Foodborne Illness Outbreaks at Retail Food Establishments ... - CDC

Results

During 2017–2019, a total of 800 foodborne illness outbreaks associated with 875 retail food establishments were reported to NEARS by the 25 participating state and local health departments. Among the 800 outbreaks, 216 (27.0%) occurred in 2017, 306 (38.3%) in 2018, and 278 (34.8%) in 2019. Of these outbreaks, 725 (90.6%) involved one establishment and 75 (9.4%) involved multiple establishments. Twenty-eight (3.5%) were multistate outbreaks. Investigators conducted an interview with a manager in 679 (84.9%) outbreaks.

Outbreak Characteristics

Investigations identified an etiologic agent in 555 (69.4%) outbreaks. Of these agents, 157 (28.3%) were suspected and 398 (71.7%) were confirmed. A majority of identified agents were viral (48.1%) and bacterial (46.8%); parasitic (2.3%) and toxic or chemical (2.5%) agents accounted for the remainder. The most common agent was norovirus, accounting for 47.0% (65.1% of which were laboratory confirmed), followed by Salmonella, accounting for 18.6% (87.4% of which were laboratory confirmed) (Table 1).

Investigators identified at least one contributing factor in 500 (62.5%) outbreaks. Outbreaks can have more than one contributing factor, and 819 contributing factors were identified altogether. Of the 500 outbreaks with an identified contributing factor, 426 (85.2%) had at least one contamination factor, 129 (25.8%) had at least one proliferation factor (i.e., conditions allowed pathogens in food to grow), and 71 (14.2%) had at least one survival factor (i.e., pathogens survived processes designed to kill or reduce their numbers) (Table 2).

The top five contributing factors to foodborne illness outbreaks were all contamination related (Box 2). The most common contributing factor was other mode of contamination (excluding cross-contamination) by a worker who was suspected to have an infectious illness (104 [20.8%]). Other sources of contamination included contaminated raw food (88 [17.6%]), bare-hand contact with ready-to-eat (RTE) food by a food worker suspected to have an infectious illness (72 [14.4%]), cross-contamination of ingredients (68 [13.6%]), and other unspecified source of contamination (62 [12.4%]) (Table 2). Contributing factors associated with ill workers (i.e., bare-hand contact with RTE food, gloved-hand contact with RTE food, and other contamination by workers suspected of having an infectious illness) were identified in 205 (41.0%) outbreaks. The most common proliferation contributing factor was improper or slow cooling of hot food (53 [10.6%]), and the most common survival contributing factor was insufficient time or temperature during cooking or heat processing (33 [6.6%]).

Outbreak Establishment Characteristics

A majority of establishments with outbreaks were independently owned (473 of 725 [65.2%]) and served ≤300 meals (upper range = 8,500 meals) daily (440 of 725 [60.7%]) (Table 3). Most were restaurants (712 of 875 [81.4%]), and 84.0% (735 of 875) served complex food items. Complex food items require a kill step (i.e., a process, such as cooking, that reduces or eliminates foodborne illness pathogens) and holding beyond same-day service, or a kill step and a combination of holding, cooling, reheating, and freezing. The most common menu type was American (485 of 875 [55.4%]). A majority (624 of 875 [71.3%]) of establishments received at least one critical violation on their last routine inspection before the outbreak.

Outbreak Establishment Policies

Most managers interviewed (665 of 725 [91.7%]) said their establishment had a policy requiring food workers to notify their manager when they were ill, and the policy was written (439 of 665 [66.0%]) (Table 4). Approximately 75% (504 of 665 [75.8%]) had policies that required ill food workers to tell managers their symptoms; 452 (68.0%) specified vomiting or diarrhea (each) as symptoms workers needed to tell managers about. Fewer policies mentioned sore throat with fever (328 [49.3%]), lesion with pus (265 [39.8%]), and jaundice (182 [27.4%]). Only 23.0% (153) of policies listed all five symptoms workers needed to tell managers about.

Of the managers interviewed, most (620 of 725 [85.5%]) said that their establishment also had a policy restricting or excluding ill food workers from working, and these policies were written (387 of 620 [62.4%) (Table 5). A majority (431 of 620 [69.5%]) said these policies specified symptoms that would prompt restriction or exclusion. Nearly two thirds of policies specifically mentioned vomiting (406 [65.5%]) and diarrhea (410 [66.1%]) as symptoms that would require restriction or exclusion. Fewer policies mentioned sore throat with fever (283 [45.6%]), lesion with pus (231 [37.3%]), and jaundice (165 [26.6%]). Only 17.8% (129) of policies listed all five symptoms that would require restriction or exclusion.

Only 16.1% (117 of 725) of establishments had policies that included the four recommendations of the FDA Food Code that were assessed. These recommendations were to have a policy that required workers to tell a manager when they are ill, a policy that specified all five symptoms workers need to tell a manager about, a policy that restricted or excluded ill or infectious workers from working, and a policy that specified all five symptoms requiring restriction or exclusion. Fewer than half (316 of 725 [43.6%]) of managers said their establishments provided paid sick leave to any workers.

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