Luaus, potlucks, a breathtaking variety of seafood and ways to eat it, and endless summer are a few of the attractions of Hawaii life. But the combination may come with a hangover: foodborne illness.

Data from the federal Centers for Disease Control and Prevention shows that people in Hawaii over the past decade-and-a-half fell ill during food-related outbreaks about twice as often as their counterparts on the mainland. The culprit was far more likely here than in the rest of the U.S. to be seafood.

The recent outbreak of hepatitis A in Hawaii has put a spotlight on foodborne illness. In fact, hepatitis A is rare in the state. But a host of other outbreaks have occurred with regularity, many associated with seafood.

Take the fondness for seafood and a cultural preference to eat it raw, mix in a warm year-round climate and a tradition of sharing food at social occasions, and you’ve got a recipe for potential foodborne illness.

Hawaii’s two most common causes of food poisoning in the CDC data are ciguatoxin and scombroid toxin, both found in seafood and both far down on the list of causes on the mainland, well behind noroviruses, salmonella and others.

The CDC’s surveillance system relies on reports from state and local governments from 1998 to last October, the most recent update. It shows that the top five foods that caused outbreaks occurring only in Hawaii were mahi mahi, ahi, roi, kole and ulua. For the U.S. as a whole, the top five vehicles were raw oysters, hamburger, salad, chicken and submarine sandwiches.

What Is It About Hawaii?

Hawaii State Epidemiologist Sarah Park has not analyzed the CDC data herself, but was not surprised by what it shows.

“Our culture is very much about eating all kinds of raw seafood,” she said. “We also are more adventurous in what we eat.”

On the mainland, food poisoning tends to be a summer phenomenon, but in a state where summer never really goes away, it happens year-round, Park said.

Then there’s a tradition of bringing foods to social occasions, where dishes may or may not be kept at recommended temperatures. Poke sitting in the sun or lukewarm kalua pork can pose problems — not to mention restaurants with sushi on conveyor belts or buffets exposed to the public for long stretches.

Park said when she sees a buffet, “I have to turn my brain off.”

Much food here is imported, like the scallops from the Philippines thought to have touched off the hepatitis outbreak. But the mainland also imports a big share of its food, Park said, so that doesn’t appear to be what differentiates Hawaii.

Hawaii As An Early Warning System

Hawaii sometimes acts as the proverbial canary in the coal mine for the rest of the country, perhaps because foodborne outbreaks can be easier to discern here.

In 2007 and 2008, Hawaii experienced a salmonella outbreak. The state asked the federal Food and Drug Administration if it was picking up a similar signal on the mainland, but the FDA couldn’t see it.

It hit Hawaii again in 2009 and 2010. But this time, it started showing up in mainland states, including California and Colorado. The FDA got involved and traced the outbreak to ahi from Indonesia.

“Before that, it was kind of, ‘Oh, that’s a Hawaii problem,’” Park said.

The top five foods that caused outbreaks occurring only in Hawaii were mahi mahi, ahi, roi, kole and ulua.

So what happened between the two outbreaks? Could it have been the beginnings of the mainland poke craze? Or maybe contaminated fish didn’t make its way to the mainland until then.

Or maybe it was just easier to see, in an isolated population where eating raw seafood is more common.

The good news is that the overwhelming majority of foodborne illnesses resolve themselves without the need for hospitalization. Only a tiny percentage result in death. Also, the rate of outbreaks in Hawaii monitored by the CDC hit a peak about a dozen years ago, and has been steadily declining since.

Still, the FDA says that foodborne illness across the country is on the rise – in part because of better detection and in part because of emerging disease-causing organisms and changing eating habits and food distribution patterns. But the FDA publishes recommendations for the safe buying and handling of seafood and says that, for most people, seafood can be enjoyed with minimal risk to health.