A Nationwide Public Health Crisis
A multistate outbreak of Listeria monocytogenes infections linked to prepared pasta meals has sickened 20 people across 15 states, resulting in 19 hospitalizations and 4 confirmed deaths as of September 25, 2025. The outbreak, which includes one pregnancy-associated illness that resulted in a fetal loss, has prompted an investigation involving multiple federal agencies and several product recalls affecting popular national retailers including Walmart, Kroger, and Trader Joe’s.
The U.S. Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) are collaborating with state and local agencies to investigate the ongoing outbreak. Epidemiologic, laboratory, and traceback data indicate that certain meals produced by FreshRealm are contaminated with Listeria monocytogenes and have caused illnesses. The investigation has identified a specific ingredient, pre-cooked pasta supplied by Nate’s Fine Foods, as a potential source of contamination, though additional testing is pending to confirm if it carries the same strain causing the outbreak.
Table: Listeria Outbreak Case Demographics (as of September 25, 2025)
| Demographic Factor | Statistics |
| Total Cases | 20 people infected |
| States Affected | 15 states |
| Hospitalizations | 19 of 20 with information available |
| Deaths | 4 reported in Illinois, Michigan, Texas, and Utah |
| Age Range | 4 to 92 years old |
| Median Age | 72 years |
| Gender Distribution | 65% female, 35% male |
| Pregnancy Impact | 1 fetal loss reported |
The Investigation Timeline: Connecting the Dots
The outbreak investigation began several months before it reached public attention. According to the CDC, the first illness samples were collected as early as August 1, 2024, with illnesses onset dates ranging from July 24, 2024, to September 11, 2025. This extended timeframe is characteristic of listeriosis outbreaks, which can have particularly long incubation periods compared to other foodborne illnesses.
The first major regulatory action occurred on March 19, 2025, when FSIS identified the outbreak strain during routine testing of FreshRealm chicken fettuccine alfredo. Importantly, this specific lot was not distributed into the food supply, potentially preventing additional illnesses. This detection marked a critical early warning, though the outbreak had already begun.
On June 17, 2025, FreshRealm issued a voluntary recall of its chicken fettuccine alfredo meals after learning that the strain of Listeria found in routine testing matched the strain associated with the ongoing outbreak. At that time, 17 people had been infected across 13 states, with 16 hospitalizations and 3 deaths reported. The initial recall included Marketside Grilled Chicken Alfredo with Fettuccine (both 12.3 oz and 32.8 oz packages) and Home Chef Chicken Fettuccine Alfredo (12.5 oz).
The investigation expanded significantly in September 2025. FreshRealm began testing individual ingredients used in their products and confirmed that linguine pasta samples were positive for Listeria monocytogenes. On September 25, 2025, the pasta supplier, Nate’s Fine Foods, recalled certain lots of pre-cooked pasta including fettuccine, linguine, and farfalle. Two days later, whole genome sequencing (WGS) performed by FreshRealm’s contracted lab confirmed the linguine sample contained the same strain of Listeria that was causing the outbreak.
Affected Products and Distribution Network
The outbreak has affected multiple products across different brands, all connected through shared manufacturing facilities or ingredients. The implicated products are ready-to-eat meals typically sold in the refrigerated sections of grocery stores (unfortunately, listeria grows well in refrigerated environments) and are intended for microwaving before consumption.
Table: Recalled Products Linked to Listeria Outbreak
| Product Name | Retailer | Size | Best if Used by Dates |
| Marketside Grilled Chicken Alfredo with Fettuccine | Walmart | 12.3 oz | June 26, 2025, or prior |
| Marketside Grilled Chicken Alfredo with Fettuccine | Walmart | 32.8 oz | June 27, 2025, or prior |
| Home Chef Chicken Fettuccine Alfredo | Kroger | 12.5 oz | June 19, 2025, or prior |
| Marketside Linguine with Beef Meatballs & Marinara Sauce | Walmart | 12 oz | September 22, 2025 September 24, 2025 September 25, 2025 September 29, 2025 September 30, 2025 October 1, 2025 |
| Trader Joe’s Cajun Style Blackened Chicken Breast Fettuccine Alfredo | Trader Joe’s | 16 oz | September 20, 2025 September 24, 2025 September 27, 2025 |
The distribution pattern for these products is nationwide, matching the geographic spread of illnesses across 15 states: California, Florida, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, North Carolina, Nevada, Ohio, South Carolina, Texas, Utah, and Virginia. The pasta supplier, Nate’s Fine Foods, does not sell affected products directly to retail consumers but supplies other manufacturers, creating a complex web of potential contamination.
As with all foodborne outbreaks, federal investigators note that the true number of sick people in this outbreak is likely higher than what has been reported, and the outbreak may not be limited to states with known illnesses. This is because some people recover without medical care and are not tested for Listeria, and there is typically a 3 to 4 week delay between when a person becomes ill and when the case is reported as part of an outbreak.
The Science Behind the Investigation: Whole Genome Sequencing and Traceback
The investigation has relied on sophisticated scientific methods to connect illnesses to contaminated food products. Public health investigators have used the PulseNet system, a national database of DNA fingerprints of bacteria that cause foodborne illnesses, to identify cases that may be part of this outbreak.
Whole genome sequencing (WGS), the advanced method of DNA fingerprinting used in this investigation, has been critical to confirming the genetic relationship between bacterial samples from different patients and from food products. WGS showed that bacteria from sick people’s samples are closely related genetically, suggesting they became ill from the same food source. This technology provides such precise discrimination that it can definitively link cases that might otherwise appear unrelated.
The traceback investigation used purchase records to connect chicken fettuccine alfredo products purchased by ill people back to FreshRealm. In some cases, ill people described chicken fettuccine alfredo products they had purchased, and FSIS follow-up at the retail stores identified FreshRealm products matching their descriptions. This combination of epidemiological interviews and product traceback has been essential in identifying the outbreak source.
Of the 13 people interviewed in the epidemiological investigation, 7 (54%) reported eating precooked meals, and 4 specifically reported eating chicken fettuccine alfredo. Notably, no people interviewed reported eating the affected meatball linguine meals, suggesting the contamination may be primarily occurring at the ingredient level before final meal assembly.
Impact on Human Health: The Devastating Toll of Listeriosis
Listeria infection, or listeriosis, poses particularly severe risks for certain vulnerable populations. The bacteria is most likely to sicken pregnant women and newborns, adults aged 65 or older, and people with weakened immune systems. While other people can be infected with Listeria, they rarely become seriously ill.
The symptoms of listeriosis can vary depending on the individual and the severity of the infection. Mild symptoms may include fever, muscle aches, nausea, tiredness, vomiting, and diarrhea. If the more severe form of listeriosis develops, symptoms may include headache, stiff neck, confusion, loss of balance, and convulsions. This severe condition, known as invasive listeriosis, occurs when the infection spreads beyond the gastrointestinal tract to other parts of the body.
The incubation period for listeriosis presents a particular challenge for investigation and diagnosis. Symptoms usually start within two weeks after eating contaminated food but may begin as early as the same day or as late as 10 weeks after exposure. This extended incubation period makes it difficult for patients and healthcare providers to connect symptoms to a specific food product.
Pregnant women typically experience only fever, fatigue, and muscle aches, but Listeria infection during pregnancy can lead to miscarriage, stillbirth, premature delivery, or life-threatening infection of the newborn. This listeria outbreak has included one pregnancy-associated illness that resulted in a fetal loss.
The demographic information collected in this outbreak reflects the typical vulnerability patterns for listeriosis. The median age of patients is 72 years, significantly higher than what would be expected in the general population, and 65% of cases are female, which may reflect both the inclusion of pregnant women and women’s generally longer life expectancy.
Regulatory Response and Public Health Actions
The regulatory response to this outbreak has involved multiple agencies operating under a coordinated framework. The FDA has primary jurisdiction over the pasta ingredient itself, while FSIS has jurisdiction over the prepared meals containing meat that are made with the contaminated pasta. This division of regulatory authority requires close collaboration between agencies during outbreak investigations.
FSIS has issued public health alerts for ready-to-eat meals containing the potentially contaminated pasta. These alerts serve to notify the public about products that may contain contaminated ingredients but have not necessarily been formally recalled. The agency expects more updates as the investigation continues and has advised consumers to check back frequently for new information.
FreshRealm has undertaken several actions in response to the investigation. The company performed tests that identified the outbreak strain in their beef meatball marinara linguine meals, which were subsequently held from distribution. They also tested individual ingredients used in their products, which led to the identification of the contaminated pasta.
On September 25, 2025, FreshRealm held the linguini pasta used in certain meal products, meaning these products should no longer be available for sale, though they may still be in consumers’ refrigerators or freezers. The company is working with the FDA and their customers to determine if additional recalls are needed.
Analysis & Next Steps
This outbreak exemplifies several evolving challenges in food safety. The contamination appears to originate from an ingredient supplier rather than the final product manufacturer, demonstrating how complex modern food supply chains can complicate outbreak investigations. The identification of the outbreak strain through routine testing before distribution in March 2025 highlights the potential value of enhanced monitoring programs. Additionally, the use of whole genome sequencing has been instrumental in connecting seemingly disparate illnesses and confirming links between patients and food products with unprecedented precision.
Listeria remains one of the most serious foodborne pathogens, with high hospitalization and mortality rates compared to other foodborne illnesses. Earlier this year, an outbreak of Listeria linked to frozen nutritional shakes resulted in 42 illnesses and 14 deaths across 21 states.
Unlike many other foodborne bacteria, Listeria can survive and even grow at refrigeration temperatures, making it a particular concern for ready-to-eat foods with extended shelf lives. The severe outcomes for vulnerable populations, including death, fetal loss, and lifelong health consequences, underscore the critical importance of effective control measures. Outbreaks like this also reveal vulnerabilities in our food safety system, particularly regarding ingredient-driven contamination events that can affect multiple products across different brands.
The impact of this outbreak extends beyond the 20 confirmed cases across 15 states. Consumers who purchased these products face potential health risks, particularly those in vulnerable categories: pregnant women, adults over 65, and immunocompromised individuals. The retailers involved, Walmart, Kroger, and Trader Joe’s, face operational disruptions and potential reputational damage, despite not being the source of contamination. Food manufacturers and ingredient suppliers throughout the industry are affected by increased regulatory scrutiny and may need to reevaluate their own safety protocols. Finally, public health agencies at local, state, and federal levels must divert significant resources to investigate and contain the outbreak.
Consumers should immediately check their refrigerators and freezers for any of the affected products and discard them or return them to the place of purchase.
“Any member of the public who has consumed these products and developed symptoms should contact their healthcare provider, especially if they belong to a high-risk group,” said Ron Simon of leading nationwide Listeria law firm Ron Simon & Associates. “All consumers, particularly vulnerable individuals, should practice safe food handling and be aware that Listeria can survive in refrigerators and easily spread to other foods and surfaces, necessitating thorough cleaning of any surfaces that may have contacted the affected products.”
The food industry should note that FSIS recently broadened its testing to include all Listeria species in ready-to-eat products and environmental samples, providing more comprehensive insights into the effectiveness of sanitation programs. Enhanced environmental monitoring, rigorous supplier verification programs, and improved traceability systems represent critical steps toward preventing similar outbreaks. Future prevention will require a collaborative approach throughout the supply chain, recognizing that food safety is a shared responsibility from ingredient suppliers to final product manufacturers.
