ABSTRACT

Foodborne disease outbreaks perhaps occur more frequently than as perceived by the public, because most investigative reports do not reach the press. Only when there is a highly publicized outbreak does the consumer get concerned; recent examples are those involving spinach (Escherichia coli O157:H7, 2006), pot pies (Salmonella I 4,5,12:i−, 2007), peanut butter (Salmonella Typhimurium, 2008-2009), salami products made with contaminated imported black and red pepper (Salmonella Montevideo, 2009-2010), eggs (Salmonella Enteritidis [SE], 2010), cantaloupes (Listeria monocytogenes, 2011), probably fenugreek seeds (E. coli O104:H4, 2011), and chicken (SE, 2013) (Todd et al., 2007a; MMWR, 2010; Buchholz et al., 2011; Chattaway et  al., 2011; CDC, 2014). Yet, these examples primarily involve food production operations, not restaurants or catering establishments. Also, the public tends to blame the last establishment they ate in for their gastrointestinal upsets (which may not even be food related), with little grasp of the importance of incubation period, types of symptoms and their severity, and duration of illness. Outbreaks do occur from foodservice facilities, and these are some of the most frequent settings, and some outbreak investigations are worth exploring in more detail to nd

14.1 Introduction .................................................................................................. 313 14.2 Outbreak No. 1: Restaurant Salmonella Enteritidis Outbreak Associated

with an Asymptomatic Infected Food Worker ............................................. 314 14.3 Outbreak No. 2: Epidemiology of an Unusually Prolonged Outbreak of

Typhoid Fever in Terrassa, Spain.................................................................. 317 14.4 Outbreak No. 3: Outbreak of Staphylococcal Food Poisoning due

to SEA-Producing Staphylococcus aureus ................................................... 320 14.5 Outbreak No. 4: Enteroaggregative Escherichia coli Associated with a

Foodborne Outbreak of Gastroenteritis ........................................................ 325 14.6 Outbreak No. 5: Norovirus Outbreaks in Michigan, 2005 and 2006 ........... 330 14.7 Conclusion .................................................................................................... 336 References .............................................................................................................. 336

out useful information on what went wrong and how the investigation proceeded to identify the cause and source of the contamination. Needless to say, each outbreak is different, but there are often striking similarities with a human dimension: the major one or more errors committed by foodservice managers or their employees. This chapter reviews the epidemiological investigation and ndings of ve foodborne disease outbreaks, each caused by a different microbiological pathogen (S. Enteritidis, Salmonella Typhi, Staphylococcus aureus, enteroaggregative Escherichia coli, and norovirus [NoV]). In this chapter covering ve outbreaks, the location, type of foodservice facility, number of cases, symptoms experienced, hospitalizations, and implicated foods are examined. In cases where the investigation was intensive, trace-back approaches to the sources of contamination and factors contributing to the outbreaks are discussed. Most outbreaks are self-limiting, but in some cases, effective outbreak management is able to prevent further cases and limit food contamination to prevent future outbreaks.