A deadly listeria outbreak connected to prepared pasta meals sold at grocery chains nationwide is worsening, federal health officials say.
As of late October, the outbreak has killed six people and sickened 27, all but two of whom were hospitalized, according to last week's update from the Centers for Disease Control and Prevention (CDC). One of those affected was a pregnant mother, resulting in a fetal loss.
Cases have been reported in 18 states: California, Florida, Hawaii, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, North Carolina, Nevada, Ohio, Oregon, South Carolina, Texas, Utah, Virginia and Washington.
"Since the last CDC case count update on September 25, 2025, a total of 7 new illnesses from 3 states have been reported, with 2 additional deaths reported," the Food and Drug Administration (FDA) said.
That list has grown in recent months. The outbreak started in June, when listeria concerns prompted recalls of several brands of ready-to-eat chicken fettuccine Alfredo mealsmade by FreshRealm Inc. and sold under the Home Chef brand at Kroger and the Marketside brand at Walmart.
In response, FreshRealm began testing some of its pasta samples — and in mid-September, they came back positive for listeria. Further genetic testing confirmed it was the same strain of listeria that was detected in FreshRealm's previously recalled chicken Alfredo meal, the FDA said at the time.
That discovery prompted the recall of two more products with specific use-by dates in late September and early October: Marketside Linguine With Beef Meatballs & Marinara Sauce, sold at Walmart, and Trader Joe's Cajun Style Blackened Chicken Breast Fettuccine Alfredo.
They shared a pasta supplier, Nate's Fine Foods. The company supplies precooked pasta and grains to the wholesale food service and restaurant industries, according to its website.
In late September, Nate's further expanded its recall to include other batches of precooked pasta "including fettucine, linguine, and farfalle (bowtie), after a sample of linguine pasta collected and tested by FreshRealm tested positive for Listeria monocytogenes," the FDA said.
Early October saw the recalls of several more pre-made pasta salads and heat-and-eat noodle dishes sold at Trader Joe's, Albertsons, Kroger, Walmart, Giant Eagle and Sprouts locations across the country.
In a late September statement, Nate's said it was recalling the products out of an "abundance of caution" and apologized for any concern it had caused.
"Our top priority is ensuring the safety of the people who enjoy our products, and we will continue to take all appropriate steps until this matter is resolved," it said, adding that it is working closely with the CDC, FDA and state health officials to identify the source.
The FDA says it is working with Nate's to determine if additional recalls are needed. Health officials say customers who purchased any of these meals should throw them away, and clean their refrigerators, containers and any surfaces that may have come into contact with the food.
At this point, the products that were recalled between June and October are more likely to be in customers' fridges and freezers than on store shelves. Most of them had use-by dates earlier than Oct. 10.
The recalled product with the longest shelf life is a frozen meal, Scott & Jon's Shrimp Scampi with Linguini Bowls. Those dishes, which were distributed to wholesale distributors and operators nationwide, have best-by dates in March 2027. A spokesperson for the company told NPR that retailers have removed the product from their shelves.
What to know — and do — about listeria
Listeria infection, or listeriosis, is most likely to sicken pregnant people and newborns, adults over 65 and people with weakened immune systems.
Pregnant people may only experience mild symptoms like fever, fatigue and muscle aches, but should be aware that listeria could cause miscarriages, premature delivery or life-threatening infection of their newborn.
Symptoms include fever, muscle aches, gastrointestinal issues, stiff neck, confusion and loss of balance. They usually start within two weeks of eating contaminated food but could start as soon as the same day or as late as 10 weeks later, the CDC says.
It can be hard to confirm the scope of an outbreak, since some people recover from the infection without medical care. For those who do require medical attention, the CDC says it usually takes three to four weeks to determine whether their illness is part of an outbreak.
The CDC says it has interviewed 13 of the people who got sick as of late September. Seven of them reported eating precooked meals before their illness started, and four specifically mentioned eating chicken fettuccine Alfredo.
The CDC and FDA say consumers should contact their health care provider to report any symptoms of listeriosis and receive care. They can also report any adverse health effects to the FDA online.
The U.S. has seen a number of listeria outbreaks in the past year.
A 2024 outbreak tied to deli meat left 10 people dead and dozens more hospitalized across the country. A U.S. Department of Agriculture report released in January blamed "inadequate sanitation practices" at a since-closed Boar's Head facility in Virginia and listed several steps it would take to better protect the public from listeria.
In February, nearly two million baked goods — including some donuts sold at Dunkin' — were recalled over listeria concerns. That same month, frozen shakes sold to nursing homes and long-term care facilities were recalled in connection with a listeria outbreak dating back to 2018. The FDA says that outbreak sickened 42 people and killed 14 — across 21 states — before authorities declared it over in May.
Copyright 2025 NPR