U. S. Food and Drug Administration
Center for Food Safety and Applied Nutrition
September 30, 2001

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

Table of Contents

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

Pathogen	Year	Location	Produce Source	Venue	Type of Melon	No. of Cases	No. of Deaths	Isolated from Produce	Comments	Reference
Escherichia coli O157:H7	1993	Oregon	NRa	Restaurant	Cantaloupe	9	0	NR	Possible contamination of cantaloupe with organism from raw beef.	See Del Rosario and Beuchat 1995; Anonymous 1993
Norwalk virus	1987	United Kingdom	NR	NR	Melon	206	0	NR	Infected food handler.	See Lund and Snowdon 2000
Salmonella Chester	1989-90	Multistate, US	Mexico and Central America	Unknown	Cantaloupe	>245 ( 25,000 estimated)	2	No	Cut cantaloupe from salad bars.	see CDC 1991; see Lund and Snowdon 2000
S. Javiana	1991	Michigan	NA	Indoor picnic and in-school party	Watermelon	26 primary 13 secondary	0	Yes	Melon 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. Miami	1954	Massachusetts	Florida	Supermarket	Watermelon	17	1	Yes	Laboratory 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. Oranienburg	1979	Illinois	Illonois	Supermarket	Watermelon	18	0	No	Damaged fruits were cut, covered with plastic film, and displayed, sometimes without refrigeration until sold.	CDC 1979
S. Oranienburg	1998	Ontario, Canada	US, Mexico, or Central America	Various	Cantaloupe	22	0	No	Possible 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. Poona	1991	Multistate, US and Canada	Texas or Mexico	Unknown	Cantaloupe	> 400 confirmed US, 72 Canada	0	NR	Fruit salads containing sliced cantaloupes.	CDC 1991
S. Poona	2000	Multistate, US (8 states)	Mexico	Various	Cantaloupe				Case control study clearl implicated.	Farrar; pers comm; unreferenced
S. Saphra	1997	California	Mexico	Home, grocery stores, and restaurants	Cantaloupe	24	0	NR	Multiple 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
Salmonella	1950	Minnesota	NA	Roadside stand	Watermelon	6	0	Yes	Prepared cut melon. S. Bareilly isolated from melon. Melon kept at ambient temperature.	See Blostein 1993
Shigella sonnei	1987	Sweden	Morocco	Dinner party	Suspect watermelon	15	0	No	Melon 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

Pathogen	Year	Location	Produce Source	Venue	Type of Berry	No. of Cases	No. of Deaths	Isolated from Produce	Comments	Reference
Cyclospora cayetanensis	1995	Florida	Guatemala likely	Two social events	Raspberries likely	87	0	No	Raspberries from both events were purchased from separate sources. Two clusters reported.	Koumans and others 1998
C. cayetanensis	1996	20 US states and 2 Canadian provinces	Guatemala	Various	Raspberries	1465	0	No	Possible contamination due to fruit spraying with insecticides and fungicides mixed with contaminated water.	Herwaldt and Ackers 1997; Fleming and others 1998
C. cayetanensis	1997	Multistate, US and Ontario, Canada	Guatemala	Various	Raspberries	1012	0	No	Source of contamination unknown.	Herwaldt and Beach 1999; CDC 1997b
C. cayetanensis	1998	Ontario, Canada	Guatemala	Various	Raspberries	315	0	No	Source of contamination unknown.	CDC 1998c; Herwaldt 2000
C. cayetanensis	1999	Ontario, Canada	Guatamala likely	Banquet hall	Blackberries suspected	104	0	NRa	Source 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

Pathogen	Year	Location	Produce Source	Venue	Type of Berry	No. of Cases	No. of Deaths	Isolated from Produce	Comments	Reference
Calicivirus	1997	Quebec, Canada	Bosnia	2 separate events	Raspberries (frozen)	>200	0	NRa	Likely contamination occurred before shipping from Bosnia.	Gaulin and others 1999
Calicivirus	1998	Finland	Imported	Unknown	Raspberries (frozen)	> 500	0	NR	Source of contamination unknown.	See Lund and Snowdon 2000
Hepatitis A	1983	Scotland	Scotland	Hotel	Raspberries (frozen)	24	0	No	Suspected raspberry mousse prepared from frozen raspberries. Suggested contamination by infected picker(s).	Reid and Robinson 1987
Hepatitis A	1988	Scotland	Scotland	Home	Raspberries (frozen)	5	0	No	Raspberries from a small farm were frozen at home. Several pickers at the farm had symptoms of Hepatitis A.	Ramsay and Upton 1989
Hepatitis A	1990	Georgia Montana	California (1988)	School Institution for disabled	Strawberries (frozen)	15 (Georgia) 13 (Missouri) +29 secondary	0	No	Frozen 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 A	1997	Multistate US	Mexico	Schools	Strawberries (frozen)	242 + 14 suspect	0	No	Frozen 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

Pathogen	Year	Location	Seed Source	Type of Sprout	No. of Cases	No. of Deaths	Isolated from Sprouts/Seeds	Comments	Reference
Bacillus cereus	1973	Texas	Uganda (soy), Holland (cress), and Denmark (mustard)	Soy, mustard, and cress	4	0	Yes/Yes	Sprouted from a home seed sprouting kit.	Portnoy and others 1976
Escherichia coli O157:H7	1996	Japan	NRa	Radish	6561 (101 with HUSb), 160 secondary cases	2	No/No	Contamination route unknown.	WHO, Weekly Epidemiological Record 1996a, 1996b
E. coli O157:H7	1997	Japan	NR	Radish	126	0	Yes/No	The 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:H7	1997	Michigan and Virginia	NR	Alfalfa	108	0	NR/NR	Sprouts were sprouted from same seed lot in both states.	CDC 1997d
E. coli O157:NM	1998	California	California and Nevada	Clover / Alfalfa	8	0	Yes/No	Sprouts 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 Bovismorbificans	1994	Sweden and Finland	Australia	Alfalfa	595	0	Yes/No	Contaminated seeds came from the same seed lot and importer.	Ponka and others 1995
S. Enteriditis	2000	Alberta and Saskatchewan, Canada	China	Alfalfa	8	0	NR/NR	Outbreaks occurred at 5 Vietnamese restaurants. Sprouts came from 2 growers who received seeds imported from China.	Farber 2000; personal communication; unreferenced
S. Enteriditis	2000	California	China	Mung	45	0	No/No	Cluster 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-Coast	1989	U.K.	The Netherlands	Cress	31	0	Yes/No	Contaminated seed and/or sprouter.	Feng 1997; Taormina and others 1999
S. Havana	1998	California and Arizona	NR	Alfalfa	14 (California) 4 (Arizona)	1	No/Yes	Sprouts 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 / Tennessee	1998	California	California	Alfalfa	34	0	Yes/Yes	Contaminated seeds were suspected.	Farrar; pers comm; unreferencd; Taormina and others 1999
S. Infantis and S. Anatum	1997	Kansas and Missouri	Unknown	Alfalfa	109	0	NR/NR	Seeds were believed to be contaminated.	Feng 1997; Taormina and others 1999
S. Mbandaka	1999	Oregon, California, Idaho, and Washington	California	Alfalfa	Appx. 68	0	Yes/Yes	Seeds 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. Meleagridis	1997	Canada	Unknown	Alfalfa	124	0	NR/NR	Sprouts were organically grown with no chlorine pre-soak.	See Feng 1997; Farber 2000; pers comm; unreferenced
S. Montevideo and S. Meleagridis	1996	California	California	Alfalfa	>500	1	Yes/No	The 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. Newport	1995	Denmark (probably US and Canada)	The Netherlands	Alfalfa	154	0	Yes/Yes	Seeds came from the same shipper as US/Canada outbreak (see below). Source of contamination unknown.	See Feng 1997; Farber 2000; personal communication; unreferenced
S. Newport	1995-96	British Columbia, Canada, Oregon (probably Georgia and Vermont) and Denmark	The Netherlands	Alfalfa	133	0	Yes/Yes	Organism isolated were indistinguishable form the Denmark outbreak (see above).	See Feng 1997; Taormina and others 1999
S. Paratyphi B var. Java	1999	Alberta, British Columbia, and Saskatchewan, Canada	Unknown	Alfalfa	46	0	NR/NR	Spouts were from the same brand or common seed source.	Farber 2000; personal communication; unreferenced
S. Saint-Paul	1988	U.K.	Thailand and Australia	Mung	143	0	Yes/Yes	Multiple 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	1988	Sweden	NR	Mung	148	0	Yes/NR	Probably 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. Senftenberg	1997-98	California	5 US states	Alfalfa and clover sprouts	52	0	Yes/No	Sprouts 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. Stanley	1995	Multistate, US, Canada and Finland	The Netherlands	Alfalfa	>272	0	No/No	Seeds came from the same sprouter. At least 4 seed lots involved. Possible contamination occurred prior to shipping.	Mahon and others 1997
S. Virchow	1988	U.K.	Thailand and Australia	Mung	7	0	Yes/NR	Probably from the same outbreak as S. Saint-Paul in UK.	O'Mahony and others 1990
Yersinia enterolitica	1982	Pennsylvania	Unknown	Bean sprouts	16	0	NR/NR	Bean 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

Pathogen	Year	Location	Fruit Source	Type of Juice	Venue	No. of Cases	No. of Deaths	Isolated from Juice	Comments	Reference
Crytosporidium parvum	1996	New York	New York	Apple	Small cider mill	20 confirmed, 11 suspected	0	NRa	No 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
Cryptosporidium	1993	Maine	Maine	Apple	School	160 primary and 53 secondary	0	Yes	Apples 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:H7	1991	Massachusetts	Massachusetts	Apple	Small cider mill	23 (4 HUS)	0	No	90% drops used in making juice. Apples were not washed or scrubbed. Cattle raised nearby.	Besser and others 1993
E. coli O157:H7	1996	Connecticut	Connecticut	Apple	Small cider mill	14 (3 HUS, 1 HUS+TTPc)	0	No	Some 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:H7	1996	Washington	Washington	Apple	Small cider mill	6	0	No	Cider was made for local church event from local orchard. Apples were washed.	See Farber 2000
E. coli O157:H7	1996	British Columbia, Canada, California, Colorado, and Washington	US	Apple	Retail	70 (14 HUS)	1	Yes	Phosphoric 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:H7	1998	Ontario, Canada	Ontario, Canada	Apple	Farm / Home	14	0	No	Cattle 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:H7	1999	Oklahoma	Oklahoma	Apple	-	7	0	NR	Drop apples used. Possible contamination from wild and domestic animal manure.	See Farber 2000
E. coli O157:H7 suspected	1980	Toronto, Ontario, Canada	Canada	Apple	Local market	14 HUSb	1	No	Juice purchased from a local market and fair. Juice tasted "bad" or "different".	Steele and others 1982
Enterotoxigenic E. coli	1992	India	India	Orange	Roadside vendor	6	0	Yes	Two roadside vendors selling fresh squeezed juice, one was 6 meters away form the garbage heap.	Singh and others 1995
Salmonella Enteriditis	2000	Multistate, US	California	Citrus	Retail and Food Service	14	0	No	Gallon sized containers of citrus juices were implicated in the outbreak.	Butler 2000
S. Gaminera, S. Hartford, and S. Rubislaw	1995	Florida	Florida	Orange	Retail	62 ill and 7 hospitalized	0	Yes	S. 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. Muenchen	1999	US and Canada	Mexico	Orange	Restaurant	207 confirmed, +91 suspected	1	Yes	Multiple 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. Typhi	1898	France	France	Apple	NR	NR	NR	NR	-
S. Typhi	1922	France	France	Apple	NR	23	0	NR	Non-potable water was used to wash apples.	Paquet 1923
S. Typhimurium	1974	New Jersey	New Jersey	Apple	Farm and small retail outlets	296	0	Yes	A 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. Typhimurium	1999	Australia	Australia	Orange	Retail	405	0	Yes	Salmonella 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

Pathogen	Year	Location	Produce	Type of Juice	Venue	No. of Cases	No. of Deaths	Isolated from Produce	Comments	Reference
Hepatitis A	1962	Missouri	Unknown	Orange (reconstituted)	Hospital	24	0	NR	The orange juice was prepared by subclinical Hepatitis A handler.	Eisenstein and others 1963
Salmonella Typhi, typhoid fever	1944	Ohio	Unknown	Orange (reconstituted)	Residential hotel	18	1	NR	Juice was handled by an asymptomatic food worker.	Duncan and others 1946
S. Typhi, typhoid fever	1989	New York	Unknown	Orange (reconstituted)	Resort hotel	46 confirmed 24 suspected	0	NR	An 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
Unknown	1965	California	Unknown	Orange (reconstituted)	Unknown	563	0	NRa	Possible 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

Pathogen	Year	Location	Produce Source	Venue	Type of Lettuce or Salad	No. of Cases	No. of Deaths	Isolated from Produce	Comments	Reference
Campylobacter jejuni	1984	British Columbia, Canada	NRa	University cafeteria	Salad	330	0	No	Possible cross contamination during food preparation and poor food storage practices. Salad appeared to initiate outbreak.	Allen 1985
C. jejuni	1996	Oklahoma	NR	Restaurant	Lettuce	14	0	NR	Probable cross contamination of lettuce with raw chicken juices.	CDC 1998b
Clostridium perfringens	1993	Ontario, Canada	Unknown	Wedding reception	Salad	48	0	No	Salad implicated but epidemiology weak.	Styliadis 1993
Cyclospora cayatenesis	1997	Florida	Possibly Peru	Restaurants cruise ship	Baby lettuce leaves (mesclun)	>91	0	NR	Possibly 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
Calicivirus	1992	Ontario, Canada	NR	Catered event	Salad	27	0	NR	Salad served at a potluck. Vegetables may have been improperly washed or cross contaminated by an infected food handler.	Todd 1998
Escherichia coli O157:H7	1995	Idaho	Unknown	Unknown	Lettuce (romaine)	21	0	NR	Possibly infected food handler.	CSPI 2000
E. coli O157:H7	1995	Maine	California	Scout camp	Lettuce (iceberg)	30	0	NR	Cross contamination with raw hamburger juice.	CSPI 2000
E. coliO157:H7	1995	Ontario, Canada	NR	Acute care hospital	Iceberg lettuce	23	0	NR	Outbreak occurred in an acute care hospital. Lettuce received was heavily spoiled.	Preston and others 1997
E.coli O157:H7	1995	Alberta, Canada	NR	Restaurant	Caesar salad	37	0	NR	-	Farber; pers comm; unrefcd
E.coli O157:H7	1995	Montana	Montana and Washington	Retail	Lettuce	70	0	No	Possible 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:H7	1996	Connecticut and Illinois	US	Various	Mesclun lettuce	49	0	Yes	The 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:H7	1998	California	NR	Restaurant	Salad	2	0	No		Griffin and Tauxe 1999
Giardia	1989	New Mexico	NR	Church dinner	Lettuce and onions	21	0	NR	Possible 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 A	1986	Florida	NR	Restaurant	Lettuce salad	103	0	No	The probable source for the outbreak was an infected foodhandler with poor hygiene practices. The lettuce was shredded with hands.	Lowry and others 1989
Hepatitis A	1988	Kentucky	US but possibly Mexico	Restaurants	Iceberg lettuce	202	0	No	Three restaurants received lettuce from the same produce distributor. Contamination suspected to have occurred before distribution.	Rosenblum and others 1990.
Shigella sonnei	1983	Texas	Arizona, California, New Mexico	University cafeteria	Lettuce	140	0	No	Two 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. sonnei	1986	Texas	Texas	Restaurants	Shredded lettuce	347	0	No	Implicated restaurants received shredded lettuce from one source. Possible contamination from food handler at the shredding facility.	Davis and others 1988
S. sonnei	1994	Norway, Sweden, and UK	Spain	Various	Lettuce (iceberg)	110 (Norway),8 (Sweden), NR (UK)	0	No	Fecal coliforms and Salmonella were detected in iceberg lettuce obtained from patient's homes.	Kapperud and others 1995
Vibrio cholerae	1970	Israel	NR	NR	Mixed vegetables	176	0	NR	Possible 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

Pathogen	Year	Location	Produce Source	Venue	Type of Produce	No. of Cases	No. of Deaths	Isolated from Produce	Comments	Reference
Clostridium botulinum (type A)	1987	Florida	NRa	Home	Cabbage salad	4	0	Yes	Preformed 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)	1989	New York	NR	Home	Chopped garlic in oil	3	0	Yes	Product 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)	1985	British Columbia, Canada	US	Restaurants	Chopped garlic in oil	37	0	Yes	The 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 parvum	1997	Washington	US	Restaurants	Green onions (inconclusive association)	54	0	No	Green 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 cayatenansis	1997	Multistate, US	US	Retail / Catered events	Basil	>308	0	Yes	Suspected fresh basil. Mode of contamination unknown.	CDC 1997b
Escherichia coli (enterotoxigenic)	1993	Rhode Island New Hampshire	US	Airline, hotel	Shredded carrots	47 121	0	NR	Possible contamination of carrots used in salads. Carrots used came from same state.	CDC 1994
E. coli O157:H7	1998	Indianapolis	NR	Restaurant	Coleslaw	33	0	Yes		Griffin and Tauxe 1999
E. coli O157:H7	1998	Wisconsin	NR	Catered event	Fruit salad	47 (3 HUS)	0	No		Griffin and Tauxe 1999
Giardia lamblia	1989	US	NR	NR	Lettuce, tomatoes, onions	21	NR	NR		See Nguyen-the and Carlin 2000
Hepatitis A	1971	Tennessee	Tennessee	Home	Raw watercress	129	0	No	Watercress 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 A	1994	Arkansas	NR	NR	Diced tomatoes	92	0	NR	Suspected contamination by food handler.	Lund and Snowdon 2000
Listeria monocytogenes	1979	Boston	NR	Hospitals	Raw tomatoes, lettuce and celery suspected	20	5	NR	Multiple 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. monocytogenes	1981	Nova Scotia, Canada	Nova Scotia, Canada	Various	Vegetable mix for coleslaw	41	17	Yes	Cabbage 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 virus	1982	Minnesota	NR	Hotel restaurant	Fruit salad, coleslaw, and tossed salad	233	0	NR	Outbreak 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 virus	1990	Hawaii	NR	Cruise ship	Fresh cut fruit	>217	0	NR	Possible contamination occurred during preparation. Fresh cut fruits included pineapple, papaya, watermelon, cantaloupe, and honeydew melon.	Herwaldt and others 1994
Salmonella Baildon	1998-99	Multistate, US	Florida	Various	Tomatoes	85	3	NR	Tomates traced to two packers in Florida. Possible field contamination by domesting or wild animals.	Susman 1999; Cummings 1999
S. Javiana	1990	Multistate, US	South Carolina	Various	Tomatoes	174	0	NR	Contamination of water bath used by packer.	See Tauxe 1997; See Beuchat 1996b
S. Montevideo	1993	Multistate, US	South Carolina	Various	Tomatoes	84	0	No	Contamination of water bath used by packer.	See Lund and Snowdon 2000; See Wei and others 1995; Tauxe 1997
S. Typhi	1998-99	US	Brazil	Unknown	Mamey	13	0	Unknown	Imported frozen mamey. Source of contamination not known.	See Lund and Snowdon, 2000
Shigella flexneri 6A	1994	Multistate, US	Mexico	Various	Green onions	72	0	ND	Possible contamination during harvest or packaging in Mexico.	Tauxe, 1997
S. sonnei	1998	Multistate, US and Canada	Mexico	Restaurants	Parsley	310	0	No	Municipal 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 cholerae	1970	Israel	NR	NR	Various raw vegetables	176	NR	NR	Contamination by irrigation and untreated waste water.	See Nguyen-the and Carlin, 2000
V. cholerae	1991	Peru	Peru	Various	Cabbage	Unknown	71	NR	Several 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

Pathogen	Year	Location	Venue	Type of Produce	No. of Cases	No. of Deaths	Isolated from Produce	Comments	Reference
Campylobacter jejuni	1984	British Columbia, Canada	University cafeteria	Salad	330	0	No	Possible cross contamination during food preparation and poor food storage practices. The salad appeared to initiate outbreak.	Allen 1985
C. jejuni	1996	Oklahoma	Restaurant	Lettuce	14	0	NRa	Probable cross contamination of lettuce with raw chicken juices.	CDC 1998b
Crytosporidium parvum	1997	Washington	Restaurants	Green onions (inconclusive association)	54	0	No	Green onions were not washed before delivery to the restaurant and not washed before serving to customers. Possible contamination by a food handler.	CDC 1998a
Calicivirus	1992	Ontario, Canada	Catered event	Salad	27	0	NR	Salad served at a potluck. Vegetables may have been improperly washed or cross contaminated by an infected food handler.	Todd 1998
Escherichia coli O157:H7	1993	Oregon	Restaurant	Cantaloupe	9	0	NR	Possible contamination of cantaloupe with organism from raw beef.	See Del Rosario and Beuchat 1995; Anonymous 1993
E. coli O157:H7	1995	Idaho	Unknown	Lettuce (romaine)	21	0	NR	Possibly contaminated by food handler.	CSPI 2000
E. coli O157:H7	1995	Maine	Scout camp	Lettuce (iceberg)	30	0	NR	Cross contamination with raw hamburger juice.	CSPI 2000
Giardia	1989	New Mexico	Church dinner	Lettuce and onions	21	0	NR	Possible 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 A	1986	Florida	Restaurant	Lettuce salad	103	0	No	The probable source for the outbreak was an infected food handler with poor hygiene practices. Lettuce was shredded by hand.	Lowry and others 1989
Hepatitis A	1994	Arkansas	Unknown	Diced tomatoes	92	0	Unknown	Suspected contamination by food handler.	Lund and Snowdon 2000
Norwalk virus	1987	United Kingdom	NR	Melon	206	0	NR	Infected food handler.	See Lund and Snowdon 2000
Norwalk virus	1990	Hawaii	Cruise ship	Fresh cut fruit	>217	0	NR	Possible 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

Pathogen	Year	Location	Produce Source	Venue	Type of Produce	No. of Cases	No. of Deaths	Isolated from Produce	Comments	Reference
Clostridium botulinum (type A)	1989	New York	NRa	Home	Chopped garlic in oil	3	0	Yes	Product 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)	1985	British Columbia, Canada	US	Restaurants	Chopped garlic in oil	37	0	Yes	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 restuarant.	Solomon and Kautter 1988
Salmonella Javiana	1991	Michigan	NA	Indoor picnic and in-school party	Watermelon	26 primary 13 secondary	0	Yes	Melon 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. Oranienburg	1979	Illinois	Illinois	Supermarket	Watermelon	18	0	No	Damaged fruits were cut, covered with plastic film, and displayed, sometimes without refrigeration until sold.	CDC 1979
S. Oranienburg	1998	Ontario, Canada	US, Mexico, or Central America	Various	Cantaloupe	22	0	No	Possible 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
Salmonella	1950	Minnesota	NR	Roadside stand	Watermelon	6	0	Yes	Prepared 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.

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