Fresh Produce: A Growing Cause of Outbreaks of Foodborne Illness in the United States, 1973 through 1997

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Fresh produce is an important part of a healthy diet. During the last three decades, the number of outbreaks caused by foodborne pathogens associated with fresh produce consumption reported to the Centers for Disease Control and Prevention has increased. To identify trends, we analyzed data for 1973 through 1997 from the Foodborne Outbreak Surveillance System. We defined a produce-associated outbreak as the occurrence of two or more cases of the same illness in which epidemiologic investigation implicated the same uncooked fruit, vegetable, salad, or juice. A total of 190 produce-associated outbreaks were reported, associated with 16,058 illnesses, 598 hospitalizations, and eight deaths. Produce-associated outbreaks accounted for an increasing proportion of all reported foodborne outbreaks with a known food item, rising from 0.7% in the 1970s to 6% in the 1990s. Among produce-associated outbreaks, the food items most frequently implicated included salad, lettuce, juice, melon, sprouts, and berries. Among 103 (54%) produce-associated outbreaks with a known pathogen, 62 (60%) were caused by bacterial pathogens, of which 30 (48%) were caused by Salmonella. During the study period, Cyclospora and Escherichia coli O157:H7 were newly recognized as causes of foodborne illness. Foodborne outbreaks associated with fresh produce in the United States have increased in absolute numbers and as a proportion of all reported foodborne outbreaks. Fruit and vegetables are major components of a healthy diet, but eating fresh uncooked produce is not risk free. Further efforts are needed to better understand the complex interactions between microbes and produce and the mechanisms by which contami-nation occurs from farm to table. During the last three decades, consumption of fresh fruits and vegetables in the United States has increased (80). Concomitantly, an increasing number of outbreaks caused by foodborne pathogens that were reported to the Centers for Disease Control and Prevention (CDC) has been associated with fresh produce consumption. This increase in outbreaks caused by produce consumption represents a shift from the vehicles traditionally associated with out-breaks of foodborne illness, generally foods of animal or-igin, such as eggs, meat, and dairy products (36). In this review, we describe the epidemiology of pro-duce-associated outbreaks of foodborne disease in the Unit-ed States that were reported to CDC from 1973 through 1997. These epidemiologic data, while limited because of the passive nature of surveillance and the inconsistent re-porting of factors contributing to outbreaks, suggest that additional control measures are needed to increase the safe-ty of fruits and vegetables.

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