Foodborne Illness Outbreaks Linked to Microbial Hazards Associated with Non-Dairy Fermented and Cultured Foods in the United States, 2011–2023

• Non-dairy fermented foods (NDFF) were linked to 39 U.S. outbreaks between 2011–2023. • Food vehicles in NDFF outbreaks were linked to 12 different food categories. • Clostridium botulinum was responsible for the largest number of NDFF outbreaks. • Salmonella spp. caused the most illnesses associated with NDFF outbreaks. • Alaska most frequently reported NDFF outbreaks (38% of all outbreaks). Approximately one-third of the human diet is made up of fermented and cultured foods, which are generally considered to be at a lower risk of contamination with foodborne pathogens than their raw ingredient counterparts. Foodborne illnesses attributable to fermented foods may be underrecognized in the literature, since many analyses classify foodborne illnesses based on the implicated food, rather than the type of processing. To determine the burden of illness attributable to non-dairy fermented foods (NDFFs) in the United States, outbreaks reported to the Foodborne Disease Outbreak Surveillance System (FDOSS) from 2011–2023 were reviewed for association with a non-dairy fermented or cultured food vehicle. In total, 39 outbreaks were identified, resulting in 509 illnesses, 132 hospitalizations, and four deaths. Clostridium botulinum was responsible for the largest number of outbreaks (16; 47% of all single-etiology outbreaks). Salmonella enterica was responsible for most illnesses (307; 64% of illnesses associated with single-etiology outbreaks), followed by C. botulinum (56 12%). Alaska was the state that reported NDFF outbreaks most frequently (15/39; 38% of outbreaks), with food vehicles linked to traditional Alaskan foods including fermented black bear meat, fermented fish, fermented seal, and fermented whale. Examples of factors that may contribute to NDFF outbreaks include use of contaminated ingredients, improper processing or fermentation, post-process contamination, and unsafe food handling practices by consumers. The occurrence of outbreaks linked to a variety of NDFFs highlights both the importance of safe food handling practices and preventive controls.