Unforgettable foods: what's more likely to make you sick. (Special Feature).

If today is an average day in the United States, 13 people will die from food poisoning. Another 200,000 will get sick for a few days. And several thousand more may begin to suffer reactive arthritis, paralysis, or other symptoms that can last for months or years (see "Food Poisoning's Long Shadow," May 2002, p. 1).

Which foods cause the outbreaks that sicken the most people? "Fruits and vegetables top the list," says Caroline Smith DeWaal, director of food safety at the Center for Science in the Public Interest (which publishes Nutrition Action Healthletter).

CSPI has just issued the fifth edition of Outbreak Alert, a tally of food poisoning outbreaks in the U.S. since 1990 in which the food sources have been identified. (The Centers for Disease Control and Prevention--CDC--declares an outbreak when at least two people who eat the same contaminated food get sick. Since 1990, 2,472 outbreaks have sickened 90,355 people.)

"About half of the fruit-and-vegetable outbreaks were caused by salads, berries, raw sprouts, and lettuce," notes DeWaal. "Four out of every ten produce outbreaks were the result of bacteria, viruses, and other pathogens that are commonly found in meat and poultry," she adds. That means that the fruits and vegetables were probably contaminated in the fields with tainted water or manure.

"Contamination is a good reason to buy only pasteurized fruit juices and to wash your fruits and vegetables under running water," says DeWaal. "It's not an excuse to eat fewer fruits and vegetables."

Second on the foods-most-likely-to-make-you-sick list: poultry. A new Consumer Reports analysis found Salmonella or Campylobacter in about half of the whole fresh chickens it purchased at supermarkets nationwide. And some of the bacteria were resistant to human antibiotics. If you become ill after eating chicken contaminated with antibiotic-resistant bacteria, you may get sicker and stay sick longer.

"The only way to protect yourself is to avoid contaminating kitchen counters and utensils when handling raw poultry and to always cook your poultry thoroughly," says DeWaal. That means making sure it reaches at least 170[degrees]F in the breast and 180[degrees]F in the other parts or in the whole bird.

Then there are beef and eggs, which are neck-and-neck in the dubious race for third place on the Food Poisoning Hit Parade.

"Use a meat thermometer to make sure you cook your burgers to at least 160[degrees] F and your steaks and roasts to at least 145[degrees]F," says DeWaal. "That will kill harmful bacteria." You also need to thoroughly cook your eggs and any dishes made with eggs.

Location, Location

Where you live figures into how likely you are to get food poisoning, according to the CDC.

"We found substantial variations in the rate of Campylobacter, Salmonella, and E. coli infections in the states we studied," says the CDC's Fred Angulo. Angulo is chief of Foodnet, a network that keeps track of foodborne illnesses in nine states.

In the year 2000, for example, California residents were six times more likely to suffer a Campylobacter infection than Tennessee residents. "That probably reflected greater rates of Campylobacter-contaminated poultry in California," says Angulo.

Bugs to Go

Where you eat can also affect your risk. "Consuming food prepared outside the home is associated with an increased risk of foodborne illness," says Angulo.

The CDC estimates that people who ate chicken out in 1998 and 1999 were twice as likely to get sick with a Salmonella infection than people who ate chicken only at home.

What's more, people who ate hamburgers at non-fast-food restaurants were ten times more likely to become infected with E. coli O157:H7 than people who ate hamburgers only at home.

"We don't know why," says Angulo. People might be more likely to report restaurant outbreaks, or there might be more opportunities for food or utensils to touch a contaminated surface in a restaurant kitchen.

On the other hand, "major fast-food restaurant chains have strict standards for the presence of bacteria like E. coli and Salmonella in the ground beef they buy from their suppliers," says Angulo. Also, production is more mechanized at fast-food chains, so it's easier to cook every burger to a temperature that kills E. coli.

For a list of the major food bugs and toxins and the symptoms they cause, see "The Dirty Dozen."

THE DIRTY DOZEN

    Bug                         Major Symptoms

Campylobacter        diarrhea (can be bloody), fever, abdominal
(bacteria)           pain, nausea, headache, muscle pain

Ciguatera            within 2 to 6 hours: abdominal pain, diarrhea,
(toxin)              general pain and weakness, nausea, tempera-
                     ture reversal (hot things feel cold and cold
                     things feel hot), tingling, vomiting
                     within 2 to 5 days: slow heartbeat, low blood
                     pressure

Clostridium          vomiting, diarrhea, blurred vision, double
botulinum            vision, difficulty swallowing, muscle weakness
(bacteria)           that spreads from the upper to the lower
                     body

Cyclospora           fatigue, frequent protracted bouts of
(parasite)           diarrhea

E. coli O157:H7      severe diarrhea that is often bloody, abdomi-
(bacteria)           nal pain, vomiting (usually accompanied by
                     little or no fever)

Hepatitis A          diarrhea, dark urine, jaundice (yellow
(virus)              "whites" of the eyes), flu-like symptoms

Listeria             fever, muscle aches, nausea, diarrhea (preg-
(bacteria)           nant women may have mild flu-like symp-
                     toms; can lead to premature delivery or still-
                     birth)

Norwalk virus        nausea, vomiting, large-volume watery
                     diarrhea

Salmonella           diarrhea, fever, abdominal cramps, vomiting
(bacteria)

Scombrotoxin         flushing; rash; burning sensation in skin,
(toxin)              mouth, and throat; dizziness, hives, tingling

Vibrio para-         watery diarrhea, abdominal cramps, nausea,
haemolyticus         vomiting
(bacteria)

Vibrio vulnificus    vomiting, diarrhea, abdominal pain, bacteria
(bacteria)           in the blood, wounds that become infected

     Bug                   Foods that Have
                          Caused Outbreaks

Campylobacter        undercooked poultry, unpas-
(bacteria)           teurized (raw) milk, contami-
                     nated water

Ciguatera            large reef fish like barracuda,
(toxin)              grouper, red snapper, and
                     amberjack

Clostridium          home-canned foods, improp-
botulinum            erly canned commercial foods,
(bacteria)           herb-infused oils, potatoes
                     baked in aluminum foil,
                     bottled garlic

Cyclospora           imported berries,
(parasite)           contaminated water, lettuce

E. coli O157:H7      undercooked beef, unpasteur-
(bacteria)           ized (raw) milk or juice, raw
                     produce, salami, contaminat-
                     ed water

Hepatitis A          shellfish, raw produce, foods
(virus)              that are not reheated after
                     coming into contact with an
                     infected food handler

Listeria             fresh soft cheeses, unpasteur-
(bacteria)           ized (raw) or inadequately
                     pasteurized milk, ready-to-eat
                     deli meats and hot dogs

Norwalk virus        poorly cooked shellfish,
                     ready-to-eat foods touched
                     by infected food handlers,
                     salads, sandwiches

Salmonella           eggs, poultry, unpasteurized
(bacteria)           (raw) milk or juice, cheese,
                     raw produce

Scombrotoxin         fresh tuna, bluefish,
(toxin)              mackerel, marlin, mahi mahi

Vibrio para-         undercooked or raw seafood
haemolyticus
(bacteria)

Vibrio vulnificus    undercooked or raw shellfish
(bacteria)           (especially oysters), other con-
                     taminated seafood

     Bug                  How Soon it            How Soon it
                        Typically Strikes      Typically Ends

Campylobacter        2 to 5 days            2 to 10 days
(bacteria)

Ciguatera            2 hours to             days to months
(toxin)              5 days

Clostridium          12 to 72 hours         days to months
botulinum                                   (get treatment
(bacteria)                                  immediately)

Cyclospora           1 to 11 days           weeks to months
(parasite)

E. coli O157:H7      1 to 8 days            5 to 10 days (get
(bacteria)                                  treatment imme-
                                            diately, especially
                                            for a child or
                                            elderly person)

Hepatitis A          15 to 50 days          2 weeks to 3
(virus)                                     months

Listeria             9 to 48 hours          days to months
(bacteria)           for gastrointesti-     (get treatment
                     nal symptoms,          immediately)
                     2 to 6 weeks for
                     infections in the
                     blood, brain, or
                     uterus

Norwalk virus        24 to 48 hours         24 to 60 hours

Salmonella           1 to 3 days            4 to 7 days
(bacteria)

Scombrotoxin         1 minute to            3 to 6 hours
(toxin)              3 hours

Vibrio para-         2 to 48 hours          2 to 5 days
haemolyticus
(bacteria)

Vibrio vulnificus    1 to 7 days            2 to 8 clays (get
(bacteria)                                  treatment
                                            immediately)

Source: Adapted from Diagnosis and Management of Foodborne Illnesses, A
Primer for Physicians (www.cdc.gov/mmwr/preview/mmwrhtml/rr5002a1.htm),
by the American Medical Association, the Centers for Disease Control
and Prevention, the Food and Drug Administration, and the U.S.
Department of Agriculture.