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Desmoteric Foodborne Outbreaks in the United States, 1974-1991

Paul R. Cieslak, MD; Michael B. Curtis, MD; Denis M. Coulombier, MD, MPH; A. Leroy Hathcock, PhD; Nancy H. Bean, PhD; Robert V. Tauxe, MD, MPH

Arch Intern Med. 1996;156(16):1883-1888.

Abstract
Background
Various disease outbreaks have been reported among prisoners. Recent foodborne outbreaks in correctional facilities in Georgia and Delaware prompted us to review the epidemiological characteristics of such outbreaks reported in the United States.

Methods
Foodborne outbreaks reported to the Centers for Disease Control and Prevention as part of routine surveillance from 1974 to 1991 were examined to identify outbreaks in jails, prisons, correctional facilities, and juvenile detention centers. Outbreak sizes, temporal trends, food vehicles, pathogens, and hygienic transgressions were analyzed.

Results
Eighty-eight desmoteric foodborne outbreaks involving 14 307 cases of illness were reported from 31 states and territories. The mean outbreak size was 163 cases, compared with a mean of 31 cases for the 9107 reported outbreaks not involving prisoners. No fatalities among prisoners were reported. No pathogen was identified in 47 (53%) of the 88 outbreaks. Salmonella species accounted for 15 (37%) of 41 outbreaks of known cause from 1974 to 1991, Clostridium perfringens for 14 (34%), and Staphylococcus aureus for 9 (22%). Fourteen of 15 Salmonella outbreaks occurred from 1984 to 1991. Food vehicles were reported for 63 (72%) of the out-breaks. Beef and poultry each were implicated in 9 (14%) of these, followed by fish or poultry salads and Mexican food, which accounted for 6 outbreaks (10%). Food-handling errors were reported for 69 (78%) of the 88 out-breaks. Improper food storage was reported in 62 (90%) of these.

Conclusions
Foodborne outbreaks are reported regularly from correctional facilities in the United States. Out-breaks caused by Salmonella species, a special threat to prisoners with human immunodeficiency virus infection, seem to be increasing. Food production in correctional facilities should meet minimum safety standards, including sufficient refrigeration facilities, training of food handlers, and exemption of ill food handlers from work.

Arch Intern Med. 1996;156:1883-1888

Author Affiliations
From the Foodborne and Diarrheal Diseases Branch (Drs Cieslak, Tauxe, and Curtis) and the Biostatistics and Information Management Branch (Dr Bean), Division of Bacterial and Mycotic Diseases, and the Division of Field Epidemiology, Epidemiology Program Office (Dr Coulombier), Centers for Disease Control and Prevention, Atlanta, Ga; and the Delaware Division of Public Health, Dover (Dr Hathcock).

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