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Multistate outbreak of Salmonella serotype Typhimurium infections associated with consumption of restaurant tomatoes, USA, 2006: hypothesis generation through case exposures in multiple restaurant clusters

  • C. BARTON BEHRAVESH (a1) (a2), D. BLANEY (a2) (a3), C. MEDUS (a4), S. A. BIDOL (a5), Q. PHAN (a6), S. SOLIVA (a7), E. R. DALY (a3), K. SMITH (a4), B. MILLER (a8), T. TAYLOR (a9), T. NGUYEN (a1), C. PERRY (a1), T. A. HILL (a10), N. FOGG (a10), A. KLEIZA (a11), D. MOORHEAD (a11), S. AL-KHALDI (a10), C. BRADEN (a1) and M. F. LYNCH (a1)...

Multiple salmonellosis outbreaks have been linked to contaminated tomatoes. We investigated a multistate outbreak of Salmonella Typhimurium infections among 190 cases. For hypothesis generation, review of patients' food histories from four restaurant-associated clusters in four states revealed that large tomatoes were the only common food consumed by patients. Two case-control studies were conducted to identify food exposures associated with infections. In a study conducted in nine states illness was significantly associated with eating raw, large, round tomatoes in a restaurant [matched odds ratio (mOR) 3·1, 95% confidence interval (CI) 1·3–7·3]. In a Minnesota study, illness was associated with tomatoes eaten at a restaurant (OR 6·3, mid-P 95% CI 1·05–50·4, P=0·046). State, local and federal regulatory officials traced the source of tomatoes to Ohio tomato fields, a growing area not previously identified in past tomato-associated outbreaks. Because tomatoes are commonly eaten raw, prevention of tomato contamination should include interventions on the farm, during packing, and at restaurants.

Corresponding author
*Author for correspondence: C. Barton Behravesh, MS, DVM, DrPH, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Outbreak Response and Prevention Branch, 1600 Clifton Road NE, Mail-Stop A-38, Atlanta, GA 30333, USA. (Email:
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1. E Scallan , Foodborne illness acquired in the United States – major pathogens. Emerging Infectious Diseases 2011; 17: 7–15.

6. SJ Swanson , Multidrug-resistant Salmonella enterica serotype Typhimurium associated with pet rodents. New England Journal of Medicine 2007; 356: 2128.

15. K Cummings , A multistate outbreak of Salmonella enterica serotype Baildon associated with domestic raw tomatoes. Emerging Infectious Diseases 2001; 7: 10461048.

16. SE Vollset , Evaluation of exact and asymptotic interval estimators in logistic analysis of matched case-control studies. Biometrics 1991; 47: 13111325.

19. AC Voetsch , FoodNet estimate of the burden of illness caused by nontyphoidal Salmonella infections infections in the United States. Clinical Infectious Diseases 2004; 38: S127S34.

20. BE Mahon , An international outbreak of Salmonella infections caused by alfalfa sprouts grown from contaminated seeds. Journal of Infectious Diseases 1997; 175: 876882.

22. CH Sandt , The key role of pulsed-field gel electrophoresis in investigation of a large multiserotype and multistate food-borne outbreak of Salmonella infections centered in Pennsylvania. Journal of Clinical Microbiology 2006; 44: 32083212.

25. X Guo , Survival of salmonellae on and in tomato plants from the time of inoculation at flowering and early stages of fruit development through fruit ripening. Applied and Environmental Microbiology 2001; 67: 47604764.

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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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