Home-grown Cyclospora increasing in US

While cyclosporiasis cases are reported year-round in the United States, cyclosporiasis acquired in the United States (i.e., “domestically acquired”, or cases of cyclosporiasis that are not associated with travel to a country that is considered endemic for Cyclospora) is most common during the spring and summer months. The exact timing and duration of U.S. cyclosporiasis seasons can vary, but reports tend to increase starting in May. In previous years the reported number of cases peaked between June and July, although activity can last as late as September. The overall health impact (e.g., number of infections or hospitalizations) and the number of identified clusters of cases (i.e., cases that can be linked to a common exposure) also vary from season-to-season.

The number of reported cases of domestically acquired cyclosporiasishas increased from the previous month and remains elevated in the United States since May 1, 2019.

As of August 28, 2019, 1,696 laboratory-confirmed cases of cyclosporiasis were reported to CDC by 33 states, District of Columbia and New York City in people who became ill since May 1, 2019 and who had no history of international travel during the 14-day period before illness onset.

The median illness onset date was June 29, 2019 (range: May 1–August 13, 2019).

At least 92 people were hospitalized; no deaths were reported.

At this time, multiple clusters of cases associated with different restaurants or events are being investigated by state public health authorities, CDC, and FDA.

One multistate outbreak of Cyclospora infections has been linked to fresh basil imported from Siga Logistics de RL de CV of Morelos, Mexico . It is unknown at this time if other reported cases of Cyclospora infection in the United States this season are linked to fresh basil. This investigation is ongoing.

Many cases of cyclosporiasis could not be directly linked to an outbreak, in part because of the lack of validated molecular typing tools for C. cayetanensis.

States reporting cases: 33

Deaths: 0

Hospitalizations: 92

2019 domestically acquired cases of Cyclosporiasis

29.aug.19

CDC

https://www.cdc.gov/parasites/cyclosporiasis/outbreaks/2019/a-050119/index.html

255 sick from same Salmonella in American beef and Mexican soft cheese

What is already known about this topic?

Decreased susceptibility to azithromycin is rare among Salmonella serotypes that cause human infections in the United States. If antibiotic treatment is indicated, azithromycin is recommended as an oral therapy.

What is added by this report?

During June 2018–March 2019, an outbreak caused by multidrug-resistant Salmonella Newport with decreased susceptibility to azithromycin led to 255 infections and 60 hospitalizations. Infections were linked to Mexican-style soft cheese obtained in Mexico and beef obtained in the United States.

What are the implications for public health practice?

Whole genome sequencing can be used in Salmonella outbreak investigations for rapid prediction of antimicrobial resistance and can link cases to each other and to possible sources of infection.

Outbreak of salmonella Newport infections with decreased susceptibility to azithromycin linked to beef obtained in the United States and soft cheese obtained in Mexico—United States 2018-2019

23.aug.19

CDC

https://www.cdc.gov/mmwr/volumes/68/wr/mm6833a1.htm?s_cid=mm6833a1_e&deliveryName=USCDC_921-DM7382

FDA seeking source of imported melons in Salmonella outbreak

When Listeria killed seven people in Australia last year, linked to rockmelon (cantaloupe for you North American types) growers acted like it never happened before and just wanted to get product back on shelves.

They should never be cut in half, although all retailers do it, and it’s just greed over public health.

In the fall of 2011, 33 people were killed and 147 sickened from Listeria linked to cantaloupe in the U.S.

And it keeps happening.k on

 The number of people with salmonella linked to fresh-cut melons shipped by Caito Foods has increased, and the Food and Drug Administration has released a list of hundreds of retail outlets that received the products.

The exact source of the imported melons, however, has not been released, and the FDA continues its traceback investigation.

The FDA expanded the list of private-label brands in the outbreak, which was first reported by the FDA on April 12. In its first update on the outbreak, the FDA on April 24 posted the locations of almost 1,500 retail locations that received the fresh-cut cantaloupehoneydew and watermelon products from Caito Foods, Indianapolis.

The Centers for Disease Control and Prevention also reported April 24 that the number of people who have become ill has risen from 93 to 117 in 10 states. PulseNet, a national network that allows health and regulatory agencies to identify outbreaks, first alerted the CDC about the outbreak on April 2.

The CDC reported illness onset dates range from March 4 to April 8. No deaths have been reported; 32 people have been hospitalized, according to the CDC.

The type of salmonella in the outbreak, Salmonella Carrau, is rare, historically seen in imported melons. Caito Foods told investigators the melons used in the products were imported, according to the FDA.

Caito Foods was linked to a similar outbreak in 2018 involving Salmonella Adelaide in fresh-cut melon products.

‘You are at your very best when things are worst’

The 1984 movie Starman is one of my favorites, not because of the actors, who are all consistently great, but because of what it says about humanity and ice hockey (at least in mythologies): You are at your very best when things are worst.

canadian-border-patrol-trumpThe results of the U.S. election feel like awaiting the results of a group project in school: Amy and I did our part, but I think the rest of youse might have really fucked this up (modified from facebook).

What can be done to make this better?

Sure the Canadian immigration site has been collapsing all night, Australia is a long ways away, and those countries have their own problems.

But for now, at this moment, I’ll go back to the humanity of Starman, and tomorrow worry about how I will chat with my five daughters, the girls I coach in hockey, and people generally around the world who are writing and saying, WTF? How did a lying, misogynist, racist, financial idiot huckster and game show host win the U.S. presidency?

Mark Shermin: Have people from your world been here before?

Starman: Before? Yes. We are interested in your species.

Mark Shermin: You mean you’re some kind of anthropologist? Is that what you’re doing here? Just checking us out?

Starman: You are a strange species. Not like any other. And you’d be surprised how many there are. Intelligent but savage. Shall I tell you what I find beautiful about you? [Shermin nods] You are at your very best when things are worst.

Crypto in the US

Cryptosporidium is the leading aetiology of waterborne disease outbreaks in the United States. This report briefly describes the temporal and geographical distribution of US cryptosporidiosis cases and presents analyses of cryptosporidiosis case data reported in the United States for 1995–2012.

pool.safety.signThe Cochran–Armitage test was used to assess changes in the proportions of cases by case status (confirmed vs. non-confirmed), sex, race, and ethnicity over the study period. Negative binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals (CI) for comparing rates across three time periods (1995–2004, 2005–2008, 2009–2012). The proportion of confirmed cases significantly decreased (P < 0·0001), and a crossover from male to female predominance in case-patients occurred (P < 0·0001). Overall, compared to 1995–2004, rates were higher in 2005–2008 (RR 2·92, 95% CI 2·08–4·09) and 2009–2012 (RR 2·66, 95% CI 1·90–3·73). However, rate changes from 2005–2008 to 2009–2012 varied by age group (Pinteraction < 0·0001): 0–14 years (RR 0·55, 95% CI 0·42–0·71), 15–44 years (RR 0·99, 95% CI 0·82–1·19), 45–64 years (RR 1·47, 95% CI 1·21–1·79) and ≥65 years (RR 2·18, 95% CI 1·46–3·25).

The evolving epidemiology of cryptosporidiosis necessitates further identification of risk factors in population subgroups. Adding systematic molecular typing of Cryptosporidium specimens to US national cryptosporidiosis surveillance would help further identify risk factors and markedly expand understanding of cryptosporidiosis epidemiology in the United States.

Evolving epidemiology of reported cryptosporidiosis cases in the United States, 1995–2012

Epidemiology and Infection, Volume 144, Issue 08, June 2016, Pages 1792–1802, http://dx.doi.org/10.1017/S0950268815003131

J.E. Painter, J.W. Gargano, J.S. Yoder, S.A. Collier, M.C. Hlavsa

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10299145&fileId=S0950268815003131

UPI gets into the Buzzfeed list business: Notable E. coli outbreaks in U.S. fast food restaurants

Most of the U.S. mainstream food safety news coming through Google Alerts over the last week has been recycled and Chipotle-related.

Much of the focus has been on the business with the same questions are being asked by many journos: Will the fast casual Mexican restaurant rebound? What will happen to their stocks? When can we eat there again? Sorta lost in the media are the stories of the folks who went to grab a lunch and ended up ill. The folks that couldn’t go to work, missed life events and may have a long recovery. The affected have been digested down to a list of numbers.Jimmy-Johns-Gourmet-sandwiches

UPI gets into the food safety list business and revisits stigma-creating events over the past 30+ years, here are some highlights:

McDonald’s (1982)
Nearly 50 people in Oregon and Michigan fell ill after eating burgers at McDonald’s. The confirmed outbreak was the first time E. coli O157:H7 was linked to food poisoning, but wouldn’t be the last time ground beef would be recalled for outbreaks of the dangerous pathogen, including Topps Meat Co. recalling nearly 22 million pounds in 2007 and Con Agra Foods pulling nearly 20 million pounds of ground beef in 2002.

Jack-in-the-Box (1993)
The 1993 Jack-in-the-Box outbreak occurred when more than 500 people became infected after eating undercooked beef patties associated with 73 restaurants in Washington, Idaho, California, and Nevada. Four children died and hundreds of customers were left with permanent injuries, including kidney damage, resulting in numerous lawsuits.

Kentucky Fried Chicken (1999)
In July of 1999, public health officials confirmed four Cincinnati-area Kentucky Fried Chickens were to blame for an outbreak of E. coli that led to 18 illnesses and at least 11 hospitalizations. Investigators identified poorly prepared coleslaw as the source of the contamination.

Sizzler (2000)
Two Sizzler restaurants in Wisconsin were responsible for 64 confirmed cases of E. coli and dozens of hospitalizations. Four patients developed hemolytic uremic syndrome, or HUS, a serious illness that can result in kidney failure. One child died. Officials linked the contamination back to watermelon, which was cross-contaminated with raw meat products. Eight years later, the family of the 3-year-old girl who died from exposure at a Sizzler restaurant reached a $13.5 million settlement with the company’s meat supplier.

Taco Bell (multiple)
In December, 2006, 71 illnesses linked to Taco Bell were reported to the CDC from five states: New Jersey, New York, Pennsylvania, Delaware, and South Carolina. Investigations indicated shredded lettuce was the likely source of the outbreak. Two years later, all Taco Bell restaurants in Philadelphia were temporarily closed and green onions removed from all 5,800 of its U.S. restaurants after tests indicated they were to blame for an E. coli outbreak that sickened at least five dozen people in New Jersey, New York and Pennsylvania.

Jimmy John’s (multiple)
In 2013, the Colorado Department of Public Health and Environment identified nine cases of E.coli O157:H7 in the Denver area linked to the consumption of Jimmy John’s sandwiches containing cucumbers imported from Mexico. This wasn’t the first time Jimmy John’s, based in Champaign, Ill., has been linked to an outbreak. Since 2008, the sandwich chain has been cited for serving contaminated sprouts at least five times.

Not just a Europe thing: DNA testing reveals horse meat in two products bought in US

Horse meat has been detected in two of 48 samples of ground meat products purchased from retailers in California.

horse.meat.butcher.france.07It is illegal for horse meat to enter the food chain in the United States.

The presence of horse meat in the two samples was detected during a study undertaken by researchers in the Food Science Program at California’s Chapman University.

The discovery comes after the 2013 horse-meat scandal in Europe, which saw a range of ready-made meals pulled from supermarket freezers across the continent after beef was found to have been contaminated with horse meat.

The resulting international investigation revealed the complexities of the food chain and its vulnerability to rogue traders.

Researchers at Chapman University have just published two separate studies exploring meat mislabeling in consumer products. One focused on identification of the species found in ground meat products and the other investigated game meat species labeling.

Both studies examined products sold in the US commercial market; and both identified species mislabeling.

In the study on identification of species found in ground meat products, 48 samples were purchased from five online specialty meat distributors and four retail outlets (three supermarkets and one butcher) in Orange County, California. The samples represented 15 different meat types.

They were tested for the presence of beef, chicken, lamb, turkey, pork and horse using a combination of DNA barcoding and real-time polymerase chain reaction (PCR).

Thirty-eight of them were found to have been labeled correctly.

However, 10 were found to have been mislabeled. Of these, nine were found to contain additional meat species and one sample was mislabeled in its entirety. Horse meat was detected in two of the samples.

One of the samples containing horse was labeled as ground bison and the other as ground lamb meat.

Both had been purchased from two different online specialty meat distributors.

Almost 1800 sickened: It’s summer (up north), but beware the water

Outbreaks of illness associated with recreational water use result from exposure to chemicals or infectious pathogens in recreational water venues that are treated (e.g., pools and hot tubs or spas) or untreated (e.g., lakes and oceans).

caddyshackFor 2011–2012, the most recent years for which finalized data were available, public health officials from 32 states and Puerto Rico reported 90 recreational water–associated outbreaks to CDC’s Waterborne Disease and Outbreak Surveillance System (WBDOSS) via the National Outbreak Reporting System (NORS).

The 90 outbreaks resulted in at least 1,788 cases, 95 hospitalizations, and one death. Among 69 (77%) outbreaks associated with treated recreational water, 36 (52%) were caused by Cryptosporidium. Among 21 (23%) outbreaks associated with untreated recreational water, seven (33%) were caused by Escherichia coli (E. coli O157:H7 or E. coli O111). Guidance, such as the Model Aquatic Health Code (MAHC), for preventing and controlling recreational water–associated outbreaks can be optimized when informed by national outbreak and laboratory (e.g., molecular typing of Cryptosporidium) data.

A recreational water–associated outbreak is the occurrence of similar illnesses in two or more persons, epidemiologically linked by location and time of exposure to recreational water or recreational water–associated chemicals volatilized into the air surrounding the water. Public health officials in the 50 states, the District of Columbia, U.S. territories, and Freely Associated States* voluntarily report outbreaks of recreational water–associated illness to CDC. In 2010, waterborne outbreaks became nationally notifiable. This report summarizes data on recreational water–associated outbreaks electronically reported by October 30, 2014 to CDC’s WBDOSS (http://www.cdc.gov/healthywater/surveillance/) for 2011 and 2012 via NORS.† Data requested for each outbreak include the number of cases,§ hospitalizations, and deaths; etiology; setting (e.g., hotel) and venue (e.g., hot tub or spa) where the exposure occurred; earliest illness onset date; and illness type. All outbreaks are classified according to the strength of data implicating recreational water as the outbreak vehicle (1). ¶Outbreak reports classified as Class I have the strongest supporting epidemiologic, clinical laboratory and environmental health data, and those classified as Class IV, the weakest. Classification does not assess adequacy or completeness of investigations.** Negative binomial regression (PROC GENMOD in SAS 9.3 [Cary, NC]) was used to assess trends in the number of outbreaks over time.

For the years 2011 and 2012, public health officials from 32 states and Puerto Rico reported 90 recreational water–associated outbreaks (http://www.cdc.gov/healthywater/surveillance/rec-water-tables-figures.html) (Figure 1), which resulted in at least 1,788 cases, 95 (5%) hospitalizations, and one death. Etiology was confirmed for 73 (81%) outbreaks: 69 (77%) outbreaks were caused by infectious pathogens, including two outbreaks with multiple etiologies, and four (4%) by chemicals (Table). Among the outbreaks caused by infectious pathogens, 37 (54%) were caused by Cryptosporidium. On the basis of data reported to CDC, 37 (41%) of the 90 outbreak reports were categorized as class IV.

Outbreaks associated with treated recreational water accounted for 69 (77%) of the 90 outbreaks reported for 2011–2012, and resulted in at least 1,309 cases, 73 hospitalizations, and one reported death. The median number of cases reported for these outbreaks was seven (range: 2–144 cases). Hotels (e.g., hotel, motel, lodge, or inn) were the setting of 13 (19%) of the treated recreational water–associated outbreaks. Twelve (92%) of these 13 outbreaks started outside of June–August; ten (77%) were at least in part associated with a spa. Among the 69 outbreaks, 36 (52%) were caused by Cryptosporidium. The 69 outbreaks had a seasonal distribution, with 42 (61%) starting in June–August (Figure 1). Acute gastrointestinal illness was the disease manifestation in 34 (81%) of these summer outbreaks, with Cryptosporidium causing 32 (94%) of them. Since 1988, the year that the first U.S. treated recreational water–associated outbreak of cryptosporidiosis was detected (2,3) (Figure 2), the number of these outbreaks reported annually (range: 0–40 outbreaks) has significantly increased (negative binomial regression; p<0.001). Incidence of these cryptosporidiosis outbreaks has also, at least in part, driven the significant increase (negative binomial regression; p<0.001) in the overall number of recreational water–associated outbreaks reported annually (range: 6–84).

caddyshack.pool.poop-1For 2011–2012, 21 (23%) outbreaks were associated with untreated recreational water. These outbreaks resulted in at least 479 cases and 22 hospitalizations. The median number of cases reported for these outbreaks was 16 (range: 2–125). Twenty (95%) of these outbreaks were associated with fresh water; 18 (86%) began in June–August; and seven (33%) were caused by E. coli O157:H7 or O111. One outbreak associated with exposure to cyanobacterial toxins was reported.

Discussion

Cryptosporidium continues to be the dominant etiology of recreational water–associated outbreaks. Half of all treated recreational water–associated outbreaks reported for 2011–2012 were caused by Cryptosporidium. Among treated recreational water–associated outbreaks of gastrointestinal illness that began in June–August, >90% were caused by Cryptosporidium, an extremely chlorine-tolerant parasite that can survive in water at CDC-recommended chlorine levels (1–3 mg/L) and pH (7.2–7.8) for >10 days (4). In contrast, among 14 untreated recreational water–associated outbreaks of gastrointestinal illness starting in June–August, 7% (one) were caused by Cryptosporidium. The decreased diversity of infectious etiologies causing treated recreational water–associated outbreaks is likely a consequence of the aquatic sector’s reliance on halogen disinfection (e.g., chlorine or bromine) and maintenance of proper pH, which are well documented to inactivate most infectious pathogens within minutes (5). Continued reporting of treated recreational water–associated outbreaks caused by chlorine-intolerant pathogens (e.g., E. coli O157:H7 and norovirus) highlights the need for continued vigilance in maintaining water quality (i.e., disinfectant level and pH), as has been recommended for decades (5).

In the United States, codes regulating public treated recreational water venues are independently written and enforced by individual state or local agencies; the consequent variation in the codes is a potential barrier to preventing and controlling outbreaks associated with these venues. In August 2014, CDC released the first edition of MAHC (http://www.cdc.gov/mahc), a comprehensive set of science-based and best-practice recommendations to reduce risk for illness and injury at public, treated recreational water venues. MAHC represents the culmination of a 7-year, multi-stakeholder effort and is an evolving resource that addresses emerging public health threats, such as treated recreational water-associated outbreaks of cryptosporidiosis, by incorporating the latest scientifically validated technologies that inactivate or remove infectious pathogens. For example, MAHC recommends additional water treatment (e.g., ultraviolet light or ozone) to inactivate Cryptosporidium oocysts at venues where WBDOSS data indicate there is increased risk for transmission. MAHC recommendations can be voluntarily adopted, in part or as a whole, by state and local jurisdictions.

The number of reported untreated recreational water–associated outbreaks confirmed or suspected to be caused by cyanobacterial toxins has decreased, from 11 (2009–2010) to one (2011–2012) (6). This decrease is likely the result of a decrease in outbreak reporting rather than a true decrease in incidence. CDC is currently developing a mechanism for reporting algal bloom–associated individual cases through NORS to better characterize their epidemiology.

The findings in this report are subject to at least two limitations. First, the outbreak counts presented are likely an underestimate of actual incidence. Many factors can present barriers to the detection, investigation, and reporting of outbreaks: 1) mild illness; 2) small outbreak size; 3) long incubation periods; 4) wide geographic dispersion of ill swimmers; 5) transient nature of contamination; 6) setting or venue of outbreak exposure (e.g., residential backyard pool); and 7) potential lack of communication between those who respond to outbreaks of chemical etiology (e.g., hazardous materials personnel) and those who usually report outbreaks (e.g., infectious disease epidemiologists). Second, because of variation in public health capacity and reporting requirements across jurisdictions, those reporting outbreaks most frequently might not be those in which outbreaks most frequently occur.

Increasingly, molecular typing tools are being employed to understand the epidemiology of waterborne disease and outbreaks. Most species and genotypes of Cryptosporidium are morphologically indistinguishable from one another, and only molecular methods can distinguish species and subtypes and thereby elucidate transmission pathways (7,8). Systematic national genotyping and subtyping of Cryptosporidium in clinical specimens and environmental samples through CryptoNet (http://www.cdc.gov/parasites/crypto/cryptonet.html) can identify circulating Cryptosporidium species and subtypes and help identify epidemiologic linkages between reported cases. Molecular typing could substantially help elucidate cryptosporidiosis epidemiology in the United States and inform development of future guidance to prevent recreational water–associated and other outbreaks of cryptosporidiosis (9,10).

Acknowledgments

State, territorial, local, and Freely Associated State waterborne disease coordinators, epidemiologists, and environmental health personnel; Lihua Xiao, Sarah A. Collier, Kathleen E. Fullerton, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC.

1Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 2Environmental Protection Agency; 3Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.

Corresponding author: Michele C. Hlavsa, mhlavsa@cdc.gov, 404-71

Outbreaks of Illness Associated with Recreational Water — United States, 2011–2012

Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report

Michele C. Hlavsa, MPH; Virginia A. Roberts, MSPH; Amy M. Kahler, MS; Elizabeth D. Hilborn, DVM; Taryn R. Mecher, MPH; Michael J. Beach, PhD; Timothy J. Wade, PhD; Jonathan S. Yoder, MPH

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6424a4.htm?s_cid=mm6424a4_e

Reported foodborne outbreaks due to fresh produce: US vs EU

Consumption of fruit and vegetables is associated with a healthy lifestyle. Various international organizations, such as the World Health Organization, encourage the daily intake of at least 400 g of fruit and vegetables per day (excluding potatoes and other starchy tubers) for the prevention of chronic diseases, such as heart disease, cancer, diabetes, and obesity.

lettuce.skull.noroA large portion of this produce is consumed raw, and the number of foodborne outbreaks associated with these products has increased correspondingly. In this context, unpasteurized fruit juices and raw sprouts are also considered high-risk foods. The 2011 Escherichia coli O104:H4 outbreak from sprouted seeds in Germany gives a clear indication of the emerging relevance of the consumption of these products within food safety issues.

Globalization and growing international trade can also increase the risk, especially if produce comes from countries with lower safety standards. Nevertheless, nutrition educators and healthcare professionals believe that the benefits of eating fresh fruits and vegetables outweigh the risk of contracting a foodborne illness by consuming fresh produce.

The number of reported outbreaks (defined as the occurrence of two or more cases of similar illness resulting from the ingestion of a common food) reported both in the United States and European Union represents only a fraction of the actual number of outbreaks that occur.

Large outbreaks, outbreaks associated with food service and institutions, and outbreaks that have a longer duration or cause serious disease are more likely to be investigated and reported. Conversely, the data may not reflect what occurs in

sporadic cases. Moreover, there are differences in the sensitivity of the national or state systems in identifying and investigating foodborne outbreaks.

melon.berriesA wide spectrum of pathogens and food vehicles has been documented in produce-associated outbreaks. The occurrence of food-related infections due to fresh produce calls for better control interventions and the need for improved prevention strategies worldwide, since food can be contaminated at any point in the food chain, and interventions must be applied where appropriate at every step. Hence, the future success of global efforts to prevent produce-related outbreaks depends on the understanding of the key contributing factors and the maintenance of best practices to reduce and eliminate contamination.

Reported foodborne outbreaks due to fresh produce in the United States and European Union: trends and causes

Foodborne Pathogens and Disease. January 2015, 12(1): 32-38

Callejón Raquel M., Rodríguez-Naranjo M. Isabel, Ubeda Cristina, Hornedo-Ortega Ruth, Garcia-Parrilla M. Carmen, and Troncoso Ana M.

http://online.liebertpub.com/doi/abs/10.1089/fpd.2014.1821#utm_source=ETOC&utm_medium=email&utm_campaign=fpd

Abstract

The consumption of fruit and vegetables continues to rise in the United States and European Union due to healthy lifestyle recommendations. Meanwhile, the rate of foodborne illness caused by the consumption of these products remains high in both regions, representing a significant public health and financial issue. This study addresses the occurrence of reported foodborne outbreaks associated with fresh fruits and vegetables consumption in the United States and European Union during the period 2004–2012, where data are available. Special attention is paid to those pathogens responsible for these outbreaks, the mechanisms of contamination, and the fresh produce vehicles involved. Norovirus is shown to be responsible for most of the produce-related outbreaks, followed by Salmonella. Norovirus is mainly linked with the consumption of salad in the United States and of berries in the European Union, as demonstrated by the Multiple Correspondence Analysis (MCA). Salmonella was the leading cause of multistate produce outbreaks in the United States and was the pathogen involved in the majority of sprouts-associated outbreaks. As is reflected in the MCA, the pattern of fresh produce outbreaks differed in the United States and European Union by the type of microorganism and the food vehicle involved.

produce.vehicle.us.jan.15

 

 

 

 

 

 

 

produce.vehicle.eu.jan.15