Jerri Reges can tell you what food poisoning feels like.
"This was worse than labor," said Reges, a mother of two.
The 39-year-old got severe stomach cramps after eating a hoagie at a convenience store July 5, becoming one of more than 300 people sickened in a recent salmonella outbreak that has hit five states. Roma tomatoes are believed to be the cause.
It is the latest high-profile scare involving fresh produce, which experts say is the new frontier in food-borne disease prevention. In this round no one has died, in contrast to last year's hepatitis outbreak that killed four people and made hundreds sick. Green onions from Mexico were blamed.
Tainted fresh foods pose more concerns than others because fruits and vegetables are often eaten raw or lightly cooked. That means salmonella, cyclospora, shigella, E. coli and other pathogens often are not killed before eating, and they generally cannot be removed by washing.
The most common of these cause diarrhea and cramps and are not fatal. The germs are often spread from the unwashed hands of food workers.
International and federal laws do not allow the United States to set tougher safety rules for imported produce than for domestic products. Although the Food and Drug Administration tightened seafood and juice regulations after outbreaks in the late 1990s, officials are still studying whether to tighten fruit and vegetable standards.
"It's really discouraging that it takes somebody to die to get anybody to do something," said Nancy Donley, president of Safe Tables Our Priority. The Burlington, Vt.-based group was formed by the parents of children who died or were seriously ill after a 1993 E. coli disease outbreak traced to undercooked hamburgers.
Donley said a key problem is that no single agency is responsible for food safety. The U.S. Department of Agriculture monitors meat, poultry and some egg products; the FDA handles eggs still in their shell, dairy products and all other foods.
"If you've got an outbreak in a place that makes both cheese and sausage pizzas, you'll have the USDA in there for the sausage pizzas and the FDA in there for the pizzas with just cheese," Donley said. "It's just silly."
Officials with those agencies note that their jurisdictions are set by Congress.
The fruit and vegetable industry, alarmed by the outbreaks, is already policing itself, said Devon Zagory, senior vice president of Davis Fresh Technologies LLC of Redding, Calif., a food safety consulting firm. Most supermarket chains, for example, make growers and suppliers use food safety programs that must be audited by third parties such as Zagory's company, he said.
When questions arise about unsafe imports, the FDA can simply ban products it cannot otherwise regulate.
The agency barred imported Mexican cantaloupes a few years ago after dozens of people got sick and two died in four separate salmonella outbreaks linked to melons. The ban was lifted for some Mexican companies that said they would adopt stricter safety standards.
But another key to combating food poisoning is measuring the problem, an inexact science that the Centers for Disease Control and Prevention is working to improve.
The CDC estimates 76 million Americans get food-borne illnesses each year, based on a study of 1997 statistics, said Robert Tauxe, chief of CDC's food-borne and diarrheal diseases branch. In that study, the CDC concluded that 325,000 Americans are hospitalized and 5,000 die each year, but that only one in 38 cases is reported.
The numbers are based on the assumption that millions of people, unlike Reges, are never hospitalized and blame their illness on a virus or the flu.
The CDC is now actively tracking food-borne illnesses in nine states and using those numbers to set nationwide estimates.