In just the last few months, food such as Boar’s Head Deli Meats, cucumbers, and even fresh basil have sent Floridians, and Americans, to the hospital. Now, federal authorities are monitoring for people sickened by baby carrots, which were sold in Florida at Publix, Target, Trader Joe’s, and Whole Foods. So far, no one in Florida has reported a case of E. coli from the carrots. Still, according to the U.S. Food & Drug Administration, there have been 39 illnesses, 15 hospitalizations, and one death nationwide. Foodborne illnesses are rising, and food safety experts expect to see more people sickened by food contamination going forward. They attribute the increase in outbreaks to the nation’s reliance on pre-packaged, cold-storage items more prone to listeria contamination, an overstretched Food and Drug Administration, and a food-safety law that gives companies wide latitude on testing. Dr. Keith Schenider, a professor of Food Science and Human Nutrition at the University of Florida, says that with fewer people buying their food from local markets, the increase in multi-state grocery vendors also increases the likelihood of more widespread outbreaks. “It’s only when we have a large number of individuals that come down with salmonella or E.coli that the health departments report these things, and then an investigation ensues.” And frequently now, more food recalls occur before people even get sick. The Centers for Disease Control website coordinates 17 to 36 investigations of foodborne illnesses involving multiple states weekly.  This week, the CDC has 21 active investigations for multistate outbreaks from E. coli, salmonella, Listeria, and Campylobacter —pathogens that can cause gastrointestinal illness. Some — not all — of its investigations are alerted with Outbreak Notices to let people know actions they can take to stay healthy. Schneider says foods like fruits and vegetables when eaten uncooked, carry a higher risk for E. Coli Listeria is a foodborne illness contracted most often by eating contaminated food such as processed meats and unpasteurized milk products. According to the FDA, listeria is “generally transmitted when food is harvested, processed, prepared, packed, transported or stored in environments contaminated with L. monocytogenes.” Listeria grows in low temperatures, which is problematic because most factories that process meat, dairy, and produce are kept at cool temperatures. In July, just over 7 million pounds of liverwurst and deli meat from Boar’s Head were recalled for listeria contamination. Florida’s Publix Supermarkets pulled the meats from its delis. Since then, listeria warnings have gone out for frozen breakfast foods, poultry products, smoked salmon and soft cheeses, Dr. Nicole Iovine, the chief epidemiologist at UF Health Shands, said while investigators piece together the cause of an outbreak, it can take awhile for the public to become aware. “It could take maybe a month, even two months,” she said. Because many people recover without medical care, the reported cases may underestimate the scope of an outbreak:  “It’s only the tip of the iceberg that we are seeing,” Iovine said. (Article continues after chart.) Symptoms and red flags A bad strain of E. coli can make you horribly sick with abdominal cramps, vomiting, and bloody diarrhea. One particular strain, makes you sick by producing a toxin called Shiga, which damages the lining of your intestine. Another nasty strain can lead to kidney failure. Someone with a listeria infection may have similar symptoms: fever, nausea, and muscle aches.  People with Salmonella infection typically have diarrhea, fever, and stomach cramps. “People who get the sickest are those under 5 and over 65,” Iovine said. “If you are a parent of young children, over 65, pregnant or immune-compromised, if you get these symptoms, you must get medical attention.” Pregnant women need to be particularly cautious. They are about 10 times more likely to become sick from listeria, and the illness can be fatal to the fetus. Related Articles Health | At least 19 people are sick in Minnesota from ground beef tied to E. coli recall Health | Which health insurance plan may be right for you? Health | Pay first, deliver later: Some women are being asked to prepay for their baby Health | California case is the first confirmed bird flu infection in a US child Health | Your cool black kitchenware could be slowly poisoning you, study says. Here’s what to do Iovine said certain warning signs indicate you need to get medical help. “If you see blood in your stool, that’s a red flag to get medical attention. Another would be if you have severe abdominal pain and are doubled over. And, if you have a high fever over 101, that’s a red flag, too,” she said. Treatment and prevention The only way to know what type of foodborne illness you have is with a stool culture. For some types of E. coli infections, antibiotics can shorten the length of time you have symptoms. But if you have fever or bloody diarrhea or if your doctor suspects Shiga toxin-producing E. coli, don’t take antibiotics. “This can be important because for some infections. If you were to take an antibiotic, it does make things worse,” Iovine explains. With Shiga toxin-producing E. coli, bacteria can sense when antibiotics are present and increase the toxin’s production, which can cause kidney failure.” Doctors also advise against taking over-the-counter medications that fight diarrhea. It can slow down your digestive system and delay your body’s shedding of the infection. When it comes to prevention, Schneider said, washing produce isn’t enough to guarantee it is safe to eat, “The problem with produce is we don’t cook it. If you are in one of the at-risk groups, stick to cooked foods.” Because consumers often want their produce in convenient forms — cleaned, chopped lettuce in bags, sliced apples, cut celery, coleslaw mix — it creates more risk. The more handling, the more opportunity for contamination. At home, Schneider said,  use a clean cutting board, wash your hands frequently, and thoroughly cook poultry and meats. “There’s an inherent risk with food,” he said. “It’s almost impossible to serve that much food without having any consequences at all.” South Florida Sun Sentinel health reporter Cindy Goodman can be reached at [email protected].