Skip to main content Accesibility Help
×
×
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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Outbreaks attributed to fresh leafy vegetables, United States, 1973–2012
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Outbreaks attributed to fresh leafy vegetables, United States, 1973–2012
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Outbreaks attributed to fresh leafy vegetables, United States, 1973–2012
      Available formats
      ×
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: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed