Appendix VII
Clinical Syndromes Associated With Foodborne Diseases1,2
Foodborne disease results from consumption of contaminated foods or beverages and
causes morbidity and mortality in children and adults. The epidemiology of foodborne
disease is complex and dynamic because of many pathogens, the variety of disease
manifestations, the increasing prevalence of immunocompromised children and adults,
dietary habits changes, and trends toward centralized food production and widespread
Consideration of a foodborne etiology is important in any patient with a gastrointes-
tinal tract illness and patients with certain acute neurologic findings. A detailed history is
invaluable, with important questions including time of onset and duration of symptoms,
history of recent travel or antimicrobial use, and presence of blood or mucus in stool.
To aid in diagnosis, foodborne disease syndromes have been categorized by incubation
period, duration, predominant symptoms, causative agent, and foods commonly associ-
ated with specific etiologic agents (food vehicles) (see Table 1, p 1009). Diagnosis can be
confirmed by laboratory testing of stool, vomitus, or blood, depending on the causative
agent. Sporadic (ie, non-outbreak associated) cases account for the majority of foodborne
illnesses. In localized outbreaks that affect individuals who shared a common meal, the
incubation period can be estimated. However, in more widely dispersed outbreaks and in
sporadic cases, the incubation period typically is unknown.
An outbreak should be considered when 2 or more people who have ingested the
same food develop an acute illness characterized by nausea, vomiting, diarrhea, or neuro-
logic signs or symptoms. If an outbreak is suspected, local or state public health officials
should be notified immediately so they can work with local health care professionals, coor-
dinate laboratory testing, and conduct epidemiologic investigations to potentially curtail
the outbreak.
1 Centers for Disease Control and Prevention. Surveillance for foodborne-disease outbreaks—United States,
2008. MMWR Morb Mortal Wkly Rep. 2011;60(35):1197–1202. Additional information can be found at and
2 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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