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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)
  • DOI:
  • Published online: 20 January 2012

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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Epidemiology & Infection
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