title: Outbreaks of salmonellosis associated with eating uncooked tomatoes: implications for public health. The Investigation Team.
abstract: Laboratory-based surveillance of salmonella isolates serotyped at four state health departments (Illinois, Michigan, Minnesota and Wisconsin) led to the identification of multistate outbreaks of salmonella infections during 1990 (176 cases of S. javiana) and 1993 (100 cases of S. montevideo). Community-based case-control studies and product traceback implicated consumption of tomatoes from a single South Carolina tomato packer (Packer A) MOR 16.0; 95% CI2.1, 120.6; P < 0.0001 in 1990 and again in 1993 (MOR 5.7; 95 % CI 1.5, 21.9; P = 0.01) as the likely vehicle. Contamination likely occurred at the packing shed, where field grown tomatoes were dumped into a common water bath. These outbreaks represent part of a growing trend of large geographically dispersed outbreaks caused by sporadic or low-level contamination of widely distributed food items. Controlling contamination of agricultural commodities that are also ready-to-eat foods, particularly fruits and vegetables, presents a major challenge to industry, regulators and public health officials.
authors.affiliation: Minnesota Department of Health, Minneapolis 55414, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Hedberg
authors.forename: F J
authors.initials: FJ
authors.lastname: Angulo
authors.forename: K E
authors.initials: KE
authors.lastname: White
authors.forename: C W
authors.initials: CW
authors.lastname: Langkop
authors.forename: W L
authors.initials: WL
authors.lastname: Schell
authors.forename: M G
authors.initials: MG
authors.lastname: Stobierski
authors.forename: A
authors.initials: A
authors.lastname: Schuchat
authors.forename: J M
authors.initials: JM
authors.lastname: Besser
authors.forename: S
authors.initials: S
authors.lastname: Dietrich
authors.forename: L
authors.initials: L
authors.lastname: Helsel
authors.forename: P M
authors.initials: PM
authors.lastname: Griffin
authors.forename: J W
authors.initials: JW
authors.lastname: McFarland
authors.forename: M T
authors.initials: MT
authors.lastname: Osterholm
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D018551:Solanum lycopersicum / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D011634:Public Health / Q000379:methods; D012475:Salmonella / Q000302:isolation & purification*; D012478:Salmonella Food Poisoning / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology