title: Multistate foodborne disease outbreaks associated with raw tomatoes, United States, 1990-2010: a recurring public health problem.
abstract: We examined multistate outbreaks attributed to raw tomatoes in the United States from 1990 to 2010. We summarized the demographic and epidemiological characteristics of 15 outbreaks resulting in 1959 illnesses, 384 hospitalizations, and three deaths. Most (80%) outbreaks were reported during 2000-2010; 73% occurred May-September. Outbreaks commonly affected adult (median age 34 years) women (median 58% of outbreak cases). All outbreaks were caused by Salmonella [serotypes Newport (n = 6 outbreaks), Braenderup (n = 2), Baildon, Enteritidis, Javiana, Montevideo, Thompson, Typhimurium (n = 1 each); multiple serotypes (n = 1)]. Red, round (69% of outbreaks), Roma (23%), and grape (8%) tomatoes were implicated. Most (93%) outbreaks were associated with tomatoes served predominantly in restaurants. However, traceback investigations suggested that contamination occurred on farms, at packinghouses, or at fresh-cut processing facilities. Government agencies, academia, trade associations, and the fresh tomato industry should consider further efforts to identify interventions to reduce contamination of tomatoes during production and processing.
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Bennett
authors.affiliation: University of Minnesota School of Public Health,Saint Paul,MN,USA.
authors.forename: K W
authors.initials: KW
authors.lastname: Littrell
authors.affiliation: Coordinated Outbreak Response and Evaluation Network,Food and Drug Administration,College Park,MD,USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Hill
authors.affiliation: Produce Safety Staff,Center for Food Safety and Applied Nutrition,Food and Drug Administration,College Park,MD,USA.
authors.forename: M
authors.initials: M
authors.lastname: Mahovic
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors.forename: C Barton
authors.initials: CB
authors.lastname: Behravesh
mesh_terms: D000328:Adult; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D018551:Solanum lycopersicum / Q000382:microbiology*; D008297:Male; D011634:Public Health; D012147:Restaurants; D012475:Salmonella / Q000145:classification / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology*; D012478:Salmonella Food Poisoning / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D014481:United States / Q000453:epidemiology
keywords: tomatoes