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Chapter IV: Outbreaks Tables

Analysis and Evaluation of Preventive Control Measures for the Control and Reduction/Elimination of Microbial Hazards on Fresh and Fresh-Cut Produce

Chapter IV

Incidence Tables   |   Outbreaks Tables   |   Growth/Survival Tables

Outbreaks Associated with Fresh Produce: Incidence, Growth, and Survival of Pathogens in Fresh and Fresh-Cut Produce

Table O-1: Examples of Reported Outbreaks of Foodborne Disease Associated with Melons
PathogenYearLocationProduce SourceVenueType of MelonNo. of CasesNo. of DeathsIsolated from ProduceCommentsReference
Escherichia coli O157:H71993OregonNRaRestaurantCantaloupe90NRPossible contamination of
cantaloupe with organism
from raw beef.
See Del Rosario and Beuchat 1995; Anonymous 1993
Norwalk virus1987United
Kingdom
NRNRMelon2060NRInfected food handler.See Lund and Snowdon 2000
Salmonella Chester1989-90Multistate,
US
Mexico and Central AmericaUnknownCantaloupe>245 ( 25,000 estimated)2NoCut cantaloupe from salad bars.see CDC 1991; see Lund and Snowdon 2000
S. Javiana1991MichiganNAIndoor picnic and in-school partyWatermelon26 primary 13 secondary0YesMelon not washed prior to cutting. Suspected contamination from
melon rind. Melon served over
3 hour period at room temperature. Leftovers served the next day.
Blostein 1993
S. Miami1954MassachusettsFloridaSupermarketWatermelon171YesLaboratory demonstration of
contamination of internal flesh
during slicing with either
contaminated melon surface or contaminated knife. Organism
recovered from shelf where knife
was kept but not from knife used to cut melons. Organism was isolated from home samples but not from supermarket samples. Melons were from Florida where S. Maimi is common.
Gayler and others 1955
S. Oranienburg1979IllinoisIllonoisSupermarketWatermelon180NoDamaged fruits were cut, covered with plastic film, and displayed, sometimes without refrigeration until sold.CDC 1979
S. Oranienburg1998Ontario,
Canada
US, Mexico, or Central AmericaVariousCantaloupe220NoPossible contamination with organism from surface when slicing. Cut fruit was probably left sitting at room temperature for several hours before consumption.Deeks and others 1998
S. Poona1991Multistate,
US and Canada
Texas or MexicoUnknownCantaloupe> 400 confirmed US, 72 Canada0NRFruit salads containing sliced cantaloupes.CDC 1991
S. Poona2000Multistate,
US (8 states)
MexicoVariousCantaloupe   Case control study clearl
implicated.
Farrar; pers comm; unreferenced
S. Saphra1997CaliforniaMexicoHome, grocery stores, and restaurantsCantaloupe240NRMultiple purchase sites suggest contamination during production or harvest. Lack of refrigeration at retail may have contributed to outbreak.Mohle-Boetani and others 1999; Farrar, pers comm; unreferenced
Salmonella1950MinnesotaNARoadside standWatermelon60YesPrepared cut melon. S. Bareilly isolated from melon. Melon kept at ambient temperature.See Blostein 1993
Shigella sonnei1987SwedenMoroccoDinner partySuspect watermelon150NoMelon consumed immediately after slicing. Possible contamination of melon from injected water.Fredlund and others 1987
a NR, not reported


 

 

Table O-2: Examples of Reported Outbreaks of Foodborne Parasitic Disease Associated with Raw Berries

PathogenYearLocationProduce SourceVenueType of BerryNo. of CasesNo. of DeathsIsolated from ProduceCommentsReference
Cyclospora cayetanensis1995FloridaGuatemala likelyTwo social eventsRaspberries likely870NoRaspberries from both events were purchased from separate sources.
Two clusters reported.
Koumans and others 1998
C. cayetanensis199620 US states and 2 Canadian provincesGuatemalaVariousRaspberries14650NoPossible contamination due to fruit spraying with insecticides and fungicides mixed with contaminated water.Herwaldt and Ackers 1997; Fleming and others 1998
C. cayetanensis1997Multistate, US and Ontario, CanadaGuatemalaVariousRaspberries10120NoSource of contamination unknown.Herwaldt and Beach 1999; CDC 1997b
C. cayetanensis1998Ontario, CanadaGuatemalaVariousRaspberries3150NoSource of contamination unknown.CDC 1998c; Herwaldt 2000
C. cayetanensis1999Ontario, CanadaGuatamala likelyBanquet hallBlackberries suspected1040NRaSource of contamination unknown.Herwaldt 2000
a NR, not reported


 

 

Table O-3: Examples of Reported Outbreaks of Foodborne Viral Disease Associated with Contaminated Frozen Berries

PathogenYearLocationProduce SourceVenueType of BerryNo. of CasesNo. of DeathsIsolated from ProduceCommentsReference
Calicivirus1997Quebec, CanadaBosnia2 separate eventsRaspberries (frozen)>2000NRaLikely contamination occurred before shipping from Bosnia.Gaulin and others 1999
Calicivirus1998FinlandImportedUnknownRaspberries (frozen)> 5000NRSource of contamination unknown.See Lund and Snowdon 2000
Hepatitis A1983ScotlandScotlandHotelRaspberries (frozen)240NoSuspected raspberry mousse prepared from frozen raspberries. Suggested contamination by infected picker(s).Reid and Robinson 1987
Hepatitis A1988ScotlandScotlandHomeRaspberries (frozen)50NoRaspberries from a small farm were frozen at home. Several pickers at the farm had symptoms of Hepatitis A.Ramsay and Upton 1989
Hepatitis A1990Georgia MontanaCalifornia (1988)School Institution for disabledStrawberries (frozen)15 (Georgia) 13 (Missouri) +29 secondary0NoFrozen strawberries used to make dessert. Empty strawberry containers with same lot number obtained from both locations implicated same source. Suspected contamination by infected picker(s). Strawberries picked and stems removed in field. Fruits washed in 3 ppm chlorine prior to slicing and freezing.Niu and others 1992
Hepatitis A1997Multistate USMexicoSchoolsStrawberries (frozen)242 + 14 suspect0NoFrozen strawberries and strawberry shortcake were implicated in the outbreak. Possible contamination during harvesting. Handwashing in field limited. Stems removed with fingernails. Evidence suggested low levels of nonuniform contamination.Hutin and others 1999; CDC 1997a
a NR, not reported


 

 

Table O-4: Examples of Reported Outbreaks of Foodborne Disease Associated with Seed Sprouts

PathogenYearLocationSeed SourceType of SproutNo. of CasesNo. of DeathsIsolated from Sprouts/SeedsCommentsReference
Bacillus cereus1973TexasUganda (soy), Holland (cress), and Denmark (mustard)Soy, mustard, and cress40Yes/YesSprouted from a home seed sprouting kit.Portnoy and others 1976
Escherichia coli O157:H71996JapanNRaRadish6561 (101 with HUSb), 160 secondary cases2No/NoContamination route unknown.WHO, Weekly Epidemiological Record 1996a, 1996b
E. coli O157:H71997JapanNRRadish1260Yes/NoThe pathogen was isolated from leftover sprouts in the refrigerator but not the seeds from the same seed lots.See Feng 1997; Taormina and others 1999
E. coli O157:H71997Michigan and VirginiaNRAlfalfa1080NR/NRSprouts were sprouted from same seed lot in both states.CDC 1997d
E. coli O157:NM1998CaliforniaCalifornia and NevadaClover / Alfalfa80Yes/NoSprouts were traced to a single sprouter. Contaminated seeds suspected (same sprouter as 1997-98 S.Senftenberg outbreak).Farrar; pers comm; unreferenced; Taormina and others 1999
Salmonella Bovismorbificans1994Sweden and FinlandAustraliaAlfalfa5950Yes/NoContaminated seeds came from the same seed lot and importer.Ponka and others 1995
S. Enteriditis2000Alberta and Saskatchewan, CanadaChinaAlfalfa80NR/NROutbreaks occurred at 5 Vietnamese restaurants. Sprouts came from 2 growers who received seeds imported from China.Farber 2000; personal communication; unreferenced
S. Enteriditis2000CaliforniaChinaMung450No/NoCluster of illness linked to 3 Vietnamese restaurants. S. Enteriditis isolated from environment at sprouter.California Dept. Health Services 2000; Farrar; pers comm; unreferenced
S. Gold-Coast1989U.K.The NetherlandsCress310Yes/NoContaminated seed and/or sprouter.Feng 1997; Taormina and others 1999
S. Havana1998California and ArizonaNRAlfalfa14 (California) 4 (Arizona)1No/YesSprouts were traced to a single producer. Seeds obtained from the same lot yielded sprouts from which S. Havana was cultured.Backer and others 2000
S. Havana / Cubana / Tennessee1998CaliforniaCaliforniaAlfalfa340Yes/YesContaminated seeds were suspected.Farrar; pers comm; unreferencd; Taormina and others 1999
S. Infantis and S. Anatum1997Kansas and MissouriUnknownAlfalfa1090NR/NRSeeds were believed to be contaminated.Feng 1997; Taormina and others 1999
S. Mbandaka1999Oregon, California, Idaho, and WashingtonCaliforniaAlfalfaAppx. 680Yes/YesSeeds were believed to come from the same lot and distributed to various growers in California, Florida, and Washington. No cases in Florida.Farrar; personal communication; unreferenced
S. Meleagridis1997CanadaUnknownAlfalfa1240NR/NRSprouts were organically grown with no chlorine pre-soak.See Feng 1997; Farber 2000; pers comm; unreferenced
S. Montevideo and S. Meleagridis1996CaliforniaCaliforniaAlfalfa>5001Yes/NoThe sprouts were traced to a specific sprouter. Seeds traced to single California seed grower. Contaminated seeds suspected.Taormina and others 1999; Farrar; pers comm; unreferenced
S. Newport1995Denmark (probably US and Canada)The NetherlandsAlfalfa1540Yes/YesSeeds came from the same shipper as US/Canada outbreak (see below). Source of contamination unknown.See Feng 1997; Farber 2000; personal communication; unreferenced
S. Newport1995-96British Columbia, Canada, Oregon (probably Georgia and Vermont) and DenmarkThe NetherlandsAlfalfa1330Yes/YesOrganism isolated were indistinguishable form the Denmark outbreak (see above).See Feng 1997; Taormina and others 1999
S. Paratyphi B var. Java1999Alberta, British Columbia, and Saskatchewan, CanadaUnknownAlfalfa460NR/NRSpouts were from the same brand or common seed source.Farber 2000; personal communication; unreferenced
S. Saint-Paul1988U.K.Thailand and AustraliaMung1430Yes/YesMultiple serovars isolated from bean spouts, seeds, and environmental samples (from producer waste materials).O'Mahony and others 1990
S. Saint-Paul
S. Havana
S. Muenchen
1988SwedenNRMung1480Yes/NRProbably same seeds as UK outbreak. S. Havana and S. Muenchen but not S. Saint-Paul isolated from sprouts.See Nguyen-the and Carlin 2000; See O'Mahony and others 1990
S. Senftenberg1997-98California5 US statesAlfalfa and clover sprouts520Yes/NoSprouts were traced to a specific sprouter. Contaminated seeds suspected. Same sprouter as 1998 E. coli O157:NM outbreak.Jeff Farrar; pers comm; unreferenced; Taormina and others 1999
S. Stanley1995Multistate, US, Canada and FinlandThe NetherlandsAlfalfa>2720No/NoSeeds came from the same sprouter. At least 4 seed lots involved. Possible contamination occurred prior to shipping.Mahon and others 1997
S. Virchow1988U.K.Thailand and AustraliaMung70Yes/NRProbably from the same outbreak as S. Saint-Paul in UK.O'Mahony and others 1990
Yersinia enterolitica1982PennsylvaniaUnknownBean sprouts160NR/NRBean sprouts were immersed at home in well water contaminated with Yersinia.See Cover and Aber 1989
a NR, not reported
b Hemolytic uremic syndrome


 

 

Table O-5: Examples of Reported Outbreaks of Foodborne Disease Associated with Unpasteurized Fruit Juice

PathogenYearLocationFruit SourceType of JuiceVenueNo. of CasesNo. of DeathsIsolated from JuiceCommentsReference
Crytosporidium parvum1996New YorkNew YorkAppleSmall cider mill20 confirmed, 11 suspected0NRaNo drops used; However, dairy farm across the street. E. coli detected in well water samples indicating fecal contamination. Apples were brushed and washed prior to pressing.CDC 1997c
Cryptosporidium1993MaineMaineAppleSchool160 primary and 53 secondary0YesApples shaken from trees and gathered from ground, cattle grazed on grass beneath trees, oocysts found in calf manure, apples inadequately washed and pressed for juice at an agricultural fair.Millard and others 1994
Escherichia coli O157:H71991MassachusettsMassachusettsAppleSmall cider mill23 (4 HUS)0No90% drops used in making juice. Apples were not washed or scrubbed. Cattle raised nearby.Besser and others 1993
E. coli O157:H71996ConnecticutConnecticutAppleSmall cider mill14 (3 HUS, 1 HUS+TTPc)0NoSome drops used in juice. Apples were brushed and washed in potable water before juiced using a wooden press. Potassium sorbate (0.1%) added as a preservative.CDC 1997c
E. coli O157:H71996WashingtonWashingtonAppleSmall cider mill60NoCider was made for local church event from local orchard. Apples were washed.See Farber 2000
E. coli O157:H71996British Columbia, Canada, California, Colorado, and WashingtonUSAppleRetail70 (14 HUS)1YesPhosphoric acid wash, brushed, and rinsed; However, phosphoric acid based solutions may have been used incorrectly (not intended for produce/waxed produce) or sometimes used at low concentrations. Possibly poor quality apples, some dropped apples used, apple orchard near cattle/deer.CDC 1996b; Cody and others 1999
E. coli O157:H71998Ontario, CanadaOntario, CanadaAppleFarm / Home140NoCattle kept in orchard prior to apple harvest. Apples collected from ground if suitable on inspection. Water supply on farm not potable. Apples used without further inspection, brushing or washing.Tamblyn and others 1999
E. coli O157:H71999OklahomaOklahomaApple-70NRDrop apples used. Possible contamination from wild and domestic animal manure.See Farber 2000
E. coli O157:H7 suspected1980Toronto, Ontario, CanadaCanadaAppleLocal market14 HUSb1NoJuice purchased from a local market and fair. Juice tasted "bad" or "different".Steele and others 1982
Enterotoxigenic E. coli1992IndiaIndiaOrangeRoadside vendor60YesTwo roadside vendors selling fresh squeezed juice, one was 6 meters away form the garbage heap.Singh and others 1995
Salmonella Enteriditis2000Multistate, USCaliforniaCitrusRetail and Food Service140NoGallon sized containers of citrus juices were implicated in the outbreak.Butler 2000
S. Gaminera, S. Hartford, and S. Rubislaw1995FloridaFloridaOrangeRetail62 ill and 7 hospitalized0YesS. Gaminera was isolated from several containers of juice after outbreak. Numerous in-plant sanitation problems found. Surface water was used for orchard irrigation. Drops were used for juice. Salmonella was isolated from amphibiams and soil around the processing plant.CDC 1995; Cook and others 1998
S. Muenchen1999US and CanadaMexicoOrangeRestaurant207 confirmed, +91 suspected1YesMultiple strains of Salmonella isolated from orange juice collected from producer. Juice squeezed in Mexico and transported to Arizona in tanker trucks where it was bottled. Follow-up investigations revealed that ice was added illegally to juice prior to transport.CDC 1999a
S. Typhi1898FranceFranceAppleNRNRNRNR- 
S. Typhi1922FranceFranceAppleNR230NRNon-potable water was used to wash apples.Paquet 1923
S. Typhimurium1974New JerseyNew JerseyAppleFarm and small retail outlets2960YesA high proportion of dropped apples used to make the juice. Manure used to fertilize apple trees. Equipment rinsed with cold water, not sanitized. Six of thirty employees were S. Typhimurium positive.CDC 1975
S. Typhimurium1999AustraliaAustraliaOrangeRetail4050YesSalmonella was isolated from unopened cartons of orange juice.Survellence Management Section 1999
a NR, not reported
b Hemolytic uremic syndrome
c Thrombotic thrombocytopenic purpura


 

 

Table O-6: Examples of Reported Outbreaks of Foodborne Disease Associated with Reconstituted Orange Juice

PathogenYearLocationProduceType of JuiceVenueNo. of CasesNo. of DeathsIsolated from ProduceCommentsReference
Hepatitis A1962MissouriUnknownOrange (reconstituted)Hospital240NRThe orange juice was prepared by subclinical Hepatitis A handler.Eisenstein and others 1963
Salmonella Typhi, typhoid fever1944OhioUnknownOrange (reconstituted)Residential hotel181NRJuice was handled by an asymptomatic food worker.Duncan and others 1946
S. Typhi, typhoid fever1989New YorkUnknownOrange (reconstituted)Resort hotel46 confirmed 24 suspected0NRAn asymptomatic food handler prepared the juice at a New York hotel. Utensils used were difficult to clean. Orange juice distributed near restrooms.Birkhead and others 1993
Unknown1965CaliforniaUnknownOrange (reconstituted)Unknown5630NRaPossible contaminated water source used to reconstitute juice.Tabershaw and others 1967
a NR, not reported


 

 

Table O-7: Examples of Reported Outbreaks of Foodborne Disease Associated with Raw Lettuce or Salads

PathogenYearLocationProduce SourceVenueType of Lettuce or SaladNo. of CasesNo. of DeathsIsolated from ProduceCommentsReference
Campylobacter jejuni1984British Columbia, CanadaNRaUniversity cafeteriaSalad3300NoPossible cross contamination during food preparation and poor food storage practices. Salad appeared to initiate outbreak.Allen 1985
C. jejuni1996OklahomaNRRestaurantLettuce140NRProbable cross contamination of lettuce with raw chicken juices.CDC 1998b
Clostridium perfringens1993Ontario, CanadaUnknownWedding receptionSalad480NoSalad implicated but epidemiology weak.Styliadis 1993
Cyclospora cayatenesis1997FloridaPossibly PeruRestaurants cruise shipBaby lettuce leaves (mesclun)>910NRPossibly related outbreaks traced to cruiseship sailing out of Florida and several Florida restaurants. Lettuce originated from Peru and US, purchased from the same distributor.See Herwaldt and Beach 1999
Calicivirus1992Ontario, CanadaNRCatered eventSalad270NRSalad served at a potluck. Vegetables may have been improperly washed or cross contaminated by an infected food handler.Todd 1998
Escherichia coli O157:H71995IdahoUnknownUnknownLettuce (romaine)210NRPossibly infected food handler.CSPI 2000
E. coli O157:H71995MaineCaliforniaScout campLettuce (iceberg)300NRCross contamination with raw hamburger juice.CSPI 2000
E. coliO157:H71995Ontario, CanadaNRAcute care hospitalIceberg lettuce230NROutbreak occurred in an acute care hospital. Lettuce received was heavily spoiled.Preston and others 1997
E.coli O157:H71995Alberta, CanadaNRRestaurantCaesar salad370NR-Farber; pers comm; unrefcd
E.coli O157:H71995MontanaMontana and WashingtonRetailLettuce700NoPossible contamination from irrigation runoff or compost used to fertilize the fields. Cattle had access to the stream above the pond used for irrigation.Ackers and others 1998
E.coli O157:H71996Connecticut and IllinoisUSVariousMesclun lettuce490YesThe implicated lettuce was traced to a single grower processor. Cattle was found near the lettuce fields.Hilborn and others 1999; See Tauxe 1997
E.coli O157:H71998CaliforniaNRRestaurantSalad20No Griffin and Tauxe 1999
Giardia1989New MexicoNRChurch dinnerLettuce and onions210NRPossible contamination from potable water used in washing the vegetables. Possible cross contamination from using the same cutting board to cut all vegetables.CDC 1989
Hepatitis A1986FloridaNRRestaurantLettuce salad1030NoThe probable source for the outbreak was an infected foodhandler with poor hygiene practices. The lettuce was shredded with hands.Lowry and others 1989
Hepatitis A1988KentuckyUS but possibly MexicoRestaurantsIceberg lettuce2020NoThree restaurants received lettuce from the same produce distributor. Contamination suspected to have occurred before distribution.Rosenblum and others 1990.
Shigella sonnei1983TexasArizona, California, New MexicoUniversity cafeteriaLettuce1400NoTwo concurrent outbreaks at separate universities. Both universities purchased lettuce from the same supplier. Supplier purchased lettuce from three states. Farm source could not be determined.Martin and others 1986
S. sonnei1986TexasTexasRestaurantsShredded lettuce3470NoImplicated restaurants received shredded lettuce from one source. Possible contamination from food handler at the shredding facility.Davis and others 1988
S. sonnei1994Norway, Sweden, and UKSpainVariousLettuce (iceberg)110 (Norway),8 (Sweden), NR (UK)0NoFecal coliforms and Salmonella were detected in iceberg lettuce obtained from patient's homes.Kapperud and others 1995
Vibrio cholerae1970IsraelNRNRMixed vegetables1760NRPossible contamination from waste water irrigation.See Nguyen-the and Carlin 2000
a NR, not reported


 

 

Table O-8: Examples of Reported Outbreaks of Foodborne Disease Associated with Raw Produce Other than Melons, Berries, Seed Sprouts, and Lettuce or Salads

PathogenYearLocationProduce SourceVenueType of ProduceNo. of CasesNo. of DeathsIsolated from ProduceCommentsReference
Clostridium botulinum (type A)1987FloridaNRaHomeCabbage salad40YesPreformed toxin and spores were found in coleslaw dressing which contained cabbage and carrot pieces. Possible growth of C. botulinum in the cabbage.Solomon and others 1990
C. botulinum (type A)1989New YorkNRHomeChopped garlic in oil30YesProduct was made from chopped garlic, ice water and olive oil sometime between 1985 and 1987. Chemical or acid additives not used. "Keep refrigerated" in small print. Jar was stored at room temperature for approximately 3 months prior to opening. Refrigerated after opening. Same processor as 1985 outbreak (Solomon and Kautter, 1988).Morse and others 1990
C. botulinum (type B)1985British Columbia, CanadaUSRestaurantsChopped garlic in oil370YesThe product was made from dehydrated and rehydrated and soybean oil. Chemical or acid additives not used. "Keep refrigerated" in small print. Jar was stored at room temperature at the restaurant.Solomon and Kautter 1988
Cryptosporidium parvum1997WashingtonUSRestaurantsGreen onions (inconclusive association)540NoGreen onions were not washed before delivery to the restaurant and not washed before serving to customers. Possible contamination by a food handler.CDC 1998a
Cyclospora cayatenansis1997Multistate, USUSRetail / Catered eventsBasil>3080YesSuspected fresh basil. Mode of contamination unknown.CDC 1997b
Escherichia coli (enterotoxigenic)1993Rhode Island New HampshireUSAirline, hotelShredded carrots47 1210NRPossible contamination of carrots used in salads. Carrots used came from same state.CDC 1994
E. coli O157:H71998IndianapolisNRRestaurantColeslaw330Yes Griffin and Tauxe 1999
E. coli O157:H71998WisconsinNRCatered eventFruit salad47 (3 HUS)0No Griffin and Tauxe 1999
Giardia lamblia1989USNRNRLettuce, tomatoes, onions21NRNR See Nguyen-the and Carlin 2000
Hepatitis A1971TennesseeTennesseeHomeRaw watercress1290NoWatercress harvested from small streams near farm. Specimen cultures revealed gross contamination with fecal organisms. Several abandoned septic tanks were seen near the stream.CDC 1971
Hepatitis A1994ArkansasNRNRDiced tomatoes920NRSuspected contamination by food handler.Lund and Snowdon 2000
Listeria monocytogenes1979BostonNRHospitalsRaw tomatoes, lettuce and celery suspected205NRMultiple hospitals involved. Tuna fish, chicken salad and cheese sandwiches epidemiologically linked to listeriosis. All served with tomatoes, raw vegetables such as celery and lettuce.Ho and others 1986; Schlech and others 1983
L. monocytogenes1981Nova Scotia, CanadaNova Scotia, CanadaVariousVegetable mix for coleslaw4117YesCabbage was grown on farm where two sheep had died of listeriosis. Raw and composed manure was used to fertilize the fields. Cold storage may have allowed for Listeria growth.Farber 2000; pers comm; unreferenced; Schlech and others 1983
Norwalk virus1982MinnesotaNRHotel restaurantFruit salad, coleslaw, and tossed salad2330NROutbreak traced to three separate banquets. Fruit salad and coleslaw prepared by one worker during her acute illness and up to 48 hours following her recovery. A second worker prepared implicated tossed salad 24 hours following her recovery.White 1986
Norwalk virus1990HawaiiNRCruise shipFresh cut fruit>2170NRPossible contamination occurred during preparation. Fresh cut fruits included pineapple, papaya, watermelon, cantaloupe, and honeydew melon.Herwaldt and others 1994
Salmonella Baildon1998-99Multistate, USFloridaVariousTomatoes853NRTomates traced to two packers in Florida. Possible field contamination by domesting or wild animals.Susman 1999; Cummings 1999
S. Javiana1990Multistate, USSouth CarolinaVariousTomatoes1740NRContamination of water bath used by packer.See Tauxe 1997; See Beuchat 1996b
S. Montevideo1993Multistate, USSouth CarolinaVariousTomatoes840NoContamination of water bath used by packer.See Lund and Snowdon 2000; See Wei and others 1995; Tauxe 1997
S. Typhi1998-99USBrazilUnknownMamey130UnknownImported frozen mamey. Source of contamination not known.See Lund and Snowdon, 2000
Shigella flexneri 6A1994Multistate, USMexicoVariousGreen onions720NDPossible contamination during harvest or packaging in Mexico.Tauxe, 1997
S. sonnei1998Multistate, US and CanadaMexicoRestaurantsParsley3100NoMunicipal water supplied to packing shed was unchlorinated. Water was used in hydrocooler where it was recirculated. Also used to make ice for packing the parsley. Workers had limited hygiene education and sanitary facilities. In restaurants parsley was often chopped and left at room temperature for several hours prior to serving.CDC, 1999b
Vibrio cholerae1970IsraelNRNRVarious raw vegetables176NRNRContamination by irrigation and untreated waste water.See Nguyen-the and Carlin, 2000
V. cholerae1991PeruPeruVariousCabbageUnknown71NRSeveral factors were associated with cholera transmission including contaminated drinking water, going to fiestas, and eating raw or lightly cooked cabbage. Farmers in region commonly used untreated sewage to irrigate crops.Swerdlow and others 1992
a NR, not reported


 

 

Table O-9: Examples of Reported Outbreaks of Foodborne Disease Associated with Raw Produce Due to Contamination During Final Preparation

PathogenYearLocationVenueType of ProduceNo. of CasesNo. of DeathsIsolated from ProduceCommentsReference
Campylobacter jejuni1984British Columbia, CanadaUniversity cafeteriaSalad3300NoPossible cross contamination during food preparation and poor food storage practices. The salad appeared to initiate outbreak.Allen 1985
C. jejuni1996OklahomaRestaurantLettuce140NRaProbable cross contamination of lettuce with raw chicken juices.CDC 1998b
Crytosporidium parvum1997WashingtonRestaurantsGreen onions (inconclusive association)540NoGreen onions were not washed before delivery to the restaurant and not washed before serving to customers. Possible contamination by a food handler.CDC 1998a
Calicivirus1992Ontario, CanadaCatered eventSalad270NRSalad served at a potluck. Vegetables may have been improperly washed or cross contaminated by an infected food handler.Todd 1998
Escherichia coli O157:H71993OregonRestaurantCantaloupe90NRPossible contamination of cantaloupe with organism from raw beef.See Del Rosario and Beuchat 1995; Anonymous 1993
E. coli O157:H71995IdahoUnknownLettuce (romaine)210NRPossibly contaminated by food handler.CSPI 2000
E. coli O157:H71995MaineScout campLettuce (iceberg)300NRCross contamination with raw hamburger juice.CSPI 2000
Giardia1989New MexicoChurch dinnerLettuce and onions210NRPossible contamination from potable water used in washing the vegetables. Possible cross contamination from using the same cutting board to cut all vegetables.CDC 1989
Hepatitis A1986FloridaRestaurantLettuce salad1030NoThe probable source for the outbreak was an infected food handler with poor hygiene practices. Lettuce was shredded by hand.Lowry and others 1989
Hepatitis A1994ArkansasUnknownDiced tomatoes920UnknownSuspected contamination by food handler.Lund and Snowdon 2000
Norwalk virus1987United KingdomNRMelon2060NRInfected food handler.See Lund and Snowdon 2000
Norwalk virus1990HawaiiCruise shipFresh cut fruit>2170NRPossible contamination occurred during preparation. Fresh cut fruits included pineapple, papaya, watermelon, cantaloupe, and honeydew melon.Herwaldt and others 1994.
a NR, not reported
Note: These outbreaks are also found in Tables 1 to 8.


 

 

Table O-10: Examples of Reported Outbreaks of Foodborne Disease Associated with Temperature Abuse

PathogenYearLocationProduce SourceVenueType of ProduceNo. of CasesNo. of DeathsIsolated from ProduceCommentsReference
Clostridium botulinum (type A)1989New YorkNRaHomeChopped garlic in oil30YesProduct was made from chopped garlic, ice water and olive oil sometime between 1985 and 1987. Chemical or acid additives not used.  "Keep refrigerated" in small print.  Jar was stored at room temperature for approximately 3 months prior to opening.  Refrigerated after opening.  Same processor as 1985 outbreak (Solomon and Kautter, 1988).Morse and others 1990
C. botulinum (type B)1985British Columbia, CanadaUSRestaurantsChopped garlic in oil370YesProduct was made from dehydrated and rehydrated and soybean oil. Chemical or acid additives not used. "Keep refrigerated" in small print. Jar was stored at room temperature at the restuarant.Solomon and Kautter 1988
Salmonella Javiana1991MichiganNAIndoor picnic and in-school partyWatermelon26 primary 13 secondary0YesMelon not washed prior to cutting.  Suspected contamination from melon rind.  Melon served over 3 hour period at room temperature.   Leftovers served the next day.Blostein 1993
S. Oranienburg1979IllinoisIllinoisSupermarketWatermelon180NoDamaged fruits were cut, covered with plastic film, and displayed, sometimes without refrigeration until sold.CDC 1979
S. Oranienburg1998Ontario, CanadaUS, Mexico, or Central AmericaVariousCantaloupe220NoPossible contamination with organism from surface when slicing.  The cut fruit was probably left sitting at room temperature for several hours before consumption.Deeks and others 1998
Salmonella1950MinnesotaNRRoadside standWatermelon60YesPrepared cut melon. S. Bareilly isolated from melon.  Melon kept at ambient temperature.See Blostein 1993
a NR, not reported
Note: These outbreaks are also found in Tables 1 to 8.