The tragedy of deaths of children linked to undercooked hamburgers in Washington State in January 1993 once again puts the spotlight on food safety. State epidemiologists and the Centers for Disease Control and Prevention (CDC) identified the illnesses in Washington, along with others in California, Nevada, and Idaho, as caused by Escherichia coli (known as E. coli) O157:H7. This bacterium has been linked to a variety of reservoirs including, as in this outbreak, undercooked ground beef. More than 500 laboratory- confirmed illnesses and 4 deaths occurred during this outbreak. The January 1993 E.coli outbreak in the Western States demonstrates the difficulty of identifying the incidence of foodbome disease and the need for mandatory reporting or new data collection systems. The CDC reported: "Despite the magnitude of this outbreak, the problem may not have been recognized in three States if the epidemiological link had not been established in Washington (State)."