Epidemiologic profiling: evaluating foodborne outbreaks for which no pathogen was isolated by routine laboratory testing: United States, 1982–9
The objective was to evaluate foodborne outbreaks of undetermined aetiology by comparing them to pathogen-specific epidemiologic profiles of laboratory-confirmed foodborne outbreaks. National foodborne outbreak data reported to CDC during 1982–9 were categorized by clinico-epidemiologic profiles based on incubation, duration, percent vomiting, fever and vomiting to fever ratio. From the pathogen-specific profiles, five syndromes were developed: a vomiting-toxin syndrome resembling Bacillus cereus and Staphylococcus aureus; a diarrhoea-toxin syndrome characteristic of Clostridium perfringens, a diarrhaeogenic Escherichia coli syndrome, a Norwalk-like virus syndrome, and a salmonella like syndrome. Of 712 outbreaks, 624 (87·6%) matched one of five syndromes; 340 (47·8%) matched the Norwalk-like syndrome and 83 (11·7%) matched the salmonella-like syndrome. After combining information on known pathogens and epidemiologic profiles, only 88 (12·4%) outbreaks remained unclassified. Norwalk-like virus outbreaks appear as common as salmonella-like outbreaks. We conclude that profiling can help classify outbreaks, guide investigations and direct laboratory testing to help detect new and emerging pathogens.(Accepted June 29 2001)
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