This article is the second in a series of several by members of the Committee on the Control of Foodborne Illness of the International Association of Food Protection, and it continues the analysis of 816 outbreaks where food workers were implicated in the spread of foodborne disease. In this article, we discuss case morbidity and mortality and the settings where the 816 outbreaks occurred. Some of the outbreaks were very large; 11 involved more than 1,000 persons, 4 with more than 3,000 ill. The larger outbreaks tended to be extended over several days with a continuing source of infections, such as at festivals, resorts, and community events, or the contaminated product had been shipped to a large number of customers, e.g., icing on cakes or exported raspberries. There were five outbreaks with more than 100 persons hospitalized, with rates ranging from 9.9 to 100%. However, overall, the hospitalization rate was low (1.4%), and deaths were rare (0.11% of the 80,682 cases). Many of the deaths were associated with high-risk persons (i.e., those who had underlying diseases, malnutrition, or both, as in a refugee camp, or young children), but a few occurred with apparently healthy adults. An analysis of the settings for the food worker-related events showed that most of the outbreaks came from food service facilities (376 outbreaks [46.1%]), followed by catered events (126 outbreaks [15.4%]), the home (83 outbreaks [10.2%]), schools and day care centers (49 [6.0%]), and health care institutions (43 outbreaks [5.3%]). However, many cases resulted from relatively few outbreaks (30 each) associated with community events (9,726), processing plants (8,580), mobile/temporary service (5,367), and camps/ armed forces (5,117). The single most frequently reported setting was restaurants, with 324 outbreaks and 16,938 cases. Improper hygienic practices in homes, on picnics, or at community events accounted for 89 of the 816 outbreaks. There were 18 outbreaks associated with commercial travel in air flights, trains, and cruise ships over several decades, although only the last seems to be a major concern today. Sixteen outbreaks occurred where food, primarily produce, was harvested and shipped from one country to another. Sometimes the presence of an infected worker preparing food was only one of several factors contributing to the outbreak.
This article is the second in a series of several reviewing the role of food workers in foodborne outbreaks. The rationale for concern over foodborne outbreaks arising from workers infected with agents such as norovirus, hepatitis A virus (HAV), Salmonella, and Shigella has previously been presented (32). These data show that there have been increasing numbers of outbreaks during the past two decades over previous years. There may also be increased opportunities for infections to spread through trade of food and travel to other countries. This article presents and discusses data on some of the largest outbreaks, the numbers of hospitalized persons and deaths, and the different settings of food service establishments, including commercial travel where these outbreaks occurred.
A description of the database of the 816 outbreaks implicating food workers and the criteria used for collecting and collating are described in Greig et al. (32).
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