Singapore suffered the largest reported outbreak of Streptococcus agalactiae (GBS) disease in 2015, associated with the consumption of raw fish. This was shown to be a totally new paradigm for GBS infection, because GBS was previously not known to be foodborne. In subsequent genomic studies, we have discovered that the particular strain of GBS causing that outbreak, ST283, is almost exclusively found in Southeast Asia. It is causing disease in both humans and farmed fish throughout the region. Our results raise the remarkable hypothesis that, in Southeast Asia, GBS actually is predominantly a foodborne disease caused by a single recently emerged clone. Furthermore, this ST283 clone may have emerged due to the new opportunities afforded by large scale intensive aquaculture fish farming, weaving together complex issues about economic development, international trade, healthcare access, and infectious disease.