These are the top reasons people get sick on Thanksgiving

It's holiday season in the U.S., which means more gatherings with loved ones and a lot of food. It also means many illnesses will go around, from respiratory viruses like the common cold and flu, to foodborne diseases.

Also known as food poisoning, foodborne illnesses occur when you eat or drink something contaminated with disease-causing germs — including bacteria, parasites or viruses — which can lead to an unpleasant bout of diarrhea, stomach cramps, and vomiting, according to the U.S. Centers for Disease Control and Prevention.

Every year in the U.S., about 48 million people get sick, 128,000 are hospitalized, and 3,000 die from foodborne diseases, per the CDC. The most common culprits are norovirus, salmonella, clostridium perfringens, campylobacter, and staphylococcus aureus. Other notorious germs include listeria and escherichia coli.

You’ve probably heard about some of these in the news lately, amid a slew of food recalls.

These germs can spread year-round, but food-centric holidays like Thanksgiving present many opportunities for people to get sick. Here's what to know:

Common causes of illnesses on Thanksgiving

“We know that outbreaks of foodborne illness can and do happen around Thanksgiving,” Laura Ford, Ph.D., epidemiologist in the division of foodborne, waterborne and environmental diseases at the CDC, tells TODAY.com.

“The CDC does not collect data specifically related to holidays, but some foods people enjoy during Thanksgiving can lead to serious foodborne illnesses, if the foods aren’t properly handled, cooked, stored or reheated,” says Ford.

Turkey, which is often the centerpiece of a Thanksgiving meal, is a common culprit. Raw turkey can be contaminated with salmonella, campylobacter, clostridium perfringens and other germs, says Ford.

Most of these can be killed by cooking foods to a safe internal temperature, Ford says, but raw poultry and its juices can also cross-contaminate anything they touch, like fresh produce that doesn't end up getting cooked.

Raw eggs used in stuffings, casseroles and desserts may also be contaminated with germs like salmonella or E. coli, Ford adds.

“Contamination can happen at each step of food production chain, from farm to fork,” says Ford. “Once the contamination occurs, further mishandling, like undercooking the food or leaving it at unsafe temperatures, can make foodborne illness more likely,” Ford adds.

Foodborne pathogens can even come from your own hands, such as norovirus. Also known as the “stomach flu,” norovirus is the leading cause of foodborne illness outbreaks in the U.S., according to the CDC, and peaks during the winter months.

During Thanksgiving, people are typically cooking much larger quantities of food than usual and often under pressure, which allows for more mistakes, according to Robert Gravani, Ph.D., professor emeritus of food science at Cornell University.

“Those larger quantities of food require more attention to detail around the preparation, cooking, and cleanup,” Gravani tells TODAY.com. This applies to both beginners and experienced cooks because food safety mishaps are easier to make than you'd think.

Here are common causes of foodborne illnesses over Thanksgiving.

Salmonella

Salmonella is one of the most prevalent foodborne illnesses in the U.S. and a common culprit over the holidays.

The bacteria is typically associated with raw poultry and raw or undercooked eggs, says Gravani. Salmonella can also contaminate unpasteurized milk or cheese, raw produce even processed foods such as nut butters.

Between 2017 and 2019, there was an outbreak of a type of multi-drug resistant salmonella that's common in live turkeys; it caused a reported 356 cases in 42 states, according to the National Institutes of Health. While not all raw poultry is infected with salmonella, it’s safest to assume it does and take precautions, Gravani says.

C. perfringens

There’s another bacteria that loves to take advantage of Thanksgiving dishes, even when food is properly cooked: clostridium perfringens.

According to the CDC, clostridium perfringens bacteria are one of the most common causes of food poisoning in the U.S., leading to nearly 1 million illnesses every year. Outbreaks occur most often in November and December.

Clostridium perfringens can be found on raw meat and poultry, in the intestines of animals and humans, and in the environment, says Ford. The bacteria produces spores, which act like a protective coating that helps the bacteria survive high cooking temperatures, per the CDC. These can grow and multiply rapidly in cooked food left in the “danger zone" (between 40 degrees and 140 degrees Fahrenheit) for longer than two hours, says Ford.

Leaving large batches of food sitting out at room temperature is a fairly common practice on Thanksgiving, the experts note, because many people wait to store and refrigerate food until after everyone is finished with their meal or done circling back for seconds.

Common sources of clostridium perfringens infections include turkey, beef, gravies and soups, Ford says, but it can also come from other foods (including vegetarian dishes) cooked in large batches and held at unsafe temperatures. This is why outbreaks tend to occur in settings where food is served to big groups of people, such as catered events or cafeteria settings, Ford says.

Past examples include a 2015 outbreak that sickened 40 at least people and a 2005 outbreak that involved hundreds of cases, both linked to catered Thanksgiving lunches at work, according to Ford.

Norovirus

Norovirus, aka the wintertime vomiting bug, is an extremely an contagious virus which can take advantage of holiday gatherings. People who are infected can shed billions of norovirus particles in their stool, and it only takes a few particles to make someone sick.

People typically get norovirus when these particles end up in their mouths. This can occur through direct person-to-person contact, consuming contaminated food or liquids, or touching contaminated surfaces and eating or putting your hands in your mouth.

Not washing your hands properly before, during, and after cooking, can allow norovirus to spread — and no one wants to serve their guests a stomach bug alongside their Thanksgiving meal.

A norovirus outbreak that sickened over 300 people in November 2022 was traced back to a sick food handler at an Illinois restaurant, a CDC report found. The individuals became sick after dining at the establishment during Thanksgiving week, the CDC said.

Signs of foodborne illness

It can take anywhere from several hours to a few days after consuming contaminated food to develop symptoms, says Ford. For clostridium perfringens, symptoms typically begin within six to 24 hours after eating contaminated food, but for salmonella, symptoms can start anywhere from six hours to six days after, says Ford.

“The most common symptoms of foodborne illness are an upset stomach, stomach cramps, nausea, vomiting, diarrhea and fever,” says Ford. Most people will have a mild illness lasting a few hours to several days, but some people can develop severe illness requiring hospitalization.

Complications of foodborne illness include dehydration, hemolytic uremic syndrome (when the small blood vessels in the kidneys are damaged), and long-term health issues, like kidney failure or Guillain Barre syndrome, says Ford. In rare cases, severe food poisoning can be deadly.

Anyone can get a foodborne illness, but some groups of people are more likely to become infected and have severe illness, Ford says. These include children under the age of 5, adults over 65, people with weakened immune systems and pregnant women.

How to prevent foodborne illness

It’s important that cooks follow these steps to minimize the risk of foodborne illness and ensure their Thanksgiving dinner is safe and healthy, Gravani says:

• Clean your hands before, during and after cooking, and sanitize utensils, cutting boards and countertops often.

• Separate raw meat, poultry and seafood and eggs from other foods while storing in the refrigerator, preparing food, and cooking, says Ford. This includes cooking stuffing outside the turkey in its own dish. Frozen, raw turkey should be kept in a sealed bag while defrosting, which can be done in the refrigerator, cold water, or the microwave, per USDA guidelines. Store raw meat in containers so the juices don't drip near other foods.

• Cook all food to a safe internal temperature using a meat thermometer inserted into the thickest part of the food, Gravani says. Poultry and casseroles should be cooked to 165 degrees Fahrenheit, eggs to 160 degrees, and beef and seafood to 145 degrees, according to the U.S. Department of Agriculture. "We can't look at the color or the texture to determine doneness."

• Chill all leftovers as soon as possible after serving to minimize the time the food is left out in the danger zone. Cooked food should be refrigerated within two hours, and larger pieces of food should be cut up or divided so they can be stored in smaller containers, Ford says.

Refrigerated leftovers will only last three or four days, says Ford. Freezing will help your leftovers keep longer, she notes, but always make sure to reheat food to 165 degrees Fahrenheit to prevent illness. Finally, if you are feeling sick, especially with any kind of gastrointestinal illness, avoid cooking if you can.

This article was originally published on TODAY.com