title: Epidemiology of restaurant-associated foodborne disease outbreaks, United States, 1998-2013.
abstract: Although contamination of food can occur at any point from farm to table, restaurant food workers are a common source of foodborne illness. We describe the characteristics of restaurant-associated foodborne disease outbreaks and explore the role of food workers by analysing outbreaks associated with restaurants from 1998 to 2013 reported to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System. We identified 9788 restaurant-associated outbreaks. The median annual number of outbreaks was 620 (interquartile range 618-629). In 3072 outbreaks with a single confirmed aetiology reported, norovirus caused the largest number of outbreaks (1425, 46%). Of outbreaks with a single food reported and a confirmed aetiology, fish (254 outbreaks, 34%) was most commonly implicated, and these outbreaks were commonly caused by scombroid toxin (219 outbreaks, 86% of fish outbreaks). Most outbreaks (79%) occurred at sit-down establishments. The most commonly reported contributing factors were those related to food handling and preparation practices in the restaurant (2955 outbreaks, 61%). Food workers contributed to 2415 (25%) outbreaks. Knowledge of the foods, aetiologies, and contributing factors that result in foodborne disease restaurant outbreaks can help guide efforts to prevent foodborne illness.
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases,National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention,Atlanta, GA,USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Angelo
authors.affiliation: Division of Viral Diseases,National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Nisler
authors.affiliation: Division of Viral Diseases,National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Hall
authors.affiliation: Division of Emergency and Environmental Health Services,National Center for Environmental Health, Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors.forename: L G
authors.initials: LG
authors.lastname: Brown
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases,National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention,Atlanta, GA,USA.
authors.forename: L H
authors.initials: LH
authors.lastname: Gould
mesh_terms: D004196:Disease Outbreaks; D005506:Food Contamination; D005511:Food Handling; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D012147:Restaurants; D014481:United States / Q000453:epidemiology
keywords: Infectious disease epidemiology; outbreaks; public health