Multistate outbreaks cause more than half of all deaths in foodborne disease outbreaks despite accounting for only a tiny fraction (3%) of reported outbreaks in the United States, according to a new Vital Signs report released in November by the Centers for Disease Control and Prevention (CDC).

The leading causes of multistate outbreaks—Salmonella, E. coli and Listeria—are more dangerous than the leading causes of single-state outbreaks. These three germs, which cause 91% of multistate outbreaks, can contaminate widely distributed foods, such as vegetables, beef, chicken and fresh fruits, and end up sickening people in many states.

“Americans should not have to worry about getting sick from the food they eat,” said CDC Director Tom Frieden, in a press release. “Top-notch epidemiology and new gene sequencing tools are helping us quickly track down the source of foodborne outbreaks—and together with our national partners we are working with the food industry to prevent them from happening in the first place.”

Highlights from the report on multistate foodborne outbreaks during 2010-2014 include:

Salmonella accounted for the most illnesses and hospitalizations and was the cause of the three largest outbreaks, which were traced to eggs, chicken and raw ground tuna.

Listeria caused the most deaths, largely due to an outbreak caused by contaminated cantaloupe in 2011 that killed 33 people.

Imported foods accounted for 18 of the 120 reported outbreaks. Food imported from Mexico was the leading source in these outbreaks, followed by food imported from Turkey.

The report recommends that local, state and national health agencies work closely with food industries to understand how their foods are produced and distributed to speed multistate outbreak investigations. The report highlights the need for food industries to play a larger role in improving food safety by following best practices for growing, processing and shipping foods. In addition, food industries can help stop outbreaks and lessen their impact by keeping detailed records to allow faster tracing of foods from source to destination, by using store loyalty cards to help identify which foods made people sick, and by notifying customers of food recalls.

Under the 2011 FDA Food Safety Modernization Act, the Food and Drug Administration (FDA) is developing new regulations that will not only require importers to verify that their suppliers are meeting U.S. food safety standards, but will hold both domestic and foreign companies accountable for preventing foodborne illness before it occurs. Final regulations for preventive controls were announced in September, and additional regulations covering produce, imported foods, intentional adulteration and sanitary transportation are expected in coming months.