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ABSTRACT: Abstract Fresh salsa and guacamole often contain diced raw produce, are often made in large batches, and are often poorly refrigerated, which may make them prone to contamination that can cause foodborne illness. The safety of salsa and guacamole is increasingly important as these foods gain popularity. Since 1973, local, state, and territorial health departments have voluntarily reported foodborne disease outbreaks to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System (FDOSS) using a standard reporting form. FDOSS used paper-based reporting for 1973-1997 and switched to electronic reporting for 1998-2008. We reviewed all reports of outbreaks during 1973-2008 in which salsa or guacamole was reported as a vehicle. We found 136 outbreaks in which salsa or guacamole was reported as a possible vehicle, which resulted in 5,658 illnesses. Of these 136 salsa- or guacamole-associated (SGA) outbreaks additional possible food vehicles were reported for 33 (24%) outbreaks. There were no SGA outbreaks reported before 1984. Among reported outbreaks, most were caused by norovirus (24%), nontyphoidal Salmonella (19%), and Shigella (7%). Eighty-four percent of outbreaks were caused by foods prepared in restaurants or delis; of these, 19% reported ill foodworkers, and 29% reported improper storage as possible contributing factors. Among all foodborne disease outbreaks with a reported food vehicle during 1984-1997, 26 (0.9%) of 2,966 outbreaks were SGA, and during 1998-2008, 110 (1.4%) of 7,738 outbreaks were SGA. The number of reported foodborne disease outbreaks attributable to salsa or guacamole increased in the United States from 1984 to 2008, especially in later years, and especially in restaurants. Fresh salsa and guacamole require careful preparation and storage. Focused prevention strategies should reduce the risk of illness and ensure that these foods are enjoyed safely.
Foodborne Pathogens and Disease 03/2013; · 2.26 Impact Factor
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ABSTRACT: Each year, >9 million foodborne illnesses are estimated to be caused by major pathogens acquired in the United States. Preventing these illnesses is challenging because resources are limited and linking individual illnesses to a particular food is rarely possible except during an outbreak. We developed a method of attributing illnesses to food commodities that uses data from outbreaks associated with both simple and complex foods. Using data from outbreak-associated illnesses for 1998-2008, we estimated annual US foodborne illnesses, hospitalizations, and deaths attributable to each of 17 food commodities. We attributed 46% of illnesses to produce and found that more deaths were attributed to poultry than to any other commodity. To the extent that these estimates reflect the commodities causing all foodborne illness, they indicate that efforts are particularly needed to prevent contamination of produce and poultry. Methods to incorporate data from other sources are needed to improve attribution estimates for some commodities and agents.
Emerging Infectious Diseases 03/2013; 19(3):407-15. · 6.79 Impact Factor
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Nicole J Cohen,
Douglas D Slaten,
Nina Marano,
Jordan W Tappero,
Michael Wellman,
Ryan J Albert,
Vincent R Hill,
David Espey,
Thomas Handzel,
Ariel Henry, Robert V Tauxe
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ABSTRACT: Organisms, including Vibrio cholerae, can be transferred between harbors in the ballast water of ships. Zones in the Caribbean region where distance from shore and water depth meet International Maritime Organization guidelines for ballast water exchange are extremely limited. Use of ballast water treatment systems could mitigate the risk for organism transfer.
Emerging Infectious Diseases 10/2012; 18(10):1680-2. · 6.79 Impact Factor
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ABSTRACT: Epidemic-assistance investigations (Epi-Aids) in response to outbreaks of foodborne and other enteric pathogens have identified novel pathogens, clinical syndromes, and sequelae; described new reservoirs and vehicles of transmission; evaluated existing prevention strategies; and identified deficiencies in the food safety systems on local, national, and international levels. Since the first Epi-Aid was issued in 1946, approximately 23% (1,023 of 4,484 for which investigations were initiated) of all Epi-Aids have been related to foodborne or other enteric diseases. Epi-Aid results have yielded valuable insights into the epidemiology of these pathogens and have molded prevention strategies for detecting, responding to, and preventing future outbreaks. New challenges, brought about in part by centralization and globalization of the food supply, will continue to emerge. The need for Epi-Aids of such outbreaks undoubtedly will persist as an integral part of future public health response efforts, prevention strategies, and training programs.
American journal of epidemiology 12/2011; 174(11 Suppl):S23-35. · 5.59 Impact Factor
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ABSTRACT: When epidemic cholera appeared in Haiti in October 2010, the medical community there had virtually no experience with the disease and needed rapid training as the epidemic spread throughout the country. We developed a set of training materials specific to Haiti and launched a cascading training effort. Through a training-of-trainers course in November 14-15, 2010, and department-level training conducted in French and Creole over the following 3 weeks, 521 persons were trained and equipped to further train staff at the institutions where they worked. After the training, the hospitalized cholera patients' case-fatality rate dropped from 4% to <2% by mid-December and was <1% by January 2011. Continuing in-service training, monitoring and evaluation, and integration of cholera management into regular clinical training will help sustain this success.
Emerging Infectious Diseases 11/2011; 17(11):2094-8. · 6.79 Impact Factor
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Vincent R Hill,
Nicole Cohen,
Amy M Kahler,
Jessica L Jones,
Cheryl A Bopp,
Nina Marano,
Cheryl L Tarr,
Nancy M Garrett,
Jacques Boncy,
Ariel Henry, [......],
Maurice Curtis,
Molly M Freeman,
Maryann Turnsek,
Ronald A Benner,
Georges Dahourou,
David Espey,
Angelo DePaola,
Jordan W Tappero,
Tom Handzel, Robert V Tauxe
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ABSTRACT: During the 2010 cholera outbreak in Haiti, water and seafood samples were collected to detect Vibrio cholerae. The outbreak strain of toxigenic V. cholerae O1 serotype Ogawa was isolated from freshwater and seafood samples. The cholera toxin gene was detected in harbor water samples.
Emerging Infectious Diseases 11/2011; 17(11):2147-50. · 6.79 Impact Factor
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ABSTRACT: After epidemic cholera emerged in Haiti in October 2010, the disease spread rapidly in a country devastated by an earthquake earlier that year, in a population with a high proportion of infant deaths, poor nutrition, and frequent infectious diseases such as HIV infection, tuberculosis, and malaria. Many nations, multinational agencies, and nongovernmental organizations rapidly mobilized to assist Haiti. The US government provided emergency response through the Office of Foreign Disaster Assistance of the US Agency for International Development and the Centers for Disease Control and Prevention. This report summarizes the participation by the Centers and its partners. The efforts needed to reduce the spread of the epidemic and prevent deaths highlight the need for safe drinking water and basic medical care in such difficult circumstances and the need for rebuilding water, sanitation, and public health systems to prevent future epidemics.
Emerging Infectious Diseases 11/2011; 17(11):2087-93. · 6.79 Impact Factor
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Elizabeth Cavallaro,
Kashmira Date,
Carlota Medus,
Stephanie Meyer,
Benjamin Miller,
Clara Kim,
Scott Nowicki,
Shaun Cosgrove,
David Sweat,
Quyen Phan, [......],
Peter Gerner-Smidt,
Robert M Hoekstra,
Colin Schwensohn,
Adam Langer,
Samir V Sodha,
Michael C Rogers,
Frederick J Angulo, Robert V Tauxe,
Ian T Williams,
Casey Barton Behravesh
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ABSTRACT: Contaminated food ingredients can affect multiple products, each distributed through various channels and consumed in multiple settings. Beginning in November 2008, we investigated a nationwide outbreak of salmonella infections.
A case was defined as laboratory-confirmed infection with the outbreak strain of Salmonella Typhimurium occurring between September 1, 2008, and April 20, 2009. We conducted two case-control studies, product "trace-back," and environmental investigations.
Among 714 case patients identified in 46 states, 166 (23%) were hospitalized and 9 (1%) died. In study 1, illness was associated with eating any peanut butter (matched odds ratio, 2.5; 95% confidence interval [CI], 1.3 to 5.3), peanut butter-containing products (matched odds ratio, 2.2; 95% CI, 1.1 to 4.7), and frozen chicken products (matched odds ratio, 4.6; 95% CI, 1.7 to 14.7). Investigations of focal clusters and single cases associated with nine institutions identified a single institutional brand of peanut butter (here called brand X) distributed to all facilities. In study 2, illness was associated with eating peanut butter outside the home (matched odds ratio, 3.9; 95% CI, 1.6 to 10.0) and two brands of peanut butter crackers (brand A: matched odds ratio, 17.2; 95% CI, 6.9 to 51.5; brand B: matched odds ratio, 3.6; 95% CI, 1.3 to 9.8). Both cracker brands were made from brand X peanut paste. The outbreak strain was isolated from brand X peanut butter, brand A crackers, and 15 other products. A total of 3918 peanut butter-containing products were recalled between January 10 and April 29, 2009.
Contaminated peanut butter and peanut products caused a nationwide salmonellosis outbreak. Ingredient-driven outbreaks are challenging to detect and may lead to widespread contamination of numerous food products.
New England Journal of Medicine 08/2011; 365(7):601-10. · 53.30 Impact Factor
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Casey Barton Behravesh,
Rajal K Mody,
Jessica Jungk,
Linda Gaul,
John T Redd,
Sanny Chen,
Shaun Cosgrove,
Erin Hedican,
David Sweat,
Lina Chávez-Hauser, [......],
Elizabeth Russo,
Matthew Mikoleit,
Lisa Theobald,
Peter Gerner-Smidt,
Robert M Hoekstra,
Frederick J Angulo,
David L Swerdlow, Robert V Tauxe,
Patricia M Griffin,
Ian T Williams
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ABSTRACT: Raw produce is an increasingly recognized vehicle for salmonellosis. We investigated a nationwide outbreak that occurred in the United States in 2008.
We defined a case as diarrhea in a person with laboratory-confirmed infection with the outbreak strain of Salmonella enterica serotype Saintpaul. Epidemiologic, traceback, and environmental studies were conducted.
Among the 1500 case subjects, 21% were hospitalized, and 2 died. In three case-control studies of cases not linked to restaurant clusters, illness was significantly associated with eating raw tomatoes (matched odds ratio, 5.6; 95% confidence interval [CI], 1.6 to 30.3); eating at a Mexican-style restaurant (matched odds ratio, 4.6; 95% CI, 2.1 to ∞) and eating pico de gallo salsa (matched odds ratio, 4.0; 95% CI, 1.5 to 17.8), corn tortillas (matched odds ratio, 2.3; 95% CI, 1.2 to 5.0), or salsa (matched odds ratio, 2.1; 95% CI, 1.1 to 3.9); and having a raw jalapeño pepper in the household (matched odds ratio, 2.9; 95% CI, 1.2 to 7.6). In nine analyses of clusters associated with restaurants or events, jalapeño peppers were implicated in all three clusters with implicated ingredients, and jalapeño or serrano peppers were an ingredient in an implicated item in the other three clusters. Raw tomatoes were an ingredient in an implicated item in three clusters. The outbreak strain was identified in jalapeño peppers collected in Texas and in agricultural water and serrano peppers on a Mexican farm. Tomato tracebacks did not converge on a source.
Although an epidemiologic association with raw tomatoes was identified early in this investigation, subsequent epidemiologic and microbiologic evidence implicated jalapeño and serrano peppers. This outbreak highlights the importance of preventing raw-produce contamination.
New England Journal of Medicine 02/2011; 364(10):918-27. · 53.30 Impact Factor
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ABSTRACT: Estimates of foodborne illness can be used to direct food safety policy and interventions. We used data from active and passive surveillance and other sources to estimate that each year 31 major pathogens acquired in the United States caused 9.4 million episodes of foodborne illness (90% credible interval [CrI] 6.6-12.7 million), 55,961 hospitalizations (90% CrI 39,534-75,741), and 1,351 deaths (90% CrI 712-2,268). Most (58%) illnesses were caused by norovirus, followed by nontyphoidal Salmonella spp. (11%), Clostridium perfringens (10%), and Campylobacter spp. (9%). Leading causes of hospitalization were nontyphoidal Salmonella spp. (35%), norovirus (26%), Campylobacter spp. (15%), and Toxoplasma gondii (8%). Leading causes of death were nontyphoidal Salmonella spp. (28%), T. gondii (24%), Listeria monocytogenes (19%), and norovirus (11%). These estimates cannot be compared with prior (1999) estimates to assess trends because different methods were used. Additional data and more refined methods can improve future estimates.
Emerging Infectious Diseases 01/2011; 17(1):7-15. · 6.79 Impact Factor
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ABSTRACT: Each year, 31 major known pathogens acquired in the United States caused an estimated 9.4 million episodes of foodborne illness. Additional episodes of illness were caused by unspecified agents, including known agents with insufficient data to estimate agent-specific illness, known agents not yet recognized as causing foodborne illness, substances known to be in food but of unproven pathogenicity, and unknown agents. To estimate these additional illnesses, we used data from surveys, hospital records, and death certificates to estimate illnesses, hospitalizations, and deaths from acute gastroenteritis and subtracted illnesses caused by known gastroenteritis pathogens. If the proportions acquired by domestic foodborne transmission were similar to those for known gastroenteritis pathogens, then an estimated 38.4 million (90% credible interval [CrI] 19.8-61.2 million) episodes of domestically acquired foodborne illness were caused by unspecified agents, resulting in 71,878 hospitalizations (90% CrI 9,924-157,340) and 1,686 deaths (90% CrI 369-3,338).
Emerging Infectious Diseases 01/2011; 17(1):16-22. · 6.79 Impact Factor
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ABSTRACT: A large outbreak of Salmonella Saintpaul associated with raw jalapeño peppers, serrano peppers, and possibly tomatoes was reported in the United States in 2008. During the outbreak, two clusters of illness investigated among restaurant patrons were significantly associated with eating salsa. Experiments were performed to determine the survival and growth characteristics of Salmonella in salsa and related major ingredients, i.e., tomatoes, jalapeño peppers, and cilantro. Intact and chopped vegetables and different formulations of salsas were inoculated with a five-strain mixture of Salmonella and then stored at 4, 12, and 21 degrees C for up to 7 days. Salmonella populations were monitored during storage. Salmonella did not grow, but survived on intact tomatoes and jalapeño peppers, whereas significant growth at 12 and 21 degrees C was observed on intact cilantro. In general, growth of Salmonella occurred in all chopped vegetables when stored at 12 and 21 degrees C, with chopped jalapeño peppers being the most supportive of Salmonella growth. Regardless of differences in salsa formulation, no growth of Salmonella (initial inoculation ca. 3 log CFU/g) was observed in salsa held at 4 degrees C; however, rapid or gradual decreases in Salmonella populations were only observed in formulations that contained both fresh garlic and lime juice. Salmonella grew at 12 and 21 degrees C in salsas, except for those formulations that contained both fresh garlic and lime juice, in which salmonellae were rapidly or gradually inactivated, depending on salsa formulation. These results highlight the importance of preharvest pathogen contamination control of fresh produce and proper formulation and storage of salsa.
Journal of food protection 03/2010; 73(3):434-44. · 1.94 Impact Factor
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ABSTRACT: To the Editor: Yersinia pseudotuberculosis, a gram-negative zoonotic bacterial pathogen, causes acute gastroenteritis and mesenteric lymphadenitis, which are often accompanied by fever and abdominal pain. Although Y. pseudotuberculosis infections are distributed worldwide, little is known about their incidence and epidemiology in the United States. Y. pseudotuberculosis was first reported in the United States in 1938 and has rarely been identified since then (1). No outbreaks have been reported, and only 14 cases were documented from 1938 through 1973 (2). Although not reportable nationally, yersiniosis is a notifiable disease in all Foodborne Diseases Active Surveillance Network (FoodNet) sites. We describe the Y. pseudotuberculosis infections reported through FoodNet surveillance sites and compare these infections with those caused by the more commonly identified Yersinia species, Y. enterocolitica.
Emerging Infectious Diseases 03/2010; 16(3):566-7. · 6.79 Impact Factor
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ABSTRACT: Turtle-associated salmonellosis was increasingly recognized in the United States during the 1960s, leading to a federal ban in 1975 on the sale of turtles <4 inches in carapace length (small turtles). Although sporadic reports of turtle-associated Salmonella are frequent, outbreaks are rare. In September 2007, several patients with Salmonella enterica serotype Paratyphi B var Java infections reported recent turtle exposure. We conducted an investigation to determine the source and extent of the infections.
Patients with Salmonella Paratyphi B var Java infections with a specific pulsed-field gel electrophoresis pattern (outbreak strain) and illness onset between May 2007 and January 2008, were compared with healthy controls. Reptile exposure and awareness of a Salmonella-reptile link were assessed. Turtle size and purchase information were collected.
We identified 107 patients with outbreak-strain infections. The median patient age was 7 years; 33% were hospitalized. Forty-seven (60%) of 78 patients interviewed reported exposure to turtles during the week before illness; 41 (87%) were small turtles, and 16 (34%) were purchased in a retail pet store. In the case-control study, 72% of 25 patients reported turtle exposure during the week before illness compared with 4% of 45 controls (matched odds ratio [mOR]: 40.9 [95% confidence interval (CI): 6.9-unbounded]). Seven (32%) of 22 patients versus 11 (28%) of 39 controls reported knowledge of a link between reptile exposure and Salmonella infection (mOR: 1.3 [95% CI: 0.4-4.6]).
We observed a strong association between turtle exposure and Salmonella infections in this outbreak. Small turtles continue to be sold and pose a health risk, especially to children; many people remain unaware of the link between Salmonella infection and reptile contact.
PEDIATRICS 10/2009; 124(5):1388-94. · 4.47 Impact Factor
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ABSTRACT: Outbreaks of illness associated with consumption of fruit juice have been a growing public health problem since the early 1990s. In response to epidemiologic investigations of outbreaks in which juice was implicated, the U.S. Food and Drug Administration implemented process control measures to regulate the production of fruit juice. The final juice regulation, which became effective in 2002, 2003, and 2004, depending on the size of the business, requires that juice operations comply with a hazard analysis critical control point (HACCP) plan. The Centers for Disease Control and Prevention (CDC) receives reports of food-associated outbreaks of illness. We reviewed fruit juice-associated outbreaks of illness reported to the CDC's Foodborne Outbreak Reporting System. From 1995 through 2005, 21 juice-associated outbreaks were reported to CDC; 10 implicated apple juice or cider, 8 were linked to orange juice, and 3 involved other types of fruit juice. These outbreaks caused 1,366 illnesses, with a median of 21 cases per outbreak (range, 2 to 398 cases). Among the 13 outbreaks of known etiology, 5 were caused by Salmonella, 5 by Escherichia coli O157:H7, 2 by Cryptosporidium, and one by Shiga toxin-producing E. coli O111 and Cryptosporidium. Fewer juice-associated outbreaks have been reported since the juice HACCP regulation was implemented. Some juice operations that are exempt from processing requirements or do not comply with the regulation continue to be implicated in outbreaks of illness.
Journal of food protection 03/2008; 71(2):356-64. · 1.94 Impact Factor
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ABSTRACT: Cholera was largely eliminated from industrialized countries by water and sewage treatment over a century ago. Today it remains a significant cause of morbidity and mortality in developing countries, where it is a marker for inadequate drinking water and sanitation infrastructure. Death from cholera can be prevented through simple treatment-oral, or in severe cases, intravenous rehydration. The cholera case-fatality rate therefore reflects access to basic health care. We reviewed World Health Organization (WHO) data on cholera cases and deaths reported between 1960 and 2005. In the 1960s, at the beginning of the seventh and current cholera pandemic, cholera had an exclusively Asian focus. In 1970, the pandemic reached sub-Saharan Africa, where it has remained entrenched. In 1991, the seventh pandemic reached Latin America, resulting in nearly 1 million reported cases from the region within 3 years. In contrast to the persisting situation in Africa, cholera was largely eliminated from Latin America within a decade. In 2005, 31 (78%) of the 40 countries that reported indigenous cases of cholera to WHO were in sub-Saharan Africa. The reported incidence of indigenous cholera in sub-Saharan Africa in 2005 (166 cases/million population) was 95 times higher than the reported incidence in Asia (1.74 cases/million population) and 16,600 times higher than the reported incidence in Latin America (0.01 cases/million population). In that same year, the cholera case fatality rate in sub-Saharan Africa (1.8%) was 3 times higher than that in Asia (0.6%); no cholera deaths were reported in Latin America. The persistence or control of cholera in Africa will be a key indicator of global efforts to reach the Millennium Development Goals and of recent commitments by leaders of the G-8 countries to increase development aid to the region.
The American journal of tropical medicine and hygiene 11/2007; 77(4):705-13. · 2.59 Impact Factor
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The Pediatric Infectious Disease Journal 04/2007; 26(3):277-8. · 3.58 Impact Factor
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ABSTRACT: We analyzed national foodborne outbreak data from 1973 through 2001 to determine the proportion of Salmonella Heidelberg outbreaks caused by specific foods. Among 6633 outbreaks with known etiology, 184 (3%) were caused by Salmonella Heidelberg. A vehicle was identified in 101 outbreaks; at least 53 were poultry or egg-related. Three outbreaks were attributed to egg consumption, 17 to consumption of egg-containing foods, 25 to poultry, and 8 to foods containing poultry and eggs. Efforts to reduce illness due to Salmonella Heidelberg shouldensure that poultry and eggs are handled appropriately to minimize contamination and cross contamination.
Journal of food protection 06/2006; 69(5):1150-3. · 1.94 Impact Factor
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Robert V Tauxe
Foodborne Pathogens and Disease 02/2006; 3(1):4-8. · 2.26 Impact Factor
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ABSTRACT: Identification and prioritization of effective food safety interventions require an understanding of the relationship between food and pathogen from farm to consumption. Critical to this cause is food attribution, the capacity to attribute cases of foodborne disease to the food vehicle or other source responsible for illness. A wide variety of food attribution approaches and data are used around the world, including the analysis of outbreak data, case-control studies, microbial subtyping and source tracking methods, and expert judgment, among others. The Food Safety Research Consortium sponsored the Food Attribution Data Workshop in October 2003 to discuss the virtues and limitations of these approaches and to identify future options for collecting food attribution data in the United States. We summarize workshop discussions and identify challenges that affect progress in this critical component of a risk-based approach to improving food safety.
Emerging infectious diseases 08/2005; 11(7):993-9. · 6.17 Impact Factor
