title: Epidemiologic profiling: evaluating foodborne outbreaks for which no pathogen was isolated by routine laboratory testing: United States, 1982-9.
abstract: The objective was to evaluate foodborne outbreaks of undetermined aetiology by comparing them to pathogen-specific epidemiologic profiles of laboratory-confirmed foodborne outbreaks. National foodborne outbreak data reported to CDC during 1982-9 were categorized by clinico-epidemiologic profiles based on incubation, duration, percent vomiting, fever and vomiting to fever ratio. From the pathogen-specific profiles, five syndromes were developed: a vomiting-toxin syndrome resembling Bacillus cereus and Staphylococcus aureus; a diarrhoea-toxin syndrome characteristic of Clostridium perfringens, a diarrhaeogenic Escherichia coli syndrome, a Norwalk-like virus syndrome, and a salmonella like syndrome. Of 712 outbreaks, 624 (87.6%) matched one of five syndromes; 340 (47.8%) matched the Norwalk-like syndrome and 83 (11.7%) matched the salmonella-like syndrome. After combining information on known pathogens and epidemiologic profiles, only 88 (12.4%) outbreaks remained unclassified. Norwalk-like virus outbreaks appear as common as salmonella-like outbreaks. We conclude that profiling can help classify outbreaks, guide investigations and direct laboratory testing to help detect new and emerging pathogens.
authors.affiliation: Minnesota Department of Health, Minneapolis, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Hall
authors.forename: J S
authors.initials: JS
authors.lastname: Goulding
authors.forename: N H
authors.initials: NH
authors.lastname: Bean
authors.forename: R V
authors.initials: RV
authors.lastname: Tauxe
authors.forename: C W
authors.initials: CW
authors.lastname: Hedberg
mesh_terms: D000465:Algorithms; D004196:Disease Outbreaks / Q000145:classification*; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology; D006801:Humans; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology