title: Multistate outbreak of Salmonella serotype Typhimurium infections associated with consumption of restaurant tomatoes, USA, 2006: hypothesis generation through case exposures in multiple restaurant clusters.
abstract: Multiple salmonellosis outbreaks have been linked to contaminated tomatoes. We investigated a multistate outbreak of Salmonella Typhimurium infections among 190 cases. For hypothesis generation, review of patients' food histories from four restaurant-associated clusters in four states revealed that large tomatoes were the only common food consumed by patients. Two case-control studies were conducted to identify food exposures associated with infections. In a study conducted in nine states illness was significantly associated with eating raw, large, round tomatoes in a restaurant [matched odds ratio (mOR) 3·1, 95% confidence interval (CI) 1·3-7·3]. In a Minnesota study, illness was associated with tomatoes eaten at a restaurant (OR 6·3, mid-P 95% CI 1·05-50·4, P=0·046). State, local and federal regulatory officials traced the source of tomatoes to Ohio tomato fields, a growing area not previously identified in past tomato-associated outbreaks. Because tomatoes are commonly eaten raw, prevention of tomato contamination should include interventions on the farm, during packing, and at restaurants.
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA. CBartonBehravesh@cdc.gov
authors.forename: C Barton
authors.initials: CB
authors.lastname: Behravesh
authors.forename: D
authors.initials: D
authors.lastname: Blaney
authors.forename: C
authors.initials: C
authors.lastname: Medus
authors.forename: S A
authors.initials: SA
authors.lastname: Bidol
authors.forename: Q
authors.initials: Q
authors.lastname: Phan
authors.forename: S
authors.initials: S
authors.lastname: Soliva
authors.forename: E R
authors.initials: ER
authors.lastname: Daly
authors.forename: K
authors.initials: K
authors.lastname: Smith
authors.forename: B
authors.initials: B
authors.lastname: Miller
authors.forename: T
authors.initials: T
authors.lastname: Taylor
authors.forename: T
authors.initials: T
authors.lastname: Nguyen
authors.forename: C
authors.initials: C
authors.lastname: Perry
authors.forename: T A
authors.initials: TA
authors.lastname: Hill
authors.forename: N
authors.initials: N
authors.lastname: Fogg
authors.forename: A
authors.initials: A
authors.lastname: Kleiza
authors.forename: D
authors.initials: D
authors.lastname: Moorhead
authors.forename: S
authors.initials: S
authors.lastname: Al-Khaldi
authors.forename: C
authors.initials: C
authors.lastname: Braden
authors.forename: M F
authors.initials: MF
authors.lastname: Lynch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016358:Contact Tracing; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005516:Food Microbiology; D006801:Humans; D016015:Logistic Models; D018551:Solanum lycopersicum / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012147:Restaurants; D012478:Salmonella Food Poisoning / Q000453:epidemiology* / Q000382:microbiology; D012486:Salmonella typhimurium / Q000302:isolation & purification*; D014481:United States / Q000453:epidemiology; D055815:Young Adult