Skip to main content
×
×
Home

Outbreaks attributed to fresh leafy vegetables, United States, 1973–2012

  • K. M. HERMAN (a1), A. J. HALL (a1) and L. H. GOULD (a1)
Summary

Leafy vegetables are an essential component of a healthy diet; however, they have been associated with high-profile outbreaks causing severe illnesses. We reviewed leafy vegetable-associated outbreaks reported to the Centers for Disease Control and Prevention between 1973 and 2012. During the study period, 606 leafy vegetable-associated outbreaks, with 20 003 associated illnesses, 1030 hospitalizations, and 19 deaths were reported. On average, leafy vegetable-associated outbreaks were larger than those attributed to other food types. The pathogens that most often caused leafy vegetable-associated outbreaks were norovirus (55% of outbreaks with confirmed aetiology), Shiga toxin-producing Escherichia coli (STEC) (18%), and Salmonella (11%). Most outbreaks were attributed to food prepared in a restaurant or catering facility (85%). An ill food worker was implicated as the source of contamination in 31% of outbreaks. Efforts by local, state, and federal agencies to control leafy vegetable contamination and outbreaks should span from the point of harvest to the point of preparation.

Copyright
Corresponding author
* Author for correspondence: Dr L. H. Gould, 1600 Clifton Rd, NE MS-C09, Atlanta, GA 30333, USA. (Email: lgould@cdc.gov)
References
Hide All
1. Centers for Disease Control and Prevention. Surveillance for foodborne disease outbreaks – United States, 2012: Annual Report (http://www.cdc.gov/foodsafety/fdoss/data/annual-summaries/index.html). Accessed 14 June 2014.
2. Painter, JA, et al. Attribution of foodborne illnesses, hospitalizations, and deaths to food commodities by using outbreak data, United States, 1998–2008. Emerging Infectious Diseases 2013; 19: 407415.
3. Wendel, AM, et al. Multistate outbreak of Escherichia coli O157:H7 infection associated with consumption of packaged spinach, August-September 2006: the Wisconsin investigation. Clinical Infectious Diseases 2009; 48: 10791086.
4. Sivapalasingam, S, et al. Fresh produce: a growing cause of outbreaks of foodborne illness in the United States, 1973 through 1997. Journal of Food Protection 2004; 67: 23422353.
5. Bean, NH, et al. Surveillance for foodborne-disease outbreaks – United States, 1988–1992. Morbidity and Mortality Weekly Report. Surveillance Summaries 1996; 45: 166.
6. United States Government Accountability Office. Fruits and vegetables: enhanced federal efforts to increase consumption could yield health benefits for Americans (http://www.gao.gov/products/gao-02-657). Washington, DC, USA: United States Government Accountability Office General Accounting Office, 2002 (Report No.: GAO-02-657).
7. Food and Drug Administration. Commodity specific food safety guidelines for the lettuce and leafy greens supply chain, 1st edn (http://www.fda.gov/downloads/Food/FoodSafety/Product-SpecificInformation/FruitsVegetablesJuices/GuidanceComplianceRegulatoryInformation/UCM169008.pdf). Accessed 11 December 2013.
8. Gould, LH, et al. Surveillance for foodborne disease outbreaks – United States, 1998–2008. Morbidity and Mortality Weekly Report. Surveillance Summaries 2013; 62: 134.
9. Hall, AJ, et al. Acute gastroenteritis surveillance through the National Outbreak Reporting System, United States. Emerging Infectious Diseases 2013; 19: 13051309.
10. United States Department of Agriculture Economic Research Service. Food availability (per capita) data system (http://www.ers.usda.gov/Data/FoodConsumption). Accessed 18 July 2013.
11. United States Census Bureau. American community survey data and documentation (http://www2.census.gov/acs2011_5yr/summaryfile/?C=M;O=A). Accessed 29 May 2013.
12. Centers for Disease Control and Prevention. Guide to confirming a diagnosis in foodborne disease (http://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/confirming_diagnosis.html). Accessed 29 May 2013.
13. Hall, AJ, et al. Epidemiology of foodborne norovirus outbreaks, United States, 2001–2008. Emerging Infectious Diseases 2012; 18: 15661573.
14. Ethelberg, S, et al. Outbreaks of gastroenteritis linked to lettuce, Denmark, January 2010. Eurosurveillance 2010; 15.
15. Food and Drug Administration Center for Food Safety and Applied Nutrition. FDA guide to minimize microbial food safety hazards for fresh fruits and vegetables (http://www.fda.gov/downloads/Food/GuidanceComplianceRegulatoryInformation/GuidanceDocuments/ProduceandPlanProducts/UCM169112.pdf). Accessed 11 December 2013.
16. United States Department of Health and Human Services. Analysis and evaluation of preventive control measures for the control and reduction/elimination of microbial hazards on fresh and fresh-cut produce (http://www.fda.gov/Food/FoodScienceResearch/SafePracticesforFoodProcesses/ucm090977.htm). Accessed 11 December 2013.
17. Wheeler, C, et al. An outbreak of hepatitis A associated with green onions. New England Journal of Medicine 2005; 353: 890897.
18. Centers for Disease Control and Prevention. Ongoing multistate outbreak of Escherichia coli serotype O157:H7 infections associated with consumption of fresh spinach – United States, September 2006. Morbidity Mortality Weekly Report 2006; 55: 10451046.
19. Centers for Disease Control Prevention. Outbreaks of Shigella sonnei infection associated with eating fresh parsley – United States and Canada, July–August 1998. Morbidity Mortality Weekly Report 1999; 48: 285289.
20. Widdowson, MA, et al. Norovirus and foodborne disease, United States, 1991–2000. Emerging Infectious Diseases 2005; 11: 95102.
21. Swaminathan, B, et al. PulseNet: the molecular subtyping network for foodborne bacterial disease surveillance, United States. Emerging Infectious Diseases 2001; 7: 382389.
22. Garrett, EH, et al. 2003. Microbiological safety of fresh and fresh-cut produce: description of the situation. Comprehensive Reviews in Food Science and Food Safety 2003; 2 (Suppl.): 1337.
23. Beuchat, LR. Ecological factors influencing survival and growth of human pathogens on raw fruits and vegetables. Microbes and Infection 2002; 4: 413423.
24. Hoffman, RE, et al. Capacity of state and territorial health agencies to prevent foodborne illness. Emerging Infectious Diseases 2005 11: 1116.
25. Food and Drug Administration. Produce safety standards. Food Safety Modernization Act (FSMA) (http://www.fda.gov/Food/GuidanceRegulation/FSMA/ucm304045.htm). Accessed 29 March 2013.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 13
Total number of PDF views: 166 *
Loading metrics...

Abstract views

Total abstract views: 782 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 16th August 2018. This data will be updated every 24 hours.