Epidemiology and Infection



Outbreaks of salmonellosis associated with eating uncooked tomatoes: implications for public health


C. W. HEDBERG a1c1, F. J. ANGULO a3, K. E. WHITE a1, C. W. LANGKOP a5, W. L. SCHELL a6, M. G. STOBIERSKI a7, A. SCHUCHAT a3, J. M. BESSER a2, S. DIETRICH a7, L. HELSEL a3, P. M. GRIFFIN a3, J. W. McFARLAND a1a4, M. T. OSTERHOLM a1 and THE INVESTIGATION TEAM  1
a1 Acute Disease Epidemiology Section, Minnesota Department of Health, Minneapolis, MN, USA
a2 Public Health Laboratory, Minnesota Department of Health, Minneapolis, MN, USA
a3 Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
a4 Division of Field Epidemiology and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
a5 Communicable Disease Control Section, Illinois Department of Health, Springfield, IL, USA
a6 Wisconsin Department of Health and Family Services, Madison, WI, USA
a7 Michigan Department of Public Health, Lansing, MI, USA

Abstract

Laboratory-based surveillance of salmonella isolates serotyped at four state health departments (Illinois, Michigan, Minnesota and Wisconsin) led to the identification of multistate outbreaks of salmonella infections during 1990 (176 cases of S. javiana) and 1993 (100 cases of S. montevideo). Community-based case-control studies and product traceback implicated consumption of tomatoes from a single South Carolina tomato packer (Packer A) MOR 16·0; 95% CI 2·1, 120·6; P<0·0001 in 1990 and again in 1993 (MOR 5·7; 95% CI 1·5, 21·9; P=0·01) as the likely vehicle. Contamination likely occurred at the packing shed, where field grown tomatoes were dumped into a common water bath. These outbreaks represent part of a growing trend of large geographically dispersed outbreaks caused by sporadic or low-level contamination of widely distributed food items. Controlling contamination of agricultural commodities that are also ready-to-eat foods, particularly fruits and vegetables, presents a major challenge to industry, regulators and public health officials.

(Accepted February 3 1999)


Correspondence:
c1 Author for correspondence: Minnesota Department of Health, 717 S.E. Delaware Street, Minneapolis, MN 55414, USA.


Footnotes

1 The investigation team consisted of epidemiologists, investigators and laboratorians from the following organizations: Centers for Disease Control and Prevention, Atlanta (David Swerdlow, Robert Tauxe, John Townes), National Center for Infectious Diseases, Foodborne and Diarrheal Diseases Branch (James Hospedales, Linda Wilson), Division of Field Epidemiology and Epidemic Intelligence Service, Epidemiology Program Office, Food and Drug Administration, Washington (Richard Kingdon, Ronald Roy), Minneapolis (John Feldman, Ray Marrs, John Scharmann), Illinois Department of Public Health, Springfield (Shirley Bohm, Kuo-Jen Kuo, Russell Martin, Paul McDonnell, Kathleen Michalak, Kennith Pannaralla, Margaret Schwartz), Michigan Department of Public Health, Lansing (William Hall), Minnesota Department of Agriculture, St. Paul (Charles Klammer, Thomas Masso), Minnesota Department of Health, Minneapolis (Kristine MacDonald, John Soler, Linda Gabriel, Richard Danila), Acute Disease Epidemiology Section (Jan Forfang, Jack Korlath, John Clare, Eric Anderson, Joseph Mariotti, Terry Ristinen), Epidemiology Field Services Section (Frederick Mitchell, Charles Schneider), Division of Environmental Health (Margaret Miller), Public Health Laboratories, Wisconsin Department of Agriculture, Trade and Consumer Protection, Madison (Gene Killiam, Jay Tucker), Wisconsin Department of Health and Family Services, Madison (Elmo Smyth, Mary Proctor, Jeffrey Davis).



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