title: Outbreaks attributed to fresh leafy vegetables, United States, 1973-2012.
abstract: Leafy vegetables are an essential component of a healthy diet; however, they have been associated with high-profile outbreaks causing severe illnesses. We reviewed leafy vegetable-associated outbreaks reported to the Centers for Disease Control and Prevention between 1973 and 2012. During the study period, 606 leafy vegetable-associated outbreaks, with 20 003 associated illnesses, 1030 hospitalizations, and 19 deaths were reported. On average, leafy vegetable-associated outbreaks were larger than those attributed to other food types. The pathogens that most often caused leafy vegetable-associated outbreaks were norovirus (55% of outbreaks with confirmed aetiology), Shiga toxin-producing Escherichia coli (STEC) (18%), and Salmonella (11%). Most outbreaks were attributed to food prepared in a restaurant or catering facility (85%). An ill food worker was implicated as the source of contamination in 31% of outbreaks. Efforts by local, state, and federal agencies to control leafy vegetable contamination and outbreaks should span from the point of harvest to the point of preparation.
authors.affiliation: Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Herman
authors.affiliation: Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Hall
authors.affiliation: Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors.forename: L H
authors.initials: LH
authors.lastname: Gould
mesh_terms: D000818:Animals; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000382:microbiology / Q000821:virology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D006801:Humans; D010271:Parasites / Q000302:isolation & purification; D011528:Protozoan Infections / Q000453:epidemiology / Q000469:parasitology; D014481:United States / Q000453:epidemiology; D014675:Vegetables; D014777:Virus Diseases / Q000453:epidemiology / Q000821:virology; D014780:Viruses / Q000145:classification / Q000302:isolation & purification
keywords: Escherichia coli; Norwalk agent and related viruses; Salmonella; food poisoning; food safety; foodborne infections