Department of Health and Human Services, CDC; 2017.
  5. Guide to confirming an etiology in foodborne disease outbreak. Atlanta, GA: US Department of Health and Human Services, CDC; 2015.
  6. Interagency Food Safety Analytics Collaboration (IFSAC) Food Categorization Scheme. Atlanta, GA: US Department of Health and Human Services, CDC; 2015.
  7. Richardson LC, Bazaco MC, Parker CC, et al. An updated scheme for categorizing foods implicated in foodborne disease outbreaks: a tri-agency collaboration. Foodborne Pathog Dis 2017;14:701–10. CrossRefPubMed
  8. US Census Bureau. Population and housing unit estimates. Washington, DC: US Department of Commerce, US Census Bureau; 2016.
  9. Angelo KM, Conrad AR, Saupe A, et al. Multistate outbreak of Listeria monocytogenesinfections linked to whole apples used in commercially produced, prepackaged caramel apples: United States, 2014–2015. Epidemiol Infect 2017;145:848–56. CrossRef PubMed
  10. Gould LH, Kline J, Monahan C, Vierk K. Outbreaks of disease associated with food imported into the United States, 1996–2014. Emerg Infect Dis 2017;23:525–8. CrossRefPubMed
  11. Gould LH, Walsh KA, Vieira AR, et al. . Surveillance for foodborne disease outbreaks—United States, 1998–2008. MMWR Surveill Summ 2013;62(No. SS-2):1–34. PubMed
  12. Hall AJ, Wikswo ME, Pringle K, Gould LH, Parashar UD. Vital signs: foodborne norovirus outbreaks—United States, 2009–2012. MMWR Morb Mortal Wkly Rep 2014;63:491–5. PubMed
  13. Food and Drug Administration. Food Code 2017. Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2018.
  14. Tauxe RV. Emerging foodborne diseases: an evolving public health challenge. Emerg Infect Dis 1997;3:425–34. CrossRefPubMed
  15. Food and Drug Administration. Egg safety final rule. Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2017.
  16. Food and Drug Administration. FDA Food Safety Modernization Act (FSMA). Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2017.
  17. Food Safety and Inspection Service. Salmonella action plan. Washington, DC: US Department of Agriculture, Food Safety and Inspection Service; 2015.

As of July 13, 2018, 212 people infected with the outbreak strains of Salmonella have been reported from 44 states.

  • Illnesses started from February 15, 2018 to June 21, 2018.
  • 34 ill people have been hospitalized, and no deaths have been reported.
  • 26% of ill people are children younger than 5 years.

Epidemiologic, traceback, and laboratory findings link these outbreaks to contact with live poultry, such as chicks and ducklings, which come from multiple hatcheries.

  • In interviews, 100 (72%) of 138 ill people with information available reported contact with chicks or ducklings in the week before their illness started.
  • People reported obtaining chicks and ducklings from several sources, including feed supply stores, websites, hatcheries, and from relatives.

WGS analysis to identify antibiotic resistance was performed for 118 isolates from ill people in this outbreak. Twenty-two isolates from ill people contained genes expected to cause resistance or decreased susceptibility to all or some of the following antibiotics: ampicillin, streptomycin, sulfamethoxazole, tetracycline, gentamicin, ceftriaxone, amoxicillin-clavulanic acid, cefoxitin, ciprofloxacin, and fosfomycin. Ninety-six isolates did not identify predicted resistance. Testing of 5 outbreak isolates using standard antibiotic susceptibility testing by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory confirmed these results. Some infections may be difficult to treat with commonly recommended antibiotics, and may require another kind of antibiotic.

Here is a good reminder:

This year’s FoodNet report summarizes 2017 preliminary surveillance data and describes trends since 2006 for infections caused by the following pathogens monitored by FoodNet: Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC), Shigella, Vibrio, Yersinia. The report also summarizes cases of hemolytic uremic syndrome (HUS) for 2016, the most recent year for which those data are available.

  • In 2017, FoodNet received reports of 24,484 illnesses, 5,677 hospitalizations, and 122 deaths in its surveillance area, which includes 15% of the U.S. population.
  • The incidence of infections per 100,000 people was highest for Campylobacter and Salmonella, which is similar to previous years.
  • The number of infections diagnosed by CIDT, a newer type of test, is increasing. 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.
  • CIDTs are revealing many infections – such as those caused by Cyclospora, Yersinia, Vibrio, and STEC non-O157 – that would not have been diagnosed before because of limited testing. CIDTs are fast and easy to use, and they detect some illnesses that would have otherwise been missed. However, CIDTs also challenge our ability to find outbreaks and monitor disease trends, because they do not provide certain information needed to characterize organisms that cause infections. For example, some information about the bacteria that cause infections, such as subtype and antimicrobial susceptibility, can be obtained only if a CIDT-positive specimen is cultured. FoodNet is gathering information to better understand the effect of CIDTs on surveillance.
  • The incidence of Salmonella infections overall did not change significantly, but there were significant changes among serotypes:
  • The incidence of infections caused by serotypes Typhimurium and Heidelberg has been decreasing since 2006–2008, with overall declines of more than 40% for both. Infections cause by serotypes Javiana, Thompson, and Infantis have all increased by more than 50% since 2006–2008.
  • Infections caused by STEC O157 have decreased in the past 10 years. The increasing use of CIDTs makes interpretation of trends in STEC infections difficult because CIDTs do not indicate which STEC serogroup caused the infection. The incidence of HUS among children younger than 5 years decreased during 2016 compared with 2006–2008. Because most cases of HUS are caused by STEC O157, the decline in HUS provides evidence that supports the finding of the decline in STEC O157 cases.


After 25 years doing food litigation, I am seldom surprised by the announcement of a foodborne illness outbreak.  It was no different last Friday when the Indiana Department of Health announced a multi-state Salmonella outbreak linked to cut fruit – mainly melons sold at large retailers in several states.  People in government or in various parts of the food industry know that an outbreak is brewing weeks before the evidence becomes too overwhelming to ignore, so on more than a few occasions, when the delay between government and industry knowledge and a public announcement becomes too slow for concerned people and I get a call, text of email.

But, it is not how the information gets out that concerns me – there will always be a difficult balance in foodborne epidemiology about when to go public.  If a contaminated food product is missed by proper production and testing, we will not know of the problem until people become ill.  And, the time between consumption, illness, investigation and recall can stretch for weeks or months depending on the numbers of people sick and the numbers of jurisdictions that encompass the outbreak.  Foodborne illness surveillance will always have challenges and continuing to make the process faster and more accurate must always be the goal.

However, what continues to both concern and perplex me is the FDA’s failure to be more transparent with the public once we know the cause of the outbreak.  In the early 2000’s the USDA/FSIS had a policy that would publicly announce who manufactured E. coli O157:H7 meat but refused to announce the location of where the product was sold – retailers or restaurants.  In 2002 the ConAgra beef E. coli O157:H7 outbreak and recall sickened dozens and killed one.  Most of the illnesses happened on or around the 4thof July.  However, a couple of illnesses happened later that Fall. When asked if those sickened had heard of the ConAgra outbreak and recall they said they had, but “we bought our meat at Safeway, not at ConAgra.”

It was not until 2008 that USDA/FSIS began to routinely disclose the retail distribution lists, so retailers and consumers would know where tainted product was shipped and potentially served.  According to a recent article in the Washington Post:

In the early 2000s, the Food Safety and Inspection Service — the branch of the U.S. Department of Agriculture that regulates meat, poultry and egg products — decided to revisit its own interpretation of the trade secrets rule. During a lengthy comments period, industry groups concerned with protecting their distribution lists from competitors faced off against consumer advocates. In 2008, after several years of debate, FSIS’s final rule concluded that it would “not cause substantial harm to the competitive position of any business” to disclose retailer names.

Not surprisingly retailers of USDA/FSIA regulated products have survived disclosure – transparency has been a benefit to consumer confidence.

Conversely, 80% of the food supply – that regulated by the FDA – has remained silent and opaque leaving retailers and consumers confused and at times angry at the lack of transparency.  According to the same Washington Post article:

In a statement to The Washington Post, the FDA affirmed that it believes its disclosure measures are sufficient and blamed the lack of downstream recall information on federal disclosure rules. Federal regulations do limit the sort of information that can be released to the public. Under the Freedom of Information Act and Title 21 of the Code of Regulations, government agencies — and specifically, the FDA — are told to exempt trade secrets and commercial information from any of their releases.

“Examples of [confidential consumer information] include raw material supplier lists, finished product customer lists, trace back information, etc.,” said Peter Cassell, a spokesman for the FDA. “CCI is exempt from Freedom of Information Act requests but can be shared through certain information sharing agreements (including with other Federal agencies).”

“The FDA publicizes recall notices, including pictures of affected products, and uses social media accounts to reach consumers as swiftly as possible,” he later added. “In some cases, the FDA can release certain information that is otherwise exempt from disclosure if it is necessary to effectuate a recall. In many cases, it is most efficient for the company to directly notify its distributors, so they can take appropriate action.”

Cassell declined to make an agency lawyer available for comment or explain how the FDA had arrived at its definitions….

Let me weigh in where the FDA would not.  Let me also be blunt – there is no reason (especially when faced with an outbreak of foodborne illness) – for the FDA to claim that the retail distribution list is a trade secret.  Transparency of the food chain for products overseen by USDA/FSIS has not lead to a collapse of trade secrets.  The FDA might well learn from a ten-year history of its sister food safety agency. Chicken Little, the sky did not fall.

An egregious example of FDA’s failure to not name retailers was 2017 E. coli outbreak linked to I.M. Healthy (great name for a product with a pathogen) soy nut butter that sickened dozens, some children seriously so. The outbreak began in December 2016 and reached critical mass in April 2017.  A recall was publicly announced, but no retailers were named.  I.M. Healthy went bankrupt and was likely uninterested or unavailable to assist in the recall.  Not surprisingly, product remained available to purchase in retail settings and online several months after the outbreak and recall were announced.

Seriously, someone at the FDA needs to explain why an arguable “trade secret” trumps public health?  The chain of distribution needed a good dose of transparency – both retailers and consumers were confused – not by too much information, but from too little.

Now back to last Friday when Indiana announced a multi-state Salmonella outbreak linked to cut fruit – mainly melons sold at large retailers in several states.  Here, the Indiana State Department of Health – not FDA, nor the manufacturer – announced the outbreak.  There was no recall yet, but Indiana did name several retailers, but not the manufacturer. The first news articles targeted retailers, not the manufacturer.  Several hours later the CDC and FDA announced a 60 – person Salmonella outbreak and named the manufacturer, but not the retail chain.  Then the manufacturer posted a press release naming the retailer chain.

Confused?  Me too.

So, my advice to the mystery FDA lawyer is simple – focus on public health and what should be disclosed and what is a trade secret will become clear.  Formulations, ingredients and how a product are made are trade secrets.  Who supplied the tainted raw material, who made the tainted product and where the tainted product was sold is not a trade secret – especially during and outbreak.  Simplicity, transparency and consistency allows for a visible supply chain and one that consumers can have confidence in.  Hiding behind “trade secrets” creates confusion and mistrust – not something that is helpful in the sale of food.

The non-profit group Stop Foodborne Illness has extended the application deadline for the Dave Theno Food Safety Fellowship until June 15.

The fellowship program is a partnership with the Michigan State University Online Food Safety Program. The fellow will live in Chicago and work with Stop Foodborne Illness while completing a 12-credit online Food Safety Certificate with Michigan State University. The fellowship includes housing, benefits, salary and tuition.

Eligible applicants include recent graduates (2016-2018) with a food science or animal science undergraduate degree from a U.S. Land Grant University. The non-profit organization said preference will be given to those seeking a career in the food industry or food regulation.

About Dave Theno
At age 66, food safety pioneer Dave Theno was hit and killed by a large wave while swimming with his grandson in Hawaii on June 19, 2017.

At the time of his death, Theno was CEO of Gray Dog Partners Inc., based in Del Mar, CA. He been CEO for the food safety consulting business since 2009.

Theno made history in food safety circles after he was hired as senior vice president and chief food safety officer for Jack-in-the-Box in 1993. The San Diego fast food chain was reeling from a massive and deadly outbreak of E. coli O157:H7. Four deaths and hundreds of illnesses were blamed on the burger chain.

At Jack in the Box, Theno implemented a comprehensive Hazard Analysis and Critical Control Point (HACCP) plan. He was instrumental in requiring finished product test-and-hold protocols for hamburger. The safety measure initially irked those in the meat industry, but was later almost universally adopted.

Theno was also actively involved in numerous food industry and scientific organizations. In May 2017 he posthumously received the lifetime achievement award at the Food Safety Summit as part of the annual NSF Food Safety Innovation awards.

The Dave Theno fellow will:

  • Work in the Stop Foodborne Illness office 35 hours a week;
  • Complete two projects defined by the Stop and MSU Online Food Safety Directors;
  • Participate in weekly Safe Food Coalition calls; with possible travel to Washington, D.C.;
  • Assist the community coordinator in identified initiatives;
  • Help staff Stop’s booth at conferences, including the 2019 International; Association for Food Protection conference in Louisville, KY;
  • Attend “Creating a Food Safety Culture Executive Education” at MSU, May 21-24, 2019; and
  • Finish the MSU Food Safety Certificate coursework (12 credits).

A studio apartment, which is provided for the duration of the fellowship, is located in Chicago’s Ravenswood neighborhood. According to the organization it is wholly furnished, including full kitchen, basic cable and utilities. The Stop Foodborne Illness office is in the same building as the fellowship apartment.

In order to be considered for the fellowship, the application and supplemental materials must now be received by the organization no later than the extended deadline of June 15, 2018.

Applicants will need official transcripts from their degree granting university and three letters of recommendation (2 academic, 1 personal). Additionally, applicants will need a Statement of Intent outlining their background, professional interests, their reason for wanting this fellowship, and how they believe it will help their future career.

To review and begin the application process click here.

About STOP Foodborne Illness 
STOP Foodborne Illness is a national nonprofit public health organization dedicated to preventing illness and death from foodborne pathogens by advocating for sound public policies, building public awareness and assisting those impacted by foodborne illness.

Former FDA Deputy Commissioner of Foods and current board member for STOP, Mike Taylor, said the organization helped create a culture of food safety that has been the driver of “everything that’s happened since [1993] … It’s absolutely clear that [STOP is the] catalyst, and that change of mindset has had a transformative effect on the food system in this country.”

By Food Safety Magazine Staff

Bill Marler is the most prominent foodborne illness lawyer in America, and a major force in food policy in the U.S. and around the world. Bill’s firm—Marler Clark: The Food Safety Law Firm—has represented thousands of individuals in claims against food companies whose contaminated products have caused life-altering injuries and even death.

Bill began litigating foodborne illness cases in 1993, when he represented Brianne Kiner, the most seriously injured survivor of the historic Jack in the Box Escherichia coli O157:H7 outbreak, in her landmark $15.6 million settlement with the fast food company. For the last 25 years, Bill has represented victims of nearly every large foodborne illness outbreak in the U.S. He has filed lawsuits and class actions against Cargill, Chili’s, Chi-Chi’s, Chipotle, ConAgra, Dole, Excel, Golden Corral, KFC, McDonald’s, Odwalla, Peanut Corporation of America, Sheetz, Sizzler, Supervalu, Taco Bell, and Wendy’s. Through his work, he has secured over $650 million for victims of E. coli, Salmonella, Listeria, and other foodborne illnesses.

Bill Marler’s advocacy for a safer food supply includes petitioning the U.S. Department of Agriculture to better regulate pathogenic E. coli, working with nonprofit food safety and foodborne illness victims’ organizations, and helping spur the passage of the Food Safety Modernization Act. His work has led to invitations to address local, national, and international gatherings on food safety, including testimony before the U.S. House of Representatives Committee on Energy and Commerce, and the British House of Lords.

Bill travels widely and frequently to speak to law schools, food industry groups, fair associations, and public health groups about the litigation of claims resulting from outbreaks of pathogenic bacteria and viruses, and the issues surrounding it. He gives frequent donations to industry groups for the promotion of improved food safety and has established numerous collegiate science scholarships across the nation.

He is a frequent writer on topics related to foodborne illness. Among other accolades, Bill was awarded the NSF Food Safety Leadership Award for Education in 2010.

Link for Podcast: 

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In this episode of Food Safety Matters, we speak to Bill Marler about: 

  • The circumstances under which he met the late Dave Theno
  • The Jack in the Box case and how it propelled his career
  • The current listeriosis outbreak in South Africa, and how it compares to the Jack in the Box case 25 years ago
  • Why foodborne illness cases involving hamburger and Escherichia coli are no longer a huge problem
  • How the Odwalla apple juice outbreak could have been avoided
  • Whether or not Salmonella should be officially declared an adulterant
  • The responsibility of food safety: consumer vs. food industry
  • His thoughts on the ongoing Peanut Corporation of America case and whether or not Stewart Parnell’s attempts at a new trial are valid
  • FSMA, and how the new regulations can be improved
  • Blockchain, whole-genome sequencing, and other technologies that are changing the food safety for the better
  • His newfound interest in public health as it relates to food safety

Related Content
Poisoned: The True Story of the Deadly E. coli Outbreak That Changed the Way Americans Eat
20 Years of Marler Clark’s Top Foodborne Illness Cases

News Mentioned in This Episode
Deadly Listeria Strain Confirmed at South Africa Meat Plant
UPDATE: One Death Caused by Romaine Lettuce as E. coli Outbreak Spreads
New USDA Report Breaks Down Food Recalls 2004-2013; Trends in Food Recalls 2004-2013
UPDATE: Study: Fresh Produce Bacteria Can Thrive Despite Routine Chlorine Sanitizing; Official Study

Seattle U Lawyer: By Claudine Benmar, April 18, 2018

Bill Marler ’87 takes calls about foodborne illness from clients around the country. 

This year marks the 25th anniversary of a massive E. coli outbreak, which hit 73 Jack in the Box restaurants in Washington, Idaho, Oregon and California; sickened 700 people; sent 171 to the hospital; and killed four. The anniversary is a somber but noteworthy milestone for accomplished food safety attorney Bill Marler ’87.

“It’s the 25th anniversary of the outbreak, but it’s also the 20th anniversary of our law firm,” he said. Seattle-based Marler Clark, which he co-founded with fellow Seattle University School of Law alumnus Bruce Clark ‘84, was the nation’s first law firm to focus solely on helping victims of foodborne illnesses and grew directly from both attorneys’ experience with the 1993 outbreak.

As milestones like this come and go, Marler, who recently turned 60, wonders whether it’s time to retire. A few of his colleagues from the law firm’s early days have already done so.

“But I really love my job,” he said. “I get to make a huge difference in people’s lives, people who have lost their kidneys, lost their large intestines, are brain-injured, families that are facing millions and millions and millions of dollars in medical expenses, or a husband who’s never going to work again. And I get to help them. That’s a reason to get up and go to work every day.”

In the last two decades, Marler Clark has been involved in the aftermath of every major and minor outbreak of foodborne illness in the United States, working not only with victims but also with scientists and public health officials to make the food supply safer. Author Jeff Benedict, who chronicled the Jack in the Box story in his 2011 book, “Poisoned,” wrote that “no individual has had more influence on the shape and direction of food safety policy in the U.S.” than Marler.

Back in 1993, just a few years out of law school, he became the lead lawyer for the plaintiffs through an effective combination of hustle, hard work, personal connections, and media savvy.

His first E. coli client was a Tacoma family referred to him by a woman he had helped with a worker’s compensation claim. He rushed from his office in downtown Seattle to his old law school hangout in Tacoma (the law school was formerly affiliated with University of Puget Sound), the Poodle Dog Restaurant, met with the family, and convinced them to hire him.

“I went from obscurity to being sort of the legal face of the outbreak. I went from having one client to five clients to 10 clients to hundreds,” he said. Two years into the class-action lawsuit, when the end was finally in sight, Marler settled $25 million worth of cases in two days of mediation.

Most notably, he secured a $15.6 million settlement – the largest of its kind at the time – on behalf of Brianne Kiner, the Seattle girl who was the most severely injured victim of the outbreak, which was traced to undercooked hamburgers at 73 Jack in the Box restaurant locations. Just 9 years old, she spent several weeks in a coma, followed by a long and painful recovery. She still struggles with lifelong health effects such as infertility, asthma, and diabetes.

When the case concluded, Marler figured he would return to a general personal injury practice, possibly specializing in medical malpractice. But then another E. coli outbreak hit, again centered in Washington state. In 1996, a tainted batch of apple juice, from a juice company called Odwalla, killed one toddler and sickened 66 people. The families called Marler for help, thanks to his high profile in the Jack in the Box litigation.

“It really was at that point that I thought, ‘Hmm, clearly people think I know what I’m doing,’” Marler joked. “But candidly, I had worked really hard. I knew the law and I knew the medicine really well. I started wondering if you could create an entire practice around this.”

You could. Or rather, he could. Marler and Clark partnered with lawyers Denis Stearns and Andy Weisbecker to create the firm in 1998. (Both Clark and Stearns essentially switched sides, having represented Jack in the Box during the earlier litigation.) Two of the firm’s most recent hires are also Seattle U Law graduates – Anthony Marangon ’15 and Josh Fensterbush ’17. Stearns and Drew Falkenstein ’02 are of counsel at the firm.

Over the years, Marler has secured more than $600 million for victims of E. coli, salmonella, and other foodborne illnesses. While lawsuits often spur companies to make important changes – Jack in the Box developed the industry’s toughest safety standards after its outbreak – Marler knows there’s more to it than litigation. So he also devotes his energy and expertise to advocate for stronger food safety laws and regulations.

He petitioned the U.S. Department of Agriculture to better regulate pathogenic E. coli and successfully advocated for the passage of the 2010-2011 FDA Food Safety Modernization Act. He has spoken to countless industry groups and journalists, established science scholarships, and written extensively on all manner of foodborne pathogens.

What motivated Bill Marler back in 1993 is what continues to motivate him today. Many people who suffer the most from foodborne illness are children, and the money he earns for them is intended to take care of them for the rest of their lives.

Marler has three daughters of his own – one is a graduate of Seattle University and two are current students. The oldest was just an infant when he took on Jack in the Box.

“When you’re representing little children and you see how injured they are,” he said, “it doesn’t take much to look at your own kids and realize just how important your job is.”

Here is the link to the “200 Million Eggs Recalled Over Salmonella Concerns”

In one of the largest-ever recalls of eggs, Rose Acre Farms ordered 206 million eggs off of consumer shelves after health officials traced a salmonella outbreak to one of its farms in North Carolina. The product is the second major recall this year, with a separate warning out to consumers of romaine lettuce because of E. coli that has spread across seven states.

This year is the 25th anniversary of the “Jack in the Box” E. coli outbreak that spread across 73 stores, sickening over 700 people and contributing to four deaths. That outbreak changed how the U.S.D.A. and F.D.A. monitor food safety today and is part of the reason why the recent recalls of eggs and packaged lettuce can be seen as signs of regulatory success.

Ben Chapman, associate professor at North Carolina State University and co-host of the Food Safety Talk podcast, and Bill Marler, attorney specializing in food-borne illness, discuss the latest recall in the context of broader regulatory trends within the federal government.


Over the last 20 plus years I have given countless talks to food industry groups on the moral and business reasons to “not poison your customers.”  However, it has only been a handful of companies who have allowed me behind the curtain (at no charge) to talk directly, candidly and forcefully about the role of litigation as a agent of change in our food system.  Today, I had the honor to talk with the leaders at Walmart whose jobs it is to protect their customers around the world from the ravages of E. coli, Salmonella, Listeria and Hepatitis A.

A commitment to a culture dedicated to safe food lessens the chances of a food poisoning event, litigation and brand damage – all under the watchful gaze of Mr. Walton.

My friends at CIDRAP did a great job of pouring over the recent FoodNet report (Mar 23 MMWR report) on the incidence of a variety of pathogens.  I will steal a bit from their work.

Good news: Salmonella Typhimurium and Heidelberg illnesses down which mirrors decrease in positives in chicken and a decreased incidence of hemolytic uremic syndrome from 2006 to 2016 which mirrors an STEC O157 decline in ground beef over the same timeframe.

A team from the US Centers for Disease Control and Prevention (CDC) and partners in 10 states that are part of the FoodNet surveillance network reported its findings today in the latest issue of Morbidity and Mortality Weekly Report (MMWR).

The group publishes an annual FoodNet report in early spring, and this year’s report sums up lab-confirmed infections from nine pathogens for 2017, detailing changes since 2006. The pathogens are Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing E coli (STEC), Shigella, Vibrio, and Yersinia.

For 2017, the FoodNet system identified 24,484 foodborne illnesses, 5,677 hospitalizations, and 122 deaths. Highest incidences per 100,000 population were for CampylobacterSalmonella, and Shigella.

Growing use of culture-independent diagnostic tests (CIDTs) at public health labs is a useful tool for quickly identifying illnesses that might be missed by other lab tests, leading to more accurate incidence estimates, the authors write. They note, however, that their use can complicate the interpretation of estimates and that culturing isolates is still needed to reveal subtype information and test for antimicrobial susceptibility.

Regarding the infections only found on CIDT testing, percentages were highest for Yersinia (51%), Campylobacter (36%), Shigella (31%), Vibrio (29%), STEC (27%), Salmonella (9%), and Listeria (1%). Compared with findings from 2014 to 2016, incidence for 2017 was significantly higher for CyclosporaYersiniaVibrio, STEC, Listeria, and Campylobacter.

Given that the use of CIDT panels are rising, tests more often routinely detect CyclosporaYersiniaVibrio, and non-O157 STEC, the group said. “The increased incidence of these infections in 2017 was most likely driven by the increased use of CIDTs,” they wrote.

Of subtyped Salmonella isolates in 2017, the five most common were Enteritidis, Typhimurium, Newport, Javiana, and I 4,[5],12:i:-, a variant of Typhimurium. For 2017, the incidence of Heidelberg was 65% lower than from 2006 to 2008, with a similar decrease for Typhimurium over the same period.

When the scientists looked at STEC isolates, they found that the incidence of non-O157 STEC increased significantly in 2017 compared with 2014 to 2016. Though O157 STEC held steady, the incidence decreased 35% compared with 2006 to 2008.