Appendix VI
Prevention of Infectious Disease From Contaminated
Food Products1
Foodborne diseases are associated with significant morbidity and mortality in people of
all ages. The Centers for Disease Control and Prevention (CDC) estimates that there are
48 million cases of foodborne illness in the United States each year, resulting in approxi-
mately 128 000 hospitalizations and 3000 deaths.2,3 Young children, the elderly, and
immunocompromised people are especially susceptible to illnesses and complications
caused by many of the organisms associated with foodborne illness. Norovirus is the most
common cause of foodborne illness in the United States.
The Foodborne Disease Active Surveillance Network (FoodNet) of the CDC’s
Emerging Infections Program conducts active, population-based surveillance in 10 states
for all laboratory-confirmed infections with select enteric pathogens transmitted com-
monly through food. The FoodNet program conducts surveillance for illnesses attribut-
able to Campylobacter species, Listeria monocytogenes, Salmonella enterica, Shiga toxin-producing
Escherichia coli (STEC) O157:H7, Shigella species, Vibrio species, and Yersinia enterocolitica
(since 1996); Cryptosporidium species and Cyclospora species since 1997; and STEC non-
O157 since 2000. FoodNet also conducts surveillance for hemolytic-uremic syndrome
(HUS), a complication of STEC infection. Additional information about FoodNet can be
found at
Outbreak surveillance provides insights into the causes of foodborne illness, types
of implicated foods, and settings where transmission occurs. The CDC collects data on
foodborne disease outbreaks submitted from all states and territories (
foodsafety/fdoss/index.html). Public health, regulatory, and agricultural profes-
sionals can use this information when creating targeted control strategies and to support
efforts to promote safe food preparation practices among food industry employees and the
public. Data on foodborne disease outbreaks are available online through the Foodborne
Outbreak Online Database (
Four general rules should be followed to maintain safety of foods:
1. Clean: Wash hands and surfaces thoroughly and often.
2. Separate: Do not cross contaminate.
3. Chill: Refrigerate foods promptly.
4. Cook: Cook food to the proper temperature.
The following preventive measures can be implemented to decrease the risk of infec-
tion and disease from specific foods.
1 Centers for Disease Control and Prevention. Diagnosis and management of foodborne illnesses: a primer for
physicians. MMWR Recomm Rep. 2004;53(RR–4):1–33
2 Centers for Disease Control and Prevention. Surveillance for foodborne disease outbreaks—United States,
2008. MMWR Morb Mortal Wkly Rep. 2011;60(35):1197–1202
3 Centers for Disease Control and Prevention. Surveillance for foodborne disease outbreaks—United States,
1998-2008. MMWR Morb Mortal Wkly Rep. 2013;62(SS–2):1–34
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