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Surveillance for Foodborne-Disease Outbreaks -- United States, 1988-1992

Nancy H. Bean, Ph.D Joy S. Goulding Christopher Lao Frederick J. Angulo, D.V.M., Ph.D. Division of Bacterial and Mycotic Diseases National Center for Infectious Diseases

Abstract Problem/Condition: Since 1973, CDC has maintained a collaborative surveillance program for collection and periodic reporting of data concerning the occurrence and causes of foodborne-disease outbreaks (FBDOs). Reporting Period Covered: This summary reviews data from January 1988 through December 1992. Description of System: The surveillance system reviews data concerning FBDOs

  • defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Before 1992, only one case of intoxication by chemical, marine toxin, or Clostridium botulinum toxin as a result of the ingestion of food was required to constitute an FBDO. Since 1992, two or more cases have been required. State and local public health departments have primary responsibility for the identifying and investigating FBDOs. State and territorial health departments report these outbreaks to CDC on a standard form. Results: During 1988-1992, a total of 2,423 outbreaks of foodborne disease were reported (451 in 1988, 505 in 1989, 532 in 1990, 528 in 1991, and 407 in 1992). These outbreaks caused a reported 77,373 persons to become ill. Among outbreaks for which the etiology was determined, bacterial pathogens caused the largest percentage of outbreaks (79%) and the largest percentage of cases (90%). Salmonella serotype Enteritidis accounted for the largest number of outbreaks, cases, and deaths; most of these outbreaks were attributed to eating undercooked, infected eggs. Chemical agents caused 14% of outbreaks and 2% of cases; parasites, 2% of outbreaks and 1% of cases; and viruses, 4% of outbreaks and 6% of cases. Interpretation: The number of FBDOs reported per year did not change substantially during the first 4 years but declined in 1992 as a result of the revised definition of an outbreak. During this reporting period, S. Enteritidis continued to be a major cause of morbidity and mortality. In addition, multistate outbreaks caused by contaminated produce and outbreaks caused by Escherichia coli O157:H7 became more prominent. Actions Taken: State and local public health departments investigate FBDOs. At the regional and national level, surveillance data provide an indication of the etiologic agents, vehicles of transmission, and contributing factors associated with FBDOs and help direct public health actions.

INTRODUCTION

The reporting of foodborne and waterborne diseases in the United States began greater than 50 years ago when state and territorial health officers, concerned about the high morbidity and mortality caused by typhoid fever and infantile diarrhea, recommended that cases of "enteric fever" be investigated and reported. The purpose of investigating and reporting these cases was to obtain information regarding the role of food, milk, and water in outbreaks of intestinal illness as the basis for public health action. Beginning in 1923, the Public Health Service published summaries of outbreaks of gastrointestinal illness attributed to milk. In 1938, it added summaries of outbreaks caused by all foods. These early surveillance efforts led to the enactment of important public health measures (e.g., the Model Milk Ordinance) that had a profound influence in decreasing the incidence of enteric diseases, particularly those transmitted by milk and water.

From 1951 through 1960, the National Office of Vital Statistics reviewed reports of outbreaks of foodborne illness and published annual summaries in Public Health Reports. In 1961, CDC -- then the Communicable Disease Center -- assumed responsibility for publishing reports concerning foodborne illness. During 1961-1965, CDC discontinued publication of annual reviews but reported pertinent statistics and detailed individual investigations in MMWR.

In 1966, the present system of surveillance of foodborne and waterborne diseases began with the incorporation of all reports of enteric-disease outbreaks attributed to microbial or chemical contamination of food or water into an annual summary. Since 1966, the quality of investigative reports has improved, primarily as a result of more active participation by state and federal agencies in the investigation of outbreaks. Since 1978, because of increasing interest and activity in waterborne-disease surveillance, waterborne- and foodborne-disease outbreaks (FBDOs) have been reported in separate annual summaries. A summary of FBDOs was published for the years 1983-1987 (1). The present report summarizes data for FBDOs reported to CDC from 1988 through 1992.

Foodborne-disease surveillance has traditionally served three purposes:

  • Disease prevention and control. A main prevention and control measure that results from surveillance of foodborne disease is early identification and removal of contaminated products from the commercial market. Other resulting prevention and control measures include both the correction of faulty food-preparation practices in food-service establishments and in the home and identification and appropriate treatment of human carriers of foodborne pathogens.

  • Knowledge of disease causation. The responsible pathogen is not identified in more than half the FBDOs reported to CDC. In many of these outbreaks, pathogens might not have been identified either because laboratory investigations were initiated too late or were incomplete. In other outbreaks, the responsible pathogen may not have been identified, even after a thorough laboratory investigation, either because it may not have been recognized as a cause of foodborne disease or because it could not be identified by available laboratory techniques. If, in the future, more thorough clinical, epidemiologic, and laboratory investigations are conducted, perhaps many of these pathogens will be identified and suitable measures for prevention and control will be instituted.

  • Administrative guidance. The information derived from investigations of FBDOs enables both assessment of trends in the prevalence of outbreaks caused by specific etiologic agents and in vehicles of disease transmission. Such information also helps identify common errors in food handling. The compilation and publication of this information enables state and local health departments and others involved in the implementation of food-protection programs to remain informed of the factors involved in FBDOs. Comprehensive surveillance should result in a greater awareness of the most important food-protection methods, the institution of better training programs, and more effective use of available resources.

METHODS Sources of Data for Foodborne-Disease Outbreaks

Outbreaks are reported to CDC on a standard reporting form (CDC Form 52.13, Investigation of a Foodborne Outbreak)(Appendix A). Most reports are received from state and local health departments; they also may be received from federal agencies (e.g., the U.S. Food and Drug Administration, the U.S. Department of Agriculture, and the U.S. Armed Forces) and occasionally from private physicians. Data on these report forms are reviewed at CDC to determine whether a specific food vehicle and etiologic agent for an outbreak have been confirmed (Appendix B). In some instances, questions concerning an etiology may be referred back to the reporting agency; otherwise, data are accepted as reported on the forms.

Limitations of the Surveillance System

FBDOs on cruise ships are not included in this surveillance system. Disease outbreaks also are not included if the food is eaten outside the United States, even if the illness occurs within the United States. Finally, FBDOs are not included in this surveillance system if the route of transmission from the contaminated food to the infected persons is indirect.

Many foods contain several ingredients, but only one food-vehicle category is chosen for categorizing each outbreak. Therefore, the reported number of outbreaks attributed to a particular food item may not include all the reported outbreaks caused by that item. For example, homemade ice cream containing milk and eggs is listed under "ice cream" rather than "milk" or "eggs." The category "Mexican food" includes vehicles made from beef, cheese, lettuce, and other ingredients.

Definition of Terms

An FBDO is defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Before 1992, three exceptions existed to this definition; only one case of botulism, marine-toxin intoxication, or chemical intoxication was required to constitute an FBDO if the etiology for that type of FBDO was confirmed. The definition was changed in 1992; currently, two or more cases are required to constitute an outbreak.

Outbreaks of known etiology are those for which laboratory evidence of a specific agent is obtained and specified criteria are met. Outbreaks of unknown etiology are those for which adequate laboratory evidence of the etiologic agent is not obtained. Outbreaks of unknown etiology are divided into four subgroups by incubation period of the illness: less than 1 hour (probable chemical poisoning), 1-7 hours (probable Staphylococcus aureus or Bacillus cereus food poisoning), 8-14 hours, and greater than or equal to 15 hours (other agents).

RESULTS

The results of this surveillance system are presented for each of the 5 years (1988-1992) as follows: outbreaks by state (Figure_1), (Figure_2), (Figure_3), (Figure_4), (Figure_5); outbreaks, cases, and deaths by etiology (Table_1), (Table_2), (Table_3), (Table_4), (Table_5); outbreaks by etiology and month of occurrence (Table_6), (Table_7), (Table_8), (Table_9), (Table_10); outbreaks by etiology and place where food was eaten (Table_11), (Table_12), (Table_13), (Table_14), (Table_15); outbreaks, cases, and deaths by vehicle of transmission (Table_16), (Table_17), (Table_18), (Table_19), (Table_20); outbreaks by etiology and vehicle of transmission (Table_21A), (Table_21B), (Table_21C), (Table_22A), (Table_22B), (Table_22C), (Table_23A), (Table_23B), (Table_23C), (Table_24A), (Table_24B), (Table_24C), (Table_25A), (Table_25B), (Table_25C); and outbreaks by etiology and contributing factors (Table_26), (Table_27), (Table_28), (Table_29), (Table_30).

For each of the years from 1988 through 1992, the most commonly reported food-preparation practice that contributed to foodborne disease concerned improper holding temperature; the second most commonly reported practice concerned poor personal hygiene of food handlers. Food obtained from an unsafe source was the least commonly reported factor for all 5 years. In most outbreaks caused by bacterial pathogens, the food was stored at improper holding temperatures. In outbreaks of trichinosis, the food was usually inadequately cooked. In outbreaks of ciguatoxin and mushroom poisoning, the food itself was unsafe, and illness was not related to improper handling or preparation.

1988

In 1988, 451 outbreaks involving 15,732 cases of foodborne diseases were reported to CDC. Reports were received from 44 states, the District of Columbia, and Puerto Rico (Figure_1). New York reported the largest number of outbreaks (106, including 17 from New York City). Washington reported the next largest number (45), followed by Illinois (37), Florida (24), Hawaii (22), Pennsylvania (21), and Wisconsin (20). The etiology was confirmed in 183 (41%) of the 451 outbreaks (Table_1).

Bacterial pathogens accounted for 139 outbreaks (7,156 cases). Salmonella caused most of the bacterial FBDOs (94 outbreaks, 2,987 cases) followed by Clostridium botulinum (20 outbreaks, 49 cases) and S. aureus (eight outbreaks, 245 cases). Salmonella serotype Enteritidis caused 44 (47%) of the 94 Salmonella outbreaks; eggs or foods containing eggs were implicated in 18 (64%) of the 28 S. Enteritidis outbreaks that had a known vehicle. Seven outbreaks (28 cases) of botulism occurred in Alaska and were associated with the preparation and storage of traditional foods of Alaskan Natives; one person died from botulism. A large outbreak of Shigella sonnei infections occurred among persons who ate a raw tofu salad at an outdoor music festival in Michigan; 3,175 persons became ill and 117 of these persons were hospitalized. A large number of volunteers handled the ingredients, and ill food handlers apparently contaminated the salad during preparation (2). An outbreak (120 cases) of Campylobacter jejuni infections was caused by drinking raw milk at a vacation Bible school in Kansas. Escherichia coli O157:H7 caused two outbreaks; one outbreak (54 cases) was caused by precooked meat patties served at a school cafeteria, and one (55 cases) was linked to roast beef served at a university banquet.

Chemical agents were responsible for 29 outbreaks (139 cases); scombrotoxin caused 16 of these 29 outbreaks (65 cases), and ciguatoxin caused four of them (eight cases). Tuna was implicated in 11 of the 16 scombrotoxin outbreaks. All three parasitic-disease outbreaks (34 cases) were caused by Trichinella spiralis; two were associated with meat obtained by hunting. All 12 viral-disease outbreaks (795 cases) were caused by hepatitis A. One hepatitis A outbreak (202 cases) occurred among restaurant patrons in Kentucky and was traced to iceberg lettuce contaminated before distribution (3). Another multistate hepatitis A outbreak (61 cases) was caused by eating raw oysters that apparently had been harvested illegally from an oyster bed in Florida that was contaminated by human feces (4).

Nineteen deaths from foodborne illness were reported; of these deaths, 14 were caused by Salmonella, three by hepatitis A, one by C. botulinum, and one by scombrotoxin. Nine of the deaths caused by Salmonella were attributed to S. Enteritidis, and seven of these deaths occurred in residents of nursing homes. The incubation period was reported for 211 (79%) of the 268 outbreaks that had an unknown etiology; in three outbreaks (1%) the incubation period was less than 1 hour; in 59 (28%), 1-7 hours; in 50 (24%), 8-14 hours; and in 99 (47%), greater than or equal to 15 hours.

1989

During 1989, 505 outbreaks involving 15,867 cases of foodborne diseases were reported to CDC. Reports were received from 38 states, Guam, and Puerto Rico (Figure_2). New York reported the largest number of outbreaks (141, including 14 from New York City). Hawaii reported the next largest number (40), followed by Illinois (37), Washington (29), and Wisconsin (28). The etiology was confirmed in 221 (44%) of the 505 outbreaks (Table_2).

Bacterial pathogens accounted for 171 outbreaks (6,557 cases). Salmonella caused most of the bacterial FBDOs (117 outbreaks, 4,920 cases) followed by S. aureus (14 outbreaks, 524 cases) and C. botulinum (13 outbreaks, 24 cases). S. Enteritidis caused 72 (62%) of the 117 Salmonella outbreaks; eggs or foods containing eggs were implicated in 18 (58%) of the 31 S. Enteritidis outbreaks that had a known vehicle. An outbreak in a nursing home in Maryland, caused by both S. Enteritidis and S. Schwarzengrund, resulted in 69 cases, 11 hospitalizations, and four deaths (5). A multistate outbreak (295 cases) of S. Chester infections was traced to cantaloupes imported from Mexico (6). A multistate outbreak (164 cases) of S. Javiana and S. Oranienberg infections was caused by mozzarella cheese that had been contaminated during shredding before it was distributed (7). A multistate outbreak of staphylococcal food poisoning was caused by canned mushrooms imported from China; 162 persons became ill, and 18 of these persons were hospitalized (8). In a restaurant in Missouri, an outbreak (101 cases) caused by Campylobacter apparently resulted from cross-contamination of cantaloupes, honeydew melons, and pineapples when poultry and fruit were sliced on the same surfaces. An outbreak (242 cases) caused by C. perfringens occurred at a Mother's Day brunch in a hotel in New York when a seafood salad was held at room temperature for many hours.

Chemical agents accounted for 37 outbreaks (153 cases); ciguatoxin caused 19 of these outbreaks (66 cases), and scombrotoxin caused 17 (80 cases). One scombrotoxin outbreak (28 cases) in a prison was caused by eating contaminated mackerel. Four parasitic-disease outbreaks (15 cases) were caused by T. spiralis and one by Giardia lamblia (21 cases). Seven of the eight viral-disease outbreaks (329 cases) were caused by hepatitis A, including an outbreak (192 cases) caused by an infected food handler in a fast-food restaurant in Washington.

Seventeen deaths from foodborne illness were reported: 14 from Salmonella, two from C. botulinum, and one from Listeria monocytogenes. Eleven of the deaths caused by Salmonella were attributed to S. Enteritidis, nine of these deaths occurred in residents of nursing homes. The incubation period was reported for 231 (81%) of the 284 outbreaks that had an unknown etiology; in eight outbreaks (3%) the incubation period was less than 1 hour; in 40 (17%), 1-7 hours; in 43 (19%), 8-14 hours; and in 140 (61%), greater than or equal to 15 hours.

1990

During 1990, 532 outbreaks involving 19,885 cases of foodborne diseases were reported to CDC. Reports were received from 45 states, the District of Columbia, Guam, and Puerto Rico (Figure_3). New York reported the largest number of outbreaks (87, including 14 from New York City). Illinois reported the next largest number of outbreaks (43), followed by Hawaii (39), Washington (33), and Ohio (29). The etiology was confirmed in 237 (45%) of the 532 outbreaks (Table_3).

Bacterial pathogens were responsible for 196 outbreaks (9,002 cases). Salmonella caused most of the bacterial FBDOs (136 outbreaks, 6,290 cases) followed by S. aureus (13 outbreaks, 372 cases) and C. botulinum (12 outbreaks, 22 cases). S. Enteritidis caused 80 (59%) of the 136 Salmonella outbreaks; eggs or foods containing eggs were implicated in 21 (68%) of the 31 S. Enteritidis outbreaks that had a known vehicle. Undercooked eggs in a bread-pudding dessert caused an outbreak of S. Enteritidis infections among conventioneers attending a banquet in an Illinois hotel; 1,100 persons became ill, and 147 of these persons were hospitalized. An outbreak of S. Agona infections among conventioneers attending a buffet catered by a South Carolina restaurant was caused by improperly handled turkey meat; 851 persons became ill and 18 of these persons were hospitalized. An outbreak of S. Montevideo infections apparently occurred when salad-bar ingredients were cross-contaminated by uncooked meat and poultry in a restaurant kitchen; 320 persons became ill, and eight of these persons were hospitalized. Four outbreaks involving 66 cases (20 hospitalizations) were caused by S. typhi; three of these outbreaks involved contamination of cold food items by infected food handlers (9). Improper food-handling practices resulted in two C. perfringens outbreaks; beef and chicken tacos were the vehicles in the outbreak (700 cases) in a Missouri prison, and prime rib was the vehicle in the outbreak (204 cases) in a Wisconsin restaurant. An outbreak (400 cases) of S. sonnei infections was associated with food prepared by an infected food handler at a Texas restaurant. An outbreak of Vibrio cholerae infections in Guam was caused by eating contaminated reef fish; 26 persons became ill, and one of these persons died.

Chemical agents accounted for 27 outbreaks (270 cases); of these 27 outbreaks, 11 were caused by scombrotoxin (194 cases), and 11 were caused by ciguatoxin (44 cases). One scombrotoxin outbreak, caused by tainted mahi-mahi, resulted in 148 cases. Two outbreaks (24 cases, one death) of paralytic shellfish poisoning were reported; one was caused by blue mussels from Rhode Island and the other by butter clams and mussels from Alaska (10). Five outbreaks of parasitic diseases were reported (234 cases); G. lamblia caused three of these outbreaks (129 cases), and T. spiralis caused two of them (105 cases). In one of the G. lamblia outbreaks, sliced raw vegetables prepared by an infected food handler were implicated (11). All nine viral-disease outbreaks (452 cases) were caused by hepatitis A; three deaths occurred. A multistate outbreak of hepatitis A (51 cases) was caused by frozen strawberries that were most likely contaminated by an infected employee before distribution (12).

Fifteen deaths from foodborne illness were reported; five from C. botulinum, three from hepatitis A, one from Salmonella, one from V. cholerae, one from V. vulnificus, one from paralytic shellfish poisoning, and three from an unknown etiology. The incubation period was reported for 241 (82%) of the 295 outbreaks that had an unknown etiology; in six outbreaks (2%) the incubation period was less than 1 hour; in 44 (18%), 1-7 hours; in 55 (23%), 8-14 hours; and in 136 (56%), greater than or equal to 15 hours.

1991

During 1991, 528 outbreaks involving 14,876 cases of foodborne disease were reported to CDC. Reports were received from 40 states, the District of Columbia, and Guam (Figure_4). New York reported the largest number of outbreaks (115, including 35 from New York City). Washington reported the next largest number (47), followed by Illinois (42), Hawaii (36), New Jersey (35), and Pennsylvania (32). The etiology was confirmed in 214 (41%) of the 528 outbreaks (Table_4).

Bacterial pathogens accounted for 173 outbreaks (6,335 cases). Salmonella caused most of the bacterial FBDOs (122 outbreaks, 4,146 cases), followed by C. botulinum (11 outbreaks, 25 cases) and C. perfringens (10 outbreaks, 1,213 cases). S. Enteritidis caused 73 (60%) of the 122 Salmonella outbreaks; eggs or foods containing eggs were implicated in 17 (50%) of the 34 S. Enteritidis outbreaks that had a known vehicle. Inadequately cooked bread stuffing containing pooled raw eggs caused an outbreak of S. Enteritidis infections in a New York prison; 393 persons became ill, and nine of these persons were hospitalized. An outbreak (673 cases) of S. Heidelberg infections was caused by tainted chicken and beef fajitas that had been improperly stored and cooked by a food vender at a festival in Connecticut. Two outbreaks of Salmonella were associated with eating contaminated melons; S. Poona (143 cases) infections were associated with eating cantaloupes (13), and S. Javiana (39 cases) infections were associated with eating watermelon. An outbreak (600 cases) of C. perfringens infections was caused by improperly handled turkey meat served at a Mother's Day brunch in a Wisconsin restaurant. Three outbreaks (33 cases) were caused by E. coli O157:H7; one of these outbreaks (23 cases) was associated with contaminated apple cider (14). Two outbreaks of V. cholerae were caused by tainted food imported into the United States; one outbreak (four cases) was associated with frozen coconut milk imported from Thailand (15), and the other outbreak (two cases) was attributed to crabs that had been imported illegally from Ecuador (16). An outbreak (100 cases) of Group A Streptococcus infections was apparently caused by an infected food handler.

Chemical agents caused 31 outbreaks (159 cases); scombrotoxin caused 17 of these outbreaks (40 cases), ciguatoxin caused seven (50 cases), and paralytic shellfish poisoning caused two (35 cases). Parasitic diseases caused three outbreaks (73 cases); G. lamblia caused two of these outbreaks (32 cases), and T. spiralis caused one of them (41 cases). All seven viral-disease outbreaks (114 cases) were caused by hepatitis A virus.

Ten deaths from foodborne illness were reported; five from Salmonella, two from C. botulinum, one from C. perfringens, one from paralytic shellfish poisoning, and one from an unknown etiology. Four of the Salmonella-associated deaths were caused by S. Enteritidis, and all were among residents of nursing homes. The incubation period was reported for 267 (85%) of the 314 outbreaks that had an unknown etiology; in 13 outbreaks (5%) the incubation period was less than 1 hour; in 67 (25%), 1-7 hours; in 60 (22%), 8-14 hours; and in 127 (48%), greater than or equal to 15 hours.

1992

During 1992, 407 outbreaks involving 11,015 cases of foodborne diseases were reported to CDC. Reports were received from 35 states and Puerto Rico (Figure_5). New York reported the largest number of outbreaks (122, including 28 from New York City). Washington reported the next largest number (49), followed by California (23), Maryland (20), and New Jersey (20). The etiology was confirmed in 146 (36%) of the 407 outbreaks (Table_5).

Bacterial pathogens accounted for 117 outbreaks (4,156 cases). Salmonella caused most of the bacterial FBDOs (80 outbreaks, 2,834 cases) followed by C. perfringens (12 outbreaks, 912 cases), S. aureus (six outbreaks, 206 cases), and Campylobacter (six outbreaks, 138 cases). S. Enteritidis caused 60 of the Salmonella outbreaks; eggs or foods containing eggs were implicated in 22 (88%) of the 25 S. Enteritidis outbreaks that had a known vehicle. Cross-contamination of cooked foods by uncooked, pooled eggs that were used for egg batter in a New York restaurant was associated with an outbreak of S. Enteritidis infection; 434 became ill, and seven of these persons were hospitalized. S. Enteritidis was the etiologic agent in four other outbreaks: one outbreak (191 cases) in a New Jersey prison was associated with banana pudding that contained undercooked eggs; two outbreaks (130 cases) -- one at a picnic in New York and one at a college in New Hampshire -- were associated with eating egg sandwiches; one outbreak (105 cases) at a convention in Vermont was associated with an unidentified food vehicle. Undercooked, pooled eggs in a rice pudding also resulted in an outbreak (113 cases) of S. Infantis infections in a state prison in Georgia. An outbreak of S. Typhimurium associated with homemade ice cream containing raw eggs resulted in 31 cases and one death. An outbreak of C. fetus in an Ohio nursing home apparently was caused by contaminated cottage cheese; 13 residents became ill, and two of these residents died. In five outbreaks, several persons were infected by C. perfringens as a result of holding food at improper temperatures for several hours. These outbreaks occurred at a New York nursing home (196 cases), a Wisconsin prison (160 cases), a catered church supper in Wisconsin (120 cases), a Washington school (115 cases), and a catered family gathering in Minnesota (100 cases). E. coli O157:H7 caused three outbreaks; one was associated with drinking raw milk from a dairy in Oregon (six cases) and two with vehicles that were not determined (13 cases).

Chemical agents were responsible for 19 outbreaks (206 cases); scombrotoxin caused 15 of these outbreaks (135 cases). Tuna was implicated in nine of the scombrotoxin outbreaks, including an outbreak (74 cases) involving greater than or equal to 20 states caused by tuna imported from Ecuador. The only parasitic-disease outbreak (two cases) was caused by G. lamblia. Eight viral-disease outbreaks (419 cases) were caused by hepatitis A; seven of these outbreaks, including an outbreak (230 cases) in a Wisconsin sandwich shop, were associated with infected food handlers. In several Minnesota schools, one viral-disease outbreak (250 cases) caused by a Norwalk-like virus was associated with contaminated hamburger buns and cookies that were prepared by ill food handlers at a bakery.

Eight deaths from foodborne-related illness were reported; four were caused by Salmonella, two by Campylobacter fetus, one by C. botulinum, and one by chemical intoxication (i.e., water-hemlock poisoning). Three of the deaths resulting from Salmonella infection were caused by S. Enteritidis and were among residents of nursing homes. The incubation period was reported for 203 (78%) of the 261 outbreaks that had an unknown etiology; in seven outbreaks (3%), this period was less than 1 hour; in 41 (20%), 1-7 hours; in 46 (23%), 8-14 hours; and in 109 (54%), greater than or equal to 15 hours.

DISCUSSION General Interpretation of Surveillance Data for Foodborne-Disease Outbreaks

The limitations concerning the quantity and quality of data presented in this report should be recognized. The number of FBDOs reported by this surveillance system represents only a small proportion of those that occur. The outbreaks reported also include only a fraction of the cases of foodborne disease that occur; an average of 15,475 cases (14 deaths) each year was reported by this surveillance system during 1988-1992, compared with a minimum estimate of 6 million cases per year (17). The likelihood of an outbreak being brought to the attention of health authorities depends on consumers' and physicians' awareness, their interest, their motivation to report the incident, and the disease-surveillance activities of state and local health and environmental agencies. For example, large outbreaks, interstate outbreaks, restaurant-associated outbreaks, and outbreaks involving serious illness, hospitalizations, or deaths are more likely to be brought to the attention of health authorities than are outbreaks of mild illness in a single family.

The quality of the data in this surveillance summary depends on the commitment to surveillance of foodborne diseases by state and local health departments, as well as other factors. A department's interest in foodborne disease and its investigative and laboratory capabilities are important determinants of the quality of any investigation. Furthermore, the likelihood that the findings of the investigation will be reported to CDC differs by the locality in which the outbreak occurs. Thus, this report should not be the basis of conclusions concerning the absolute incidence of foodborne disease or the relative incidence of foodborne diseases by specific causes. For example, foodborne diseases characterized by short incubation periods (e.g., those caused by a chemical agent or staphylococcal enterotoxin) are more likely to be recognized as common-source FBDOs than are those diseases that have longer incubation periods (e.g., hepatitis A). Outbreaks involving less commonly identified pathogens (e.g., B. cereus, E. coli, or G. lamblia) are less likely to be confirmed because these organisms are sometimes not considered in clinical, epidemiologic, and laboratory investigations of FBDOs. Also, pathogens that usually cause mild illness will be underrepresented, whereas those causing serious illness (e.g., C. botulinum) are more likely to be identified and reported. Similarly, outbreaks associated with restaurants or commercial products are more likely to be reported.

Foodborne-Disease Outbreaks During 1988-1992

The annual numbers for outbreaks reported during 1988-1992 ranged from 407 to 532. When the change in the outbreak definition in 1992 is considered, these numbers were comparable with those in other recent years. During this period, both multistate outbreaks caused by contaminated produce and outbreaks caused by E. coli O157:H7 became more prominent. In addition, unexpected vehicles of transmission (e.g., apple cider) were described. Several outbreaks also involved imported food items, which demonstrated the complexity of modern food production and distribution.

FBDOs on cruise ships are not included in this surveillance system (18). FBDOs also are not included if the food is eaten outside the United States, even if the illness occurs within the United States. For example, an outbreak (75 cases) of cholera occurred among persons who ate seafood salad during an airline flight from Peru to Los Angeles; although the onset of illness began after these persons arrived in California, the outbreak was not included in this report because the salad was eaten outside the United States (19). Finally, disease outbreaks are not included in this surveillance system if the route of transmission from the contaminated food to the infected persons is indirect. For example, although chitterlings (i.e., pig intestines) were ultimately established as the source of Yersinia enterocolitica infections for several infants in Georgia in 1988, these cases are not included in this report because the infants did not eat the chitterlings; the infants apparently became infected from person-to-person contact or from an item touched by a food preparer (20).

The etiology was not determined for 59% of the reported outbreaks. This percentage reflects the need for improved investigative skills so that known pathogens can be recognized more readily and new pathogens can be identified. Most of the outbreaks that had an unknown etiology had an incubation period greater than or equal to 15 hours, suggesting an infectious agent; many of these outbreaks may have had a viral etiology. Viruses are probably a much more important cause of disease than this report indicates. The capability of testing serum for antibody to viruses involved in FBDOs (e.g., Norwalk and Norwalk-like viruses) is not widely available and makes identification of such outbreaks difficult. Investigators have analyzed reports of FBDOs and have reported that as many as 35% of these outbreaks were probably caused by viruses (21).

The etiology was determined for 1,001 (41%) of the 2,423 outbreaks reported to CDC for 1988-1992; these outbreaks involved 36,890 cases. Of those outbreaks for which an etiology was determined, bacterial pathogens caused the largest percentage of outbreaks (79%) and cases (90%). Chemical agents caused 14% of outbreaks and 2% of cases; parasites, 2% of outbreaks and 1% of cases; and viruses, 4% of outbreaks and 6% of cases.

Salmonella caused 549 (69%) of the 796 bacterial FBDOs during 1988-1992; 60% of these 549 outbreaks were caused by S. Enteritidis. During this reporting period, an increasing number of Salmonella outbreaks were caused by S. Enteritidis (e.g., 47% in 1988 versus 75% in 1992). S. Enteritidis also was the most frequently reported cause of FBDOs during this period, accounting for 14% of all outbreaks and 33% of outbreaks for which an etiology was determined; most of these outbreaks for which a food vehicle could be determined were attributed to eating undercooked eggs. S. Enteritidis also resulted in more deaths (27) than any other pathogen; 23 (85%) of these deaths occurred among residents of nursing homes, which reflects the seriousness of S. Enteritidis infections in elderly persons, many of whom may be immunocompromised. Persons can decrease their risk for egg-associated infections caused by S. Enteritidis by not eating raw or undercooked eggs. Nursing homes, hospitals, and commercial kitchens only should use pasteurized egg products for all recipes requiring pooled or lightly cooked eggs (22).

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  12. Niu MT, Polish LB, Robertson BH, et al. Multistate outbreak of hepatitis A associated with frozen strawberries. J Infect Dis 1992;166:518-24.

  13. CDC. Multistate outbreak of Salmonella poona infections -- United States and Canada, 1991. MMWR 1991;40:549-52.

  14. Besser RE, Lett SM, Weber JT, et al. An outbreak of diarrhea and hemolytic uremic syndrome from Escherichia coli O157:H7 in fresh-pressed apple cider. JAMA 1993;269:2217-20.

  15. Taylor JL, Tuttle J, Pramukul T, et al. An outbreak of cholera in Maryland associated with imported commercial frozen coconut milk. J Infect Dis 1993;167:1330-5.

  16. CDC. Cholera associated with international travel, 1992. MMWR 1992;41:664-7.

  17. Council for Agricultural Science and Technology. Foodborne pathogens: risks and consequences. Ames, IA: Council for Agricultural Science and Technology, 1994. (Task force report no. 122).

  18. Koo D, Maloney K, Tauxe R. Epidemiology of diarrheal disease outbreaks on cruise ships, 1986 through 1993. JAMA 1996;275:545-7.

  19. Besser RE, Feikin DR, Eberhart-Phillips JE, Mascola L, Griffin PM. Diagnosis and treatment of cholera in the United States: are we prepared? JAMA 1994;272:1203-5.

  20. Lee LA, Taylor J, Carter GP, Quinn B, et al. Yersinia enterocolitica O:3: an emerging cause of pediatric gastroenteritis in the United States. J Infec Dis 1991;163:660-3.

  21. Helmick CG, Griffin PM, Addiss DG, Tauxe RV, Juranek DD. Infectious diarrheas. In: Everhart JE, ed. Digestive diseases in the United States: epidemiology and impact. Washington, DC: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases;1994:85-123; NIH publication no. 94-1447.

  22. Levine WC, Smart JF, Archer DL, Bean NH, Tauxe RV. Foodborne disease outbreaks in nursing homes, 1975 through 1987. JAMA 1991;266:2105-9.


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Table_1
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TABLE  1. Number of reported foodborne-disease outbreaks, cases, and deaths, by etiology -- United States, * 1988
====================================================================================================================

                           Outbreaks                            Cases                         Deaths
                         --------------                   ---------------                ---------------
Etiology                 No.        (%)                     No.       (%)                 No.        (%)
--------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus            5    (  1.1)                      51   (  0.3)                   0    (  0.0)
Campylobacter              4    (  0.9)                     134   (  0.9)                   0    (  0.0)
Clostridium               20    (  4.4)                      49   (  0.3)                   1    (  5.3)
botulinum
Escherichia coli           2    (  0.4)                     109   (  0.7)                   0    (  0.0)
Salmonella                94    ( 20.8)                   2,987   ( 19.0)                  14    ( 73.7)
Shigella                   6    (  1.3)                   3,581   ( 22.8)                   0    (  0.0)
Staphylococcus             8    (  1.8)                     245   (  1.6)                   0    (  0.0)
aureus

Total bacterial          139    ( 30.8)                   7,156   ( 45.5)                  15    ( 78.9)

Chemical
Ciguatoxin                 4    (  0.9)                       8   (  0.1)                   0    (  0.0)
Heavy metals               2    (  0.4)                      19   (  0.1)                   0    (  0.0)
Mushroom poisoning         2    (  0.4)                       9   (  0.1)                   0    (  0.0)
Paralytic shellfish        1    (  0.2)                       6   (  0.0)                   0    (  0.0)
Scombrotoxin              16    (  3.5)                      65   (  0.4)                   1    (  5.3)
Other chemical             4    (  0.9)                      32   (  0.2)                   0    (  0.0)

Total chemical            29    (  6.4)                     139   (  0.9)                   1    (  5.3)

Parasitic
Trichinella                3    (  0.7)                      34   (  0.2)                   0    (  0.0)
spiralis

Viral
Hepatitis A               12    (  2.7)                     795   (  5.1)                   3    ( 15.8)

Confirmed etiology       183    ( 40.6)                   8,124   ( 51.6)                  19    (100.0)

Unknown etiology         268    ( 59.4)                   7,608   ( 48.4)                   0    (  0.0)

Total 1988               451    (100.0)                  15,732   (100.0)                  19    (100.0)
--------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
====================================================================================================================

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Table_2
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TABLE  2. Number of reported foodborne-disease outbreaks, cases, and deaths, by etiology--United States, * 1989
==========================================================================================================================

                                Outbreaks                              Cases                               Deaths
                             ----------------                     ----------------                    -----------------
Etiology                      No.        (%)                       No.        (%)                      No.         (%)
--------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                 3    (  0.6)                        61    (  0.4)                        0     (  0.0)
Campylobacter                   8    (  1.6)                       295    (  1.9)                        0     (  0.0)
Clostridium                    13    (  2.6)                        24    (  0.2)                        2     ( 11.8)
botulinum
Clostridium                     7    (  1.4)                       436    (  2.7)                        0     (  0.0)
perfringens
Escherichia coli                1    (  0.2)                         3    (  0.0)                        0     (  0.0)
Listeria                        1    (  0.2)                         2    (  0.0)                        1     (  5.9)
monocytogenes
Salmonella                    117    ( 23.2)                     4,920    ( 31.0)                       14     ( 82.4)
Shigella                        6    (  1.2)                       257    (  1.6)                        0     (  0.0)
Staphylococcus                 14    (  2.8)                       524    (  3.3)                        0     (  0.0)
aureus
Streptococcus Group             1    (  0.2)                        35    (  0.2)                        0     (  0.0)
A

Total bacterial               171    ( 33.9)                     6,557    ( 41.3)                       17     (100.0)

Chemical
Ciguatoxin                     19    (  3.8)                        66    (  0.4)                        0     (  0.0)
Heavy metals                    1    (  0.2)                         7    (  0.0)                        0     (  0.0)
Scombrotoxin                   17    (  3.4)                        80    (  0.5)                        0     (  0.0)

Total chemical                 37    (  7.3)                       153    (  1.0)                        0     (  0.0)

Parasitic
Giardia lamblia                 1    (  0.2)                        21    (  0.1)                        0     (  0.0)
Trichinella spiralis            4    (  0.8)                        15    (  0.1)                        0     (  0.0)

Total parasitic                 5    (  1.0)                        36    (  0.2)                        0     (  0.0)

Viral
Hepatitis A                     7    (  1.4)                       329    (  2.1)                        0     (  0.0)
Norwalk                         1    (  0.2)                        42    (  0.3)                        0     (  0.0)

Total viral                     8    (  1.6)                       371    (  2.3)                        0     (  0.0)

Confirmed etiology            221    ( 43.8)                     7,117    ( 44.9)                       17     (100.0)

Unknown etiology              284    ( 56.2)                     8,750    ( 55.1)                        0     (  0.0)

Total 1989                    505    (100.0)                    15,867    (100.0)                       17     (100.0)
--------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
==========================================================================================================================

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Table_3
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TABLE 3. Number of reported foodborne-disease outbreaks, cases, and deaths, by etiology--United States, * 1990
========================================================================================================================

                                Outbreaks                              Cases                             Deaths
                              ---------------                    -----------------                  --------------------
Etiology                      No.         (%)                      No.        (%)                     No.        (%)
------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                 5     (  0.9)                       43    (  0.2)                       0    (  0.0)
Campylobacter                   3     (  0.6)                       72    (  0.4)                       0    (  0.0)
Clostridium botulinum          12     (  2.3)                       22    (  0.1)                       5    ( 33.3)
Clostridium                    11     (  2.1)                    1,240    (  6.2)                       0    (  0.0)
perfringens
Escherichia coli                2     (  0.4)                       80    (  0.4)                       0    (  0.0)
Salmonella                    136     ( 25.6)                    6,290    ( 31.6)                       1    (  6.7)
Shigella                        8     (  1.5)                      834    (  4.2)                       0    (  0.0)
Staphylococcus aureus          13     (  2.4)                      372    (  1.9)                       0    (  0.0)
Vibrio cholerae                 1     (  0.2)                       26    (  0.1)                       1    (  6.7)
Vibrio                          4     (  0.8)                       21    (  0.1)                       0    (  0.0)
parahemolyticus
Vibrio vulnificus               1     (  0.2)                        2    (  0.0)                       1    (  6.7)

Total bacterial               196     ( 36.8)                    9,002    ( 45.3)                       8    ( 53.3)

Chemical
Ciguatoxin                     11     (  2.1)                       44    (  0.2)                       0    (  0.0)
Mushroom poisoning              1     (  0.2)                        5    (  0.0)                       0    (  0.0)
Paralytic shellfish             2     (  0.4)                       24    (  0.1)                       1    (  6.7)
Scombrotoxin                   11     (  2.1)                      194    (  1.0)                       0    (  0.0)
Other chemical                  2     (  0.4)                        3    (  0.0)                       0    (  0.0)

Total chemical                 27     (  5.1)                      270    (  1.4)                       1    (  6.7)

Parasitic
Giardia lamblia                 3     (  0.6)                      129    (  0.6)                       0    (  0.0)
Trichinella spiralis            2     (  0.4)                      105    (  0.5)                       0    (  0.0)

Total parasitic                 5     (  0.9)                      234    (  1.2)                       0    (  0.0)

Viral
Hepatitis A                     9     (  1.7)                      452    (  2.3)                       3    ( 20.0)

Confirmed etiology            237     ( 44.5)                    9,958    ( 50.1)                      12    ( 80.0)

Unknown etiology              295     ( 55.5)                    9,925    ( 49.9)                       3    ( 20.0)

Total 1990                    532     (100.0)                   19,883    (100.0)                      15    (100.0)
------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
========================================================================================================================

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Table_4
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TABLE  4. Number of reported foodborne-disease outbreaks, cases, and deaths, by etiology--United States, * 1991
=====================================================================================================================
                               Outbreaks                            Cases                              Deaths
                             --------------                    ----------------                    --------------
Etiology                     No.        (%)                      No.       (%)                     No.        (%)
---------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                5    (  0.9)                      253   (  1.7)                       0    (  0.0)
Campylobacter                  6    (  1.1)                       93   (  0.6)                       0    (  0.0)
Clostridium                   11    (  2.1)                       25   (  0.2)                       2    ( 20.0)
botulinum
Clostridium                   10    (  1.9)                    1,213   (  8.2)                       1    ( 10.0)
perfringens
Escherichia coli               3    (  0.6)                       33   (  0.2)                       0    (  0.0)
Salmonella                   122    ( 23.1)                    4,146   ( 27.9)                       5    ( 50.0)
Shigella                       4    (  0.8)                      112   (  0.8)                       0    (  0.0)
Staphylococcus                 9    (  1.7)                      331   (  2.2)                       0    (  0.0)
aureus
Streptococcus Group            1    (  0.2)                      100   (  0.7)                       0    (  0.0)
A
Vibrio cholerae                2    (  0.4)                        6   (  0.0)                       0    (  0.0)

Total bacterial              173    ( 32.8)                    6,335   ( 42.6)                       8    ( 80.0)

Chemical
Ciguatoxin                     7    (  1.3)                       50   (  0.3)                       0    (  0.0)
Mushroom poisoning             2    (  0.4)                        4   (  0.0)                       0    (  0.0)
Paralytic shellfish            2    (  0.4)                       35   (  0.2)                       1    ( 10.0)
Scombrotoxin                  17    (  3.2)                       40   (  0.3)                       0    (  0.0)
Other chemical                 3    (  0.6)                       30   (  0.2)                       0    (  0.0)

Total chemical                31    (  5.9)                      159   (  1.1)                       1    ( 10.0)

Parasitic
Giardia lamblia                2    (  0.4)                       32   (  0.2)                       0    (  0.0)
Trichinella spiralis           1    (  0.2)                       41   (  0.3)                       0    (  0.0)

Total parasitic                3    (  0.6)                       73   (  0.5)                       0    (  0.0)

Viral
Hepatitis A                    7    (  1.3)                      114   (  0.8)                       0    (  0.0)

Confirmed etiology           214    ( 40.5)                    6,658   ( 44.8)                       9    ( 90.0)

Unknown etiology             314    ( 59.5)                    8,218   ( 55.2)                       1    ( 10.0)

Total 1991                   528    (100.0)                   14,876   (100.0)                      10    (100.0)
---------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=====================================================================================================================

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Table_5
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TABLE  5. Number of reported foodborne-disease outbreaks, cases, and deaths, by etiology--United States, * 1992
=============================================================================================================================
                               Outbreaks                           Cases                                        Deaths
                             --------------                  ----------------                               ---------------
Etiology                     No.        (%)                    No.        (%)                                No.        (%)
-----------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                3    (  0.7)                     25    (  0.2)                                  0    (  0.0)
Campylobacter                  6    (  1.5)                    138    (  1.3)                                  2    ( 25.0)
Campylobacter/Salmon           1    (  0.2)                      3    (  0.0)                                  0    (  0.0)
ella
Clostridium                    4    (  1.0)                     13    (  0.1)                                  1    ( 12.5)
botulinum
Clostridium                   12    (  2.9)                    912    (  8.3)                                  0    (  0.0)
perfringens
Escherichia coli               3    (  0.7)                     19    (  0.2)                                  0    (  0.0)
Salmonella                    80    ( 19.7)                  2,834    ( 25.7)                                  4    ( 50.0)
Shigella                       1    (  0.2)                      4    (  0.0)                                  0    (  0.0)
Staphylococcus                 6    (  1.5)                    206    (  1.9)                                  0    (  0.0)
aureus
Vibrio cholerae                1    (  0.2)                      2    (  0.0)                                  0    (  0.0)

Total bacterial              117    ( 28.7)                  4,156    ( 37.7)                                  7    ( 87.5)

Chemical
Ciguatoxin                     1    (  0.2)                      8    (  0.1)                                  0    (  0.0)
Scombrotoxin                  15    (  3.7)                    135    (  1.2)                                  0    (  0.0)
Other chemical                 3    (  0.7)                     63    (  0.6)                                  1    ( 12.5)

Total chemical                19    (  4.7)                    206    (  1.9)                                  1    ( 12.5)

Parasitic
Giardia lamblia                1    (  0.2)                      2    (  0.0)                                  0    (  0.0)

Viral
Hepatitis A                    8    (  2.0)                    419    (  3.8)                                  0    (  0.0)
Norwalk-like virus             1    (  0.2)                    250    (  2.3)                                  0    (  0.0)

Total viral                    9    (  2.2)                    669    (  6.1)                                  0    (  0.0)

Confirmed etiology           146    ( 35.9)                  5,033    ( 45.7)                                  8    (100.0)

Unknown etiology             261    ( 64.1)                  5,982    ( 54.3)                                  0    (  0.0)

Total 1992                   407    (100.0)                 11,015    (100.0)                                  8    (100.0)
-----------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=============================================================================================================================

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Table_6
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TABLE  6. Number of reported foodborne-disease outbreaks, by etiology and month of occurrence -- United States, * 1988
=================================================================================================================================
                                                                   Month of occurrence
                                 ------------------------------------------------------------------------------------------------
Etiology                           Jan    Feb    Mar    Apr    May    Jun    Jul    Aug    Sep    Oct    Nov    Dec     Total
---------------------------------------------------------------------------------------------------------------------------------
ETIOLOGY
Bacterial
Bacillus cereus                     --     --     --     --     --      3      1      1     --     --     --     --         5
Campylobacter                       --     --     --     --     --      3     --     --     --      1     --     --         4
Clostridium                          1      1      1      1      1      6      5     --     --      2      1      1        20
botulinum
Escherichia coli                    --     --     --     --      1     --     --     --     --      1     --     --         2
Salmonella                           3      4      2      5     10     10     12     21     12      6      6      3        94
Shigella                            --      1     --     --      1      1     --      1      1     --      1     --         6
Staphylococcus                      --      1      1      1     --      1     --      1     --      2      1     --         8
aureus

Total bacterial                      4      7      4      7     13     24     18     24     13     12      9      4       139

Chemical
Ciguatoxin                          --     --      1     --     --     --      1      1     --      1     --     --         4
Heavy metals                        --      1     --     --     --     --      1     --     --     --     --     --         2
Mushroom poisoning                  --     --     --     --     --     --     --     --      1      1     --     --         2
Paralytic shellfish                 --     --     --     --     --     --     --     --      1     --     --     --         1
Scombrotoxin                         1      1     --      4     --      1      2      2      2      3     --     --        16
Other chemical                      --     --      1      1      1     --     --     --     --      1     --     --         4

Total chemical                       1      2      2      5      1      1      4      3      4      6     --     --        29

Parasitic
Trichinella spiralis                --     --     --     --      1     --     --     --     --     --      1      1         3

Viral
Hepatitis A                          2      3     --     --     --      3      1     --      1     --      1      1        12

Confirmed etiology                   7     12      6     12     15     28     23     27     18     18     11      6       183

Unknown etiology                    13     15     17     23     34     22     22     31     19     20     26     26       268

Total 1988                          20     27     23     35     49     50     45     58     37     38     37     32       451
---------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=================================================================================================================================

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Table_7
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TABLE  7. Number of reported foodborne-disease outbreaks, by etiology and month of occurrence -- United States, * 1989
=================================================================================================================================================

                                                                               Month of occurrence
                                      -----------------------------------------------------------------------------------------------------------
Etiology                               Jan     Feb     Mar     Apr     May     Jun     Jul     Aug     Sep      Oct     Nov     Dec      Total
-------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                          1      --      --      --       1      --       1      --      --       --      --      --          3
Campylobacter                           --      --       2      --       2       1      --      --      --        1       1       1          8
Clostridium                             --       1       1      --       2       3       3      --      --        3      --      --         13
botulinum
Clostridium                             --      --      --       1       1       2       1      --      --       --      --       2          7
perfringens
Escherichia coli                        --      --      --      --      --      --      --       1      --       --      --      --          1
Listeria                                --      --      --      --      --       1      --      --      --       --      --      --          1
monocytogenes
Salmonella                               1       2       3       4      14      20      21       8      18       13       9       4        117
Shigella                                --       1      --      --       2      --       2      --      --        1      --      --          6
Staphylococcus                          --       3       2       1       2       2       1      --       1       --      --       2         14
aureus
Streptococcus Group                     --      --      --      --      --      --      --      --       1       --      --      --          1
A

Total bacterial                          2       7       8       6      24      29      29       9      20       18      10       9        171

Chemical
Ciguatoxin                              --      --       2      --       1       4       4       2      --        4       1       1         19
Heavy metals                            --      --      --      --      --      --      --      --      --        1      --      --          1
Mushroom poisoning                      --      --      --      --      --      --      --      --      --       --      --      --         --
Scombrotoxin                             1       2       1       3      --       1      --       4       3       --       1       1         17

Total chemical                           1       2       3       3       1       5       4       6       3        5       2       2         37

Parasitic
Giardia lamblia                         --      --       1      --      --      --      --      --      --       --      --      --          1
Trichinella spiralis                    --      --      --      --      --       3      --      --      --       --       1      --          4

Total parasitic                         --      --       1      --      --       3      --      --      --       --       1      --          5

Viral
Hepatitis A                             --      --      --      --       1      --      --       1       1        3      --       1          7
Norwalk                                  1      --      --      --      --      --      --      --      --       --      --      --          1

Total viral                              1      --      --      --       1      --      --       1       1        3      --       1          8

Confirmed etiology                       4       9      12       9      26      37      33      16      24       26      13      12        221

Unknown etiology                        17      11      27      31      36      33      21      22      18       18      13      37        284

Total 1989                              21      20      39      40      62      70      54      38      42       44      26      49        505
-------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=================================================================================================================================================

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Table_8
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TABLE  8. Number of reported foodborne-disease outbreaks, by etiology and month of occurrence -- United States, * 1990
==================================================================================================================================
                                                                         Month of occurrence
                                    ----------------------------------------------------------------------------------------------
Etiology                            Jan    Feb    Mar    Apr    May    Jun    Jul    Aug    Sep    Oct    Nov    Dec    Total
----------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                      --     --      1     --     --     --      2     --     --      1     --      1        5
Campylobacter                        --     --      1     --      1     --     --     --      1     --     --     --        3
Clostridium                           1     --     --      1     --      1      2      1      2      3      1     --       12
botulinum
Clostridium                           1      1      1      2      1      1     --     --     --     --      4     --       11
perfringens
Escherichia coli                     --     --     --     --     --     --      1     --     --     --      1     --        2
Salmonella                            5      7      6      7     16     23     20     13     14     15      4      6      136
Shigella                             --     --     --      1     --      2      1      1      1      1      1     --        8
Staphylococcus                        1      1     --      1      3      2      3      1      1     --     --     --       13
aureus
Vibrio cholerae                      --     --     --     --      1     --     --     --     --     --     --     --        1
Vibrio                               --     --     --     --     --     --      2      2     --     --     --     --        4
parahemolyticus
Vibrio vulnificus                    --     --     --      1     --     --     --     --     --     --     --     --        1

Total bacterial                       8      9      9     13     22     29     31     18     19     20     11      7      196

Chemical
Ciguatoxin                            2     --      1     --     --      1     --      1      3     --      2      1       11
Mushroom poisoning                   --     --     --     --     --      1     --     --     --     --     --     --        1
Paralytic shellfish                  --     --     --     --      2     --     --     --     --     --     --     --        2
Scombrotoxin                         --     --      1      1      1      2      1      1      1      1      2     --       11
Other chemical                       --     --     --      1     --     --      1     --     --     --     --     --        2

Total chemical                        2     --      2      2      3      4      2      2      4      1      4      1       27

Parasitic
Giardia lamblia                      --     --     --     --     --     --      1      1     --     --      1     --        3
Trichinella spiralis                 --     --     --     --     --     --      1     --     --     --      1     --        2

Total parasitic                      --     --     --     --     --     --      2      1     --     --      2     --        5

Viral
Hepatitis A                          --     --      2      1      1      2     --      1     --      1     --      1        9

Confirmed etiology                   10      9     13     16     26     35     35     22     23     22     17      9      237

Unknown etiology                     16     14     23     23     36     35     21     31     32     20     24     20      295

Total 1990                           26     23     36     39     62     70     56     53     55     42     41     29      532
----------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
==================================================================================================================================

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Table_9
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TABLE  9. Number of reported foodborne-disease outbreaks, by etiology and month of occurrence -- United States, * 1991
==================================================================================================================================
                                                                     Month of occurrence
                                    ----------------------------------------------------------------------------------------------
Etiology                            Jan    Feb    Mar    Apr    May    Jun    Jul    Aug    Sep    Oct    Nov    Dec    Total
----------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                      --     --     --      1      1     --      1      1     --     --     --      1        5
Campylobacter                        --     --     --      1      1     --      2     --     --      1     --      1        6
Clostridium                           1     --     --     --      1      2      1      1      2      2     --      1       11
botulinum
Clostridium                          --     --     --      1      3     --      2     --     --      1      1      2       10
perfringens
Escherichia coli                     --     --     --     --     --     --     --      1      1      1     --     --        3
Salmonella                            4      1      5      7     16     13     25     18     11     12      6      4      122
Shigella                             --     --     --     --      1     --     --      2      1     --     --     --        4
Staphylococcus                       --     --      2      1     --      2      2     --     --      1      1     --        9
aureus
Streptococcus Group                  --     --     --     --      1     --     --     --     --     --     --     --        1
A
Vibrio cholerae                      --     --     --      1     --     --     --      1     --     --     --     --        2

Total bacterial                       5      1      7     12     24     17     33     24     15     18      8      9      173

Chemical
Ciguatoxin                           --     --     --      1     --      1      1      2      2     --     --     --        7
Mushroom poisoning                   --     --      1     --     --     --     --     --     --     --      1     --        2
Paralytic shellfish                  --     --     --     --     --      1     --     --     --     --      1     --        2
Scombrotoxin                          1     --     --     --      1      1      3      3      2      2      4     --       17
Other chemical                       --     --     --      1     --     --     --     --      1     --     --      1        3

Total chemical                        1     --      1      2      1      3      4      5      5      2      6      1       31

Parasitic
Giardia lamblia                      --     --      1     --     --     --      1     --     --     --     --     --        2
Trichinella spiralis                 --      1     --     --     --     --     --     --     --     --     --     --        1

Total parasitic                      --      1      1     --     --     --      1     --     --     --     --     --        3

Viral
Hepatitis A                           1      1      1      1      2     --     --     --     --     --      1     --        7

Confirmed etiology                    7      3     10     15     27     20     38     29     20     20     15     10      214

Unknown etiology                     24     23     14     20     32     37     31     20     25     24     31     33      314

Total 1991                           31     26     24     35     59     57     69     49     45     44     46     43      528
-----------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
===================================================================================================================================

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Table_10
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TABLE  10. Number of reported foodborne-disease outbreaks, by etiology and month of occurrence -- United States, * 1992
==================================================================================================================================
                                                                        Month of occurrence
                                    ----------------------------------------------------------------------------------------------
Etiology                             Jan    Feb    Mar    Apr    May    Jun    Jul    Aug    Sep    Oct    Nov    Dec    Total
----------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                       --     --      2     --     --     --     --     --     --     --     --      1        3
Campylobacter                         --      1     --      1      2     --     --     --      1     --     --      1        6
Campylobacter/Salmon                  --     --     --     --     --      1     --     --     --     --     --     --        1
ella
Clostridium                           --      1     --     --      1     --     --      2     --     --     --     --        4
botulinum
Clostridium                           --      1      3      1      2     --     --      1      1      1     --      2       12
perfringens
Escherichia coli                      --     --     --     --      1     --      1     --     --     --     --      1        3
Salmonella                             2      3      2      6      6      8     15     12      9      6      7      4       80
Shigella                              --     --     --     --     --     --     --     --     --      1     --     --        1
Staphylococcus                        --     --      1      1      1     --      1     --      1     --     --      1        6
aureus
Vibrio cholerae                       --      1     --     --     --     --     --     --     --     --     --     --        1

Total bacterial                        2      6      8     10     13      9     17     15     12      8      7     10      117

Chemical
Ciguatoxin                            --     --     --     --     --      1     --     --     --     --     --     --        1
Scombrotoxin                          --      2      2      1      3      1      1      1      2      2     --     --       15
Other chemical                        --     --     --     --      1     --     --     --     --      1     --      1        3

Total chemical                        --      2      2      1      4      2      1      1      2      3     --      1       19

Parasitic
Giardia lamblia                       --     --     --     --     --     --     --     --     --     --     --      1        1

Viral
Hepatitis A                            2     --      1     --     --      2     --     --     --      1      2     --        8
Norwalk-like virus                    --     --     --     --     --     --     --     --     --     --      1     --        1

Total viral                            2     --      1     --     --      2     --     --     --      1      3     --        9

Confirmed etiology                     4      8     11     11     17     13     18     16     14     12     10     12      146

Unknown etiology                      17     24     24     30     25     21     18     20     17     15     21     29      261

Total 1992                            21     32     35     41     42     34     36     36     31     27     31     41      407
----------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
==================================================================================================================================

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Table_11
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TABLE  11. Number of reported foodborne-disease outbreaks, by etiology and place where food was eaten -- United States, * 1988
===============================================================================================================================================================

                                                               Place where food was eaten
                       ------------------------------------------------------------------------------------------------
                       Private residence   Delicatessen,
                                            afeteria, or
                                              restaurant      School          Picnic      Church        Camp      Other   Total place    Total place     Total
Etiology                                                                                                                        known      unknown
---------------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                       --              3           --              --           1          --           1           5         --             5
Campylobacter                         --              2            1               1          --          --          --           4         --             4
Clostridium botulinum                  3             --           --              --          --          --          --           3         17            20
Escherichia coli                      --             --            2              --          --          --          --           2         --             2
Salmonella                            17             41            6               4           1          --          25          94         --            94
Shigella                               1              1            1              --          --          --           2           5          1             6
Staphylococcus aureus                 --              5            1              --          --          --           2           8         --             8

Total bacterial                       21             52           11               5           2          --          30         121         18           139

Chemical
Ciguatoxin                             3             --           --              --          --          --          --           3          1             4
Heavy metals                          --              2           --              --          --          --          --           2         --             2
Mushroom poisoning                     1             --           --              --          --          --          --           1          1             2
Paralytic shellfish                   --             --           --              --          --          --           1           1         --             1
Scombrotoxin                           1             14           --              --          --          --          --          15          1            16
Other chemical                         3              1           --              --          --          --          --           4         --             4

Total chemical                         8             17           --              --          --          --           1          26          3            29

Parasitic
Trichinella spiralis                  --             --           --              --          --          --           2          11          1            12

Viral
Hepatitis A                           --              9           --              --          --          --           2          11          1            12

Confirmed etiology                    29             78           11               5           2          --          34         159         24           183

Unknown etiology                      50            128           14               3           4           3          56         258         10           268

Total 1988                            79            206           25               8           6           3          90         417         34           451
---------------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
===============================================================================================================================================================

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Table_12
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TABLE  12. Number of reported foodborne-disease outbreaks, by etiology and place where food was eaten -- United States, * 1989
=================================================================================================================================================================
                                                              Place where food was eaten
                        -----------------------------------------------------------------------------------------------
                                             Delicatessen,
                                             cafeteria, or
Etiology                Private residence       restaurant      School        Picnic      Church        Camp     Other   Total place   Total place
                                                                                                                            known      unknown           Total
-----------------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                         1               1          --             --          --          --         1         3        --                   3
Campylobacter                           2               2          --              1          --          --         3         8        --                   8
Clostridium                             9              --          --             --          --          --        --         9         4                  13
botulinum
Clostridium                             1               4           1             --          --          --         1         7        --                   7
perfringens
Escherichia coli                       --               1          --             --          --          --        --         1        --                   1
Listeria                                1              --          --             --          --          --        --         1        --                   1
monocytogenes
Salmonella                             11              43           2             --           1           2        51       110         7                 117
Shigella                               --               2          --             --          --          --         4         6        --                   6
Staphylococcus                          3               1           1             --          --          --         9        14        --                  14
aureus
Streptococcus Group                    --              --          --             --          --          --         1         1        --                   1
A

Total bacterial                        28              54           4              1           1           2        70       160        11                 171

Chemical
Ciguatoxin                             16               3          --             --          --          --        --        19        --                  19
Heavy metals                            1              --          --             --          --          --        --         1        --                   1
Scombrotoxin                           --              14          --             --          --          --         3        17        --                  17

Total chemical                         17              17          --             --          --          --         3        37        --                  37

Parasitic
Giardia lamblia                        --              --          --             --           1          --        --         1        --                   1
Trichinella spiralis                   --              --          --             --          --          --        --        --         4                   4

Total parasitic                        --              --          --             --           1          --        --         1         4                   5

Viral
Hepatitis A                             1               3          --             --           1          --         2         7        --                   7
Norwalk                                --               1          --             --          --          --        --         1        --                   1

Total viral                             1               4          --             --           1          --         2         8        --                   8

Confirmed etiology                     46              75           4              1           3           2        75       206        15                 221

Unknown etiology                       43             137          17              2           8           7        67       281         3                 284

Total 1989                             89             212          21              3          11           9       142       487        18                 505
-----------------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=================================================================================================================================================================

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Table_13
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TABLE  13. Number of reported foodborne-disease outbreaks, by etiology and place where food was eaten -- United States, * 1990
=================================================================================================================================================================
                                                                 Place where food was eaten
                     -----------------------------------------------------------------------------------------------
                                           Delicatessen,
                                           cafeteria, or
Etiology             Private residence     restaurant       School           Picnic     Church       Camp     Other  Total place  Total place         Total
                                                                                                                         known       unknown
-----------------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                      1               2          --               --         --         --         2          5         --                 5
Campylobacter                       --              --           1               --         --         --         2          3         --                 3
Clostridium                          9              --          --               --         --         --        --          9          3                12
botulinum
Clostridium                          1               2           2                1          1         --         4         11         --                11
perfringens
Escherichia coli                    --              --           1               --         --         --         1          2         --                 2
Salmonella                          15              51           5                5          3          1        55        135          1               136
Shigella                            --               3          --               --         --         --         5          8         --                 8
Staphylococcus                       2               4           2               --         --         --         5         13         --                13
aureus
Vibrio cholerae                      1              --          --               --         --         --        --          1         --                 1
Vibrio                               1               2          --               --         --         --         1          4         --                 4
parahemolyticus
Vibrio vulnificus                   --               1          --               --         --         --        --          1         --                 1

Total bacterial                     30              65          11                6          4          1        75        192          4               196

Chemical
Ciguatoxin                           7               3          --               --         --         --         1         11         --                11
Mushroom poisoning                   1              --          --               --         --         --        --          1         --                 1
Paralytic                           --              --          --               --         --         --         2          2         --                 2
shellfish
Scombrotoxin                         3               7          --               --         --         --         1         11         --                11
Other chemical                       1              --          --               --         --         --         1          2         --                 2

Total chemical                      12              10          --               --         --         --         5         27         --                27

Parasitic
Giardia lamblia                     --               1          --               --         --         --         2          3         --                 3
Trichinella                          1              --          --               --         --         --         1          2         --                 2
spiralis

Total parasitic                      1               1          --               --         --         --         3          5         --                 5

Viral
Hepatitis A                          1               5          --               --         --         --         2          8          1                 9

Confirmed etiology                  44              81          11                6          4          1        85        232          5               237

Unknown etiology                    59             113          12                7          5          4        93        293          2               295

Total 1990                         103             194          23               13          9          5       178        525          7               532
-----------------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=================================================================================================================================================================

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Table_14
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TABLE  14. Number of reported foodborne-disease outbreaks, by etiology and place where food was eaten -- United States, * 1991
=================================================================================================================================================================
                                                                     Place where food was eaten
                     -------------------------------------------------------------------------------------------------
                                           Delicatessen,
                                           cafeteria, or
                                            restaurant       School           Picnic     Church       Camp       Other  Total place  Total place
Etiology             Private residence                                                                                      known     unknown          Total
-----------------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                      2                1          --               --         --         --          2         5        --                  5
Campylobacter                       --                3          --               --         --          1          2         6        --                  6
Clostridium                          3               --          --               --         --         --         --         3         8                 11
botulinum
Clostridium                          1                4          --               --         --         --          5        10        --                 10
perfringens
Escherichia coli                     1               --          --                1         --         --          1         3        --                  3
Salmonella                          14               47           3                2          2          4         47       119         3                122
Shigella                             2               --          --               --         --         --          2         4        --                  4
Staphylococcus                       2                1          --               --         --          1          5         9        --                  9
aureus
Streptococcus                       --               --          --               --         --         --          1         1        --                  1
Group A
Vibrio cholerae                      1               --          --               --         --         --          1         2        --                  2

Total bacterial                     26               56           3                3          2          6         66       162        11                173

Chemical
Ciguatoxin                           5                1          --               --         --         --          1         7        --                  7
Mushroom poisoning                   1               --          --               --         --         --          1         2        --                  2
Paralytic                            2               --          --               --         --         --         --         2        --                  2
shellfish
Scombrotoxin                         4               10          --               --         --         --          2        16        --                 16
Other chemical                       1                1           1               --         --         --         --         3        --                  3

Total chemical                      13               12           1               --         --         --          4        30        --                 30

Parasitic
Giardia lamblia                     --                1          --               --         --         --          1         2        --                  2
Trichinella                          1               --          --               --         --         --         --         1        --                  1
spiralis

Total parasitic                      1                1          --               --         --         --          1         3        --                  3

Viral
Hepatitis A                         --                3           2               --         --         --          2         7         1                  8

Confirmed etiology                  40               72           6                3          2          6         73       202        12                214

Unknown etiology                    63              138           9                4         10          2         80       306         8                314

Total 1991                         103              210          15                7         12          8        153       508        20                528
-----------------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=================================================================================================================================================================

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Table_15
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TABLE  15. Number of reported foodborne-disease outbreaks, by etiology and place where food was eaten -- United States, * 1992
========================================================================================================================================================================
                                                       Place where food was eaten
                     ----------------------------------------------------------------------------------
                                         Delicatessen,
                                         cafeteria, or
Etiology             Private residence   restaurant    School    Picnic     Church      Camp     Other    Total place       Total place     Total
                                                                                                               known           unknown
------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                     --              2            --             --        --        --          1         3        --              3
Campylobacter                        1             --            --             --         1        --          3         5         1              6
Campylobacter/Salm                   1             --            --             --        --        --         --         1        --              1
onella
Clostridium                          2             --            --             --        --        --         --         2         2              4
botulinum
Clostridium                         --              2             2             --         1        --          7        12        --             12
perfringens
Escherichia coli                    --              1            --             --        --        --          1         2         1              3
Salmonella                          15             27            --              3        --        --         34        79         1             80
Shigella                            --              1            --             --        --        --         --         1        --              1
Staphylococcus                      --              1             1             --        --        --          4         6        --              6
aureus
Vibrio cholerae                      1             --            --             --        --        --         --         1        --              1

Total bacterial                     20             34             3              3         2        --         50       112         5            117

Chemical
Ciguatoxin                           1             --            --             --        --        --         --         1        --              1
Scombrotoxin                         4              6            --             --        --        --          5        15        --             15
Other chemical                      --              1            --             --        --        --          2         3        --              3

Total chemical                       5              7            --             --        --        --          7        19        --             19

Parasitic
Giardia lamblia                     --              1            --             --        --        --         --         1        --              1

Viral
Hepatitis A                         --              3             1             --        --        --          3         7         1              8
Norwalk-like virus                  --             --             1             --        --        --         --         1        --              1

Total viral                         --              3             2             --        --        --          3         8         1              9

Confirmed etiology                  25             45             5              3         2        --         60       140         6            146

Unknown etiology                    48            106            10             --         5         3         85       257         4            261

Total 1992                          73            151            15              3         7         3        145       397        10            407
------------------------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
========================================================================================================================================================================

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Table_16
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TABLE 16. Number of reported foodborne-disease outbreaks, cases, and deaths,  by vehicle of
transmission -- United States, * 1988
=====================================================================================================
                                 Outbreaks                   Cases                     Deaths
                             -----------------          ---------------            ------------------
Etiology                     No.           (%)           No.        (%)            No.         (%)
-----------------------------------------------------------------------------------------------------
Baked foods                    2       (  0.4)            15    (  0.1)              0     (  0.0)
Beef                          16       (  3.5)           513    (  3.3)              0     (  0.0)
Chicken                        7       (  1.6)           130    (  0.8)              0     (  0.0)
Chinese food                   4       (  0.9)            84    (  0.5)              0     (  0.0)
Eggs                           7       (  1.6)           294    (  1.9)              2     ( 10.5)
Fruits and                    14       (  3.1)           374    (  2.4)              3     ( 15.8)
vegetables
Ham                            5       (  1.1)           116    (  0.7)              0     (  0.0)
Ice cream                      6       (  1.3)           163    (  1.0)              0     (  0.0)
Mexican food                   2       (  0.4)            15    (  0.1)              0     (  0.0)
Milk                           1       (  0.2)           120    (  0.8)              0     (  0.0)
Multiple vehicles             66       ( 14.6)         3,309    ( 21.0)              8     ( 42.1)
Mushrooms                      2       (  0.4)             9    (  0.1)              0     (  0.0)
Nondairy beverage              7       (  1.6)         1,070    (  6.8)              0     (  0.0)
Other fish                    27       (  6.0)           225    (  1.4)              1     (  5.3)
Other salad                   11       (  2.4)         3,636    ( 23.1)              0     (  0.0)
Other/unknown meat             8       (  1.8)            57    (  0.4)              1     (  5.3)
Pork                           4       (  0.9)           326    (  2.1)              0     (  0.0)
Potato salad                   4       (  0.9)           190    (  1.2)              0     (  0.0)
Poultry, fish, or egg salad    5       (  1.1)           147    (  0.9)              0     (  0.0)
Sausage                        1       (  0.2)             8    (  0.1)              0     (  0.0)
Shellfish                      3       (  0.7)            87    (  0.6)              0     (  0.0)
Turkey                         4       (  0.9)           272    (  1.7)              1     (  5.3)

Confirmed vehicle            206       ( 45.7)        11,160    ( 70.9)             16     ( 84.2)

Unknown vehicle              245       ( 54.3)         4,572    ( 29.1)              3     ( 15.8)

Total 1988                   451       (100.0)        15,732    (100.0)             19     (100.0)
-----------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=====================================================================================================

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Table_17
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TABLE 17. Number of reported foodborne-disease outbreaks, cases, and deaths, by vehicle of
transmission -- United States, * 1989
=====================================================================================================
                               Outbreaks                   Cases                     Deaths
                           ------------------         ----------------           -----------------
Etiology                    No.           (%)           No.        (%)            No.        (%)
-----------------------------------------------------------------------------------------------------
Baked foods                   3       (  0.6)            84    (  0.5)              1    (  4.3)
Beef                         12       (  2.4)           489    (  3.0)              0    (  0.0)
Cheese                        1       (  0.2)           164    (  1.0)              0    (  0.0)
Chicken                       9       (  1.8)           225    (  1.4)              0    (  0.0)
Chinese food                  6       (  1.2)            45    (  0.3)              0    (  0.0)
Eggs                          3       (  0.6)            74    (  0.5)              0    (  0.0)
Fruits and                   21       (  4.2)         1,072    (  6.8)              0    (  0.0)
vegetables
Ham                           6       (  1.2)           602    (  3.8)              0    (  0.0)
Ice cream                     1       (  0.2)            16    (  0.1)              0    (  0.0)
Mexican food                  7       (  1.4)           360    (  2.3)              0    (  0.0)
Milk                          3       (  0.6)            48    (  0.3)              0    (  0.0)
Multiple vehicles            75       ( 14.9)         3,904    ( 24.6)              2    (  8.7)
Mushrooms                     1       (  0.2)           162    (  1.0)              0    (  0.0)
Nondairy beverage             2       (  0.4)            87    (  0.5)              0    (  0.0)
Other fish                   39       (  7.7)           200    (  1.3)              0    (  0.0)
Other salad                  17       (  3.4)           560    (  3.5)              1    (  4.3)
Other/unknown dairy           1       (  0.2)            22    (  0.1)              0    (  0.0)
Other/unknown meat            8       (  1.6)            40    (  0.3)              1    (  4.3)
Potato salad                  3       (  0.6)           207    (  1.3)              0    (  0.0)
Poultry, fish, or egg salad   3       (  0.6)            82    (  0.5)              0    (  0.0)
Sausage                       2       (  0.4)            12    (  0.1)              0    (  0.0)
Shellfish                     8       (  1.6)           273    (  1.7)              0    (  0.0)
Turkey                        6       (  1.2)           154    (  1.0)              0    (  0.0)

Confirmed vehicle           237       ( 46.9)         8,882    ( 56.0)              5    ( 21.7)

Unknown vehicle             268       ( 53.1)         6,985    ( 44.0)             18    ( 78.3)

Total 1989                  505       (100.0)        15,867    (100.0)             23    (100.0)
-----------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=====================================================================================================

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Table_18
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TABLE 18. Number of reported foodborne-disease outbreaks, cases, and deaths, by vehicle of
transmission -- United States, * 1990
=====================================================================================================
                                Outbreaks                   Cases                     Deaths
                           ------------------         ------------------         -------------------
Etiology                     No.         (%)            No.         (%)            No.        (%)
Baked foods                    7     (  1.3)            111     (  0.6)              0    (  0.0)
Beef                          13     (  2.4)            507     (  2.5)              0    (  0.0)
Carbonated drinks              2     (  0.4)             19     (  0.1)              0    (  0.0)
Cheese                         3     (  0.6)             50     (  0.3)              0    (  0.0)
Chicken                        7     (  1.3)            396     (  2.0)              0    (  0.0)
Chinese food                   5     (  0.9)             33     (  0.2)              0    (  0.0)
Eggs                           5     (  0.9)            381     (  1.9)              0    (  0.0)
Fruits and                    15     (  2.8)            602     (  3.0)              5    ( 33.3)
vegetables
Ham                            4     (  0.8)            109     (  0.5)              0    (  0.0)
Ice cream                      6     (  1.1)            148     (  0.7)              0    (  0.0)
Mexican food                  10     (  1.9)            976     (  4.9)              0    (  0.0)
Milk                           3     (  0.6)             68     (  0.3)              0    (  0.0)
Multiple vehicles             79     ( 14.8)          4,626     ( 23.3)              2    ( 13.3)
Mushrooms                      1     (  0.2)              5     (  0.0)              0    (  0.0)
Other fish                    31     (  5.8)            451     (  2.3)              2    ( 13.3)
Other salad                   20     (  3.8)          1,444     (  7.3)              0    (  0.0)
Other/unknown dairy            1     (  0.2)             40     (  0.2)              0    (  0.0)
Other/unknown meat             2     (  0.4)             20     (  0.1)              0    (  0.0)
Pork                           3     (  0.6)            142     (  0.7)              0    (  0.0)
Potato salad                   1     (  0.2)             40     (  0.2)              0    (  0.0)
Poultry, fish, or egg salad    6     (  1.1)             27     (  1.4)              0    (  0.0)
Sausage                        1     (  0.2)              1     (  0.0)              0    (  0.0)
Shellfish                     11     (  2.1)            153     (  0.8)              2    ( 13.3)
Turkey                         6     (  1.1)          1,094     (  5.5)              0    (  0.0)

Confirmed vehicle            242     ( 45.5)         11,688     ( 58.8)             11    ( 73.3)

Unknown vehicle              290     ( 54.5)          8,195     ( 41.2)              4    ( 26.7)

Total 1990                   532     (100.0)         19,883     (100.0)             15    (100.0)
-----------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=====================================================================================================

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Table_19
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TABLE 19. Number of reported foodborne-disease outbreaks, cases, and deaths, by vehicle of
transmission -- United States, * 1991
=====================================================================================================
                                Outbreaks                    Cases                    Deaths
                           --------------------       -------------------        ------------------
Etiology                     No.          (%)            No.        (%)            No.        (%)
-----------------------------------------------------------------------------------------------------
Baked foods                   11      (  2.1)            506    (  3.4)              0    (  0.0)
Beef                          13      (  2.5)            326    (  2.2)              0    (  0.0)
Carbonated drinks              1      (  0.2)              1    (  0.0)              0    (  0.0)
Cheese                         1      (  0.2)             25    (  0.2)              0    (  0.0)
Chicken                       10      (  1.9)            308    (  2.1)              0    (  0.0)
Chinese food                   4      (  0.8)            111    (  0.7)              0    (  0.0)
Eggs                           2      (  0.4)             17    (  0.1)              0    (  0.0)
Fruits and                    12      (  2.3)            308    (  2.1)              1    ( 10.0)
vegetables
Ham                            2      (  0.4)             56    (  0.4)              0    (  0.0)
Ice cream                      4      (  0.8)             62    (  0.4)              0    (  0.0)
Mexican food                   7      (  1.3)          1,774    ( 11.9)              0    (  0.0)
Milk                           1      (  0.2)             37    (  0.2)              0    (  0.0)
Multiple vehicles             81      ( 15.3)          4,386    ( 29.5)              1    ( 10.0)
Mushrooms                      2      (  0.4)              4    (  0.0)              0    (  0.0)
Nondairy beverage              3      (  0.6)            120    (  0.8)              0    (  0.0)
Other fish                    29      (  5.5)            114    (  0.8)              0    (  0.0)
Other salad                   17      (  3.2)            610    (  4.1)              0    (  0.0)
Other/unknown dairy            2      (  0.4)             23    (  0.2)              0    (  0.0)
Other/unknown meat             9      (  1.7)            132    (  0.9)              2    ( 20.0)
Pork                           3      (  0.6)            223    (  1.5)              0    (  0.0)
Potato salad                   2      (  0.4)             80    (  0.5)              0    (  0.0)
Poultry, fish, or egg salad    3      (  0.6)             23    (  1.6)              0    (  0.0)
Sausage                        1      (  0.2)             41    (  0.3)              0    (  0.0)
Shellfish                      7      (  1.3)             72    (  0.5)              1    ( 10.0)
Turkey                         9      (  1.7)            854    (  5.7)              0    (  0.0)

Confirmed vehicle            236      ( 44.6)         10,427    ( 70.1)              5    ( 50.0)

Unknown vehicle              293      ( 55.4)          4,449    ( 29.9)              5    ( 50.0)

Total 1991                   529      (100.0)         14,876    (100.0)             10    (100.0)
-----------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=====================================================================================================

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Table_20
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TABLE 20. Number of reported foodborne-disease outbreaks, cases, and deaths, by vehicle of
transmission -- United States, * 1992
=====================================================================================================
                              Outbreaks                  Cases                     Deaths
                          -----------------        -----------------         -------------------
Etiology                   No.         (%)           No.        (%)            No.        (%)
-----------------------------------------------------------------------------------------------------
Baked foods                  6     (  1.5)           104    (  0.9)              0    (  0.0)
Beef                         9     (  2.2)           250    (  2.3)              0    (  0.0)
Chicken                      7     (  1.7)           535    (  4.9)              0    (  0.0)
Chinese food                 2     (  0.5)            13    (  0.1)              0    (  0.0)
Eggs                         3     (  0.7)           486    (  4.4)              0    (  0.0)
Fruits and                   2     (  0.5)            92    (  0.8)              0    (  0.0)
vegetables
Ham                          2     (  0.5)            65    (  0.6)              0    (  0.0)
Ice cream                    3     (  0.7)            81    (  0.7)              1    ( 12.5)
Mexican food                 8     (  2.0)           315    (  2.9)              0    (  0.0)
Milk                         3     (  0.7)            79    (  0.7)              0    (  0.0)
Multiple vehicles           54     ( 13.3)         2,580    ( 23.4)              2    ( 25.0)
Nondairy beverage            1     (  0.2)             8    (  0.1)              0    (  0.0)
Other fish                  20     (  4.9)           382    (  3.5)              0    (  0.0)
Other salad                 11     (  2.7)           381    (  3.5)              0    (  0.0)
Other/unknown dairy          1     (  0.2)            12    (  0.1)              0    (  0.0)
Other/unknown meat           3     (  0.7)           218    (  2.0)              0    (  0.0)
Potato salad                 3     (  0.7)            58    (  0.5)              0    (  0.0)
Poultry, fish, or egg salad  5     (  1.2)            44    (  4.0)              1    ( 12.5)
Shellfish                    5     (  1.2)            94    (  0.9)              0    (  0.0)
Turkey                       3     (  0.7)           124    (  1.1)              0    (  0.0)

Confirmed vehicle          151     ( 37.1)         6,318    ( 57.4)              4    ( 50.0)

Unknown vehicle            256     ( 62.9)         4,697    ( 42.6)              4    ( 50.0)

Total 1992                 407     (100.0)        11,015    (100.0)              8    (100.0)
-----------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=====================================================================================================

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Table_21A
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TABLE 21.  Number of reported foodborne-disease outbreaks, by etiology and vehicle of transmission -- United States, * 1988
====================================================================================================================================================
                                                                             Vehicle of transmission
                                   -----------------------------------------------------------------------------------------------------------------
Etiology                             Beef       Ham    Pork    Sausage    Chicken     Turkey      Other meats and   Shellfish  Other fish    Milk
                                                                                                            stews
----------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                        --        --      --         --         --         --                   --          --           1      --
Campylobacter                          --        --      --         --         --         --                   --          --          --       1
Clostridium                            --        --      --         --         --         --                    4          --           2      --
botulinum
Escherichia coli                        2        --      --         --         --         --                   --          --          --      --
Salmonella                              6         2       3         --          2          1                    1          --           2      --
Shigella                               --        --      --         --         --         --                   --          --          --      --
Staphylococcus                          1         3      --         --         --          1                   --          --          --      --
aureus

Total bacterial                         9         5       3         --          2          2                    5          --           5       1

Chemical
Ciguatoxin                             --        --      --         --         --         --                   --          --           4      --
Heavy metals                           --        --      --         --         --         --                   --          --          --      --
Mushroom poisoning                     --        --      --         --         --         --                   --          --          --      --
Paralytic shellfish                    --        --      --         --         --         --                   --           1          --      --
Scombrotoxin                           --        --      --         --         --         --                   --          --          16      --
Other chemical                         --        --      --         --         --         --                   --          --          --      --

Total chemical                         --        --      --         --         --         --                   --           1          20      --

Parasitic
Trichinella spiralis                   --        --      --         --         --         --                    2          --          --      --

Viral
Hepatitis A                            --        --      --         --         --         --                   --           1          --      --

Confirmed etiology                      9         5       3         --          2          2                    7           2          25       1

Unknown etiology                        7        --       1          1          5          2                    1           1           2      --

Total 1988                             16         5       4          1          7          4                    8           3          27       1
----------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
====================================================================================================================================================

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Table_21B
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TABLE 21.  Number of reported foodborne-disease outbreaks, by etiology and vehicle of transmission -- United States, * 1988, continued
===================================================================================================================================================================
                                                                        Vehicle of transmission
                          -----------------------------------------------------------------------------------------------------------------------------------------
                          Cheese     Eggs   Ice cream   Other/ multiple  Baked foods         Fruits and      Potato salad    Poultry,   Other  Chinese food
                                                                  dairy                      vegetables                      fish, egg  salad
Etiology                                                                                                                       salad
-------------------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus               --       --          --                --           --                 --               --          1      --           3
Campylobacter                 --       --          --                --           --                 --               --         --      --          --
Clostridium                   --       --          --                --           --                  8                1         --      --          --
botulinum
Escherichia coli              --       --          --                --           --                 --               --         --      --          --
Salmonella                    --        7           6                --            1                 --                1          1      --           1
Shigella                      --       --          --                --           --                 --               --         --       2          --
Staphylococcus aureus         --       --          --                --           --                 --               --         --      --          --

Total bacterial               --        7           6                --            1                  8                2          2       2           4

Chemical
Ciguatoxin                    --       --          --                --           --                 --               --         --      --          --
Heavy metal                   --       --          --                --           --                 --               --         --      --          --
Mushroom poisoning            --       --          --                --           --                 --               --         --      --          --
Paralytic shellfish           --       --          --                --           --                 --               --         --      --          --
Scombrotoxin                  --       --          --                --           --                 --               --         --      --          --
Other chemical                --       --          --                --            1                  1               --         --      --          --

Total chemical                --       --          --                --            1                  1               --         --      --          --

Parasitic
Trichinella spiralis          --       --          --                --           --                 --               --         --      --          --

Viral
Hepatitis A                   --       --          --                --           --                  2               --         --       1          --

Confirmed etiology            --        7           6                --            2                 11                2          2       3           4

Unknown etiology              --       --          --                --           --                  3                2          3       8          --

Total 1988                    --        7           6                --            2                 14                4          5      11           4
-------------------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
===================================================================================================================================================================

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Table_21C
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TABLE  21. Number of reported foodborne-disease outbreaks, by etiology and vehicle of transmission -- United States, * 1988, continued
===========================================================================================================================================================
                                                  Vehicle of transmission
                             --------------------------------------------------------------------------
Etiology                     Mexican food      Carbonated        Non-dairy          Multiple  Mushrooms         Total known       Total unknown    Total
                                                    drink         beverage          vehicles                        vehicle            vehicle
-----------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                        --              --               --                --         --                   5                 --         5
Campylobacter                          --              --               --                --         --                   1                  3         4
Clostridium botulinum                  --              --               --                 2         --                  17                  3        20
Escherichia coli                       --              --               --                --         --                   2                 --         2
Salmonella                             --              --               --                26         --                  60                 34        94
Shigella                               --              --               --                 1         --                   3                  3         6
Staphylococcus aureus                  --              --               --                 3         --                   8                 --         8

Total bacterial                        --              --               --                32         --                  96                 43       139

Chemical
Ciguatoxin                             --              --               --                --         --                   4                 --         4
Heavy metals                           --              --                2                --         --                   2                 --         2
Mushroom poisoning                     --              --               --                --          2                   2                 --         2
Paralytic shellfish                    --              --               --                --         --                   1                 --         1
Scombrotoxin                           --              --               --                --         --                  16                 --        16
Other chemical                          1              --                1                --         --                   4                 --         4

Total chemical                          1              --                3                --          2                  29                 --        29

Parasitic
Trichinella spiralis                   --              --               --                --         --                   2                  1         3

Viral
Hepatitis A                            --              --                1                 2         --                   7                  5        12

Confirmed etiology                      1              --                4                34          2                 134                 49       183

Unknown etiology                        1              --                3                32         --                  72                196       268

Total 1988                              2              --                7                66          2                 206                245       451
-----------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
===========================================================================================================================================================

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Table_22A
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TABLE  22.  Number  of  reported foodborne-disease outbreaks,  by  etiology  and vehicle of transmission -- United States, * 1989
=====================================================================================================================================================
                                                                         Vehicle of transmission
Etiology                            Beef      Ham     Pork   Sausage   Chicken   Turkey        Other meats and  Shellfish  Other fish     Milk
                                                                                                         stews
-----------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                       --       --       --        --         1       --                     --         --          --       --
Campylobacter                          1       --       --        --        --       --                     --         --          --        1
Clostridium botulinum                 --       --       --        --        --       --                      2         --           1       --
Clostridium perfringens                2       --       --        --        --       --                     --         --          --       --
Escherichia coli                      --       --       --        --        --       --                     --         --          --       --
Listeria                              --       --       --        --        --       --                     --         --          --       --
monocytogenes
Salmonella                             1        1       --        --         1        3                     --          1          --       --
Shigella                              --       --       --        --        --       --                     --         --          --       --
Staphylococcus                        --        3       --        --        --       --                     --         --           1       --
aureus
Streptococcus Group A                 --       --       --        --        --       --                     --         --          --       --

Total bacterial                        4        4       --        --         2        3                      2          1           2        1

Chemical
Ciguatoxin                            --       --       --        --        --       --                      1         --          18       --
Heavy metals                          --       --       --        --        --       --                     --         --          --       --
Scombrotoxin                          --       --       --        --        --       --                     --         --          17       --

Total chemical                        --       --       --        --        --       --                      1         --          35       --

Parasitic
Giardia lamblia                       --       --       --        --        --       --                     --         --          --       --
Trichinella spiralis                  --       --       --         1        --       --                      3         --          --       --

Total parasitic                       --       --       --         1        --       --                      3         --          --       --

Viral
Hepatitis A                           --       --       --        --        --       --                      1         --          --       --
Norwalk                               --       --       --        --        --       --                     --         --          --       --

Total viral                           --       --       --        --        --       --                      1         --          --       --

Confirmed etiology                     4        4       --         1         2        3                      7          1          37        1

Unknown etiology                       8        2       --         1         7        3                      1          7           2        2

Total 1988                            12        6       --         2         9        6                      8          8          39        3
---------------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
===============================================================================================================================================================

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Table_22B
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TABLE 22. Number of reported foodborne-disease outbreaks, by etiology and vehicle of transmission -- United States, * 1989, continued
============================================================================================================================================================
                                                         Vehicle of transmission
                           ---------------------------------------------------------------------------------------------------------------------------------
Etiology                    Cheese     Eggs   Ice cream    Other/ multiple  Baked foods    Fruits and  Potato salad    Poultry     Other    Chinese
                                                                     dairy                 vegetables                  fish, egg   salad       food
                                                                                                                         salad
------------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                 --       --          --                 --           --            --            --         --        --          2
Campylobacter                   --       --          --                 --           --             1            --         --        --         --
Clostridium botulinim           --       --          --                 --           --             7            --         --        --         --
Clostridium perfringens         --       --          --                 --           --            --            --         --        --         --
Escherichia coli                --       --          --                 --           --            --            --         --        --         --
Listeria monocytogenes          --       --          --                 --           --            --            --         --        --         --
Salmonella                       1        3           1                 --            3             3             1          1         5          1
Shigella                        --       --          --                 --           --            --             1         --         2         --
Staphylococcus aureus           --       --          --                 --           --            --            --         --        --          1
Streptococcus Group A           --       --          --                 --           --            --            --         --        --         --

Total bacterial                  1        3           1                 --            3            11             2          1         7          4

Chemical
Ciguatoxin                      --       --          --                 --           --            --            --         --        --         --
Heavy metal                     --       --          --                 --           --            --            --         --        --         --
Scombrotoxin                    --       --          --                 --           --            --            --         --        --         --

Total chemical                  --       --          --                 --           --            --            --         --        --         --

Parasitic
Giardia lamblia                 --       --          --                 --           --            --            --         --        --         --
Trichinella spiralis            --       --          --                 --           --            --            --         --        --         --

Total parasitic                 --       --          --                 --           --            --            --         --        --         --

Viral
Hepatitis A                     --       --          --                 --           --            --            --         --        --         --
Norwalk                         --       --          --                 --           --            --            --         --        --         --

Total viral                     --       --          --                 --           --            --            --         --        --         --

Confirmed etiology               1        3           1                 --            3            11             2          1         7          4

Unknown etiology                --       --          --                  1           --            10             1          2        10          2

Total 1989                       1        3           1                  1            3            21             3          3        17          6
------------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
============================================================================================================================================================

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Table_22C
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TABLE  22.  Number  of  reported foodborne-disease outbreaks, by etiology and vehicle of transmission -- United States, * 1989, continued
========================================================================================================================================================

                                                      Vehicle of transmission
                           ---------------------------------------------------------------------------
Etiology                   Mexican food       Carbonated         Non-dairy        Multiple  Mushrooms       Total known      Total unknown     Total
                                                   drink          beverage        vehicles                      vehicle            vehicle
--------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                      --               --                --              --         --                 3                 --         3
Campylobacter                        --               --                --               2         --                 5                  3         8
Clostridium botulinim                --               --                --               1         --                11                  2        13
Clostridium perfringens               3               --                --               1         --                 6                  1         7
Escherichia coli                     --               --                --              --         --                --                  1         1
Listeria monocytogenes               --               --                --              --         --                --                  1         1
Salmonella                           --               --                 1              29         --                56                 61       117
Shigella                             --               --                --               1         --                 4                  2         6
Staphylococcus aureus                 1               --                --               7          1                14                 --        14
Streptococcus Group A                --               --                --              --         --                --                  1         1

Total bacterial                       4               --                 1              41          1                99                 72       171

Chemical
Ciguatoxin                           --               --                --              --         --                19                 --        19
Heavy metals                         --               --                --               1         --                 1                 --         1
Scombrotoxin                         --               --                --               1         --                17                 --        17

Total chemical                       --               --                 1              --         --                37                 --        37

Parasitic
Giardia lamblia                      --               --                --               1         --                 1                 --         1
Trichinella spiralis                 --               --                --              --         --                 4                 --         4

Total parasitic                      --               --                --               1         --                 5                 --         5

Viral
Hepatitis A                           1               --                --              --         --                 2                  5         7
Norwalk                              --               --                --              --         --                --                  1         1

Total viral                           1               --                --              --         --                 2                  6         8

Confirmed etiology                    5               --                 1              43          1               143                 78       221

Unknown etiology                      2               --                 1              32         --                94                190       284

Total 1989                            7               --                 2              75          1               237                268       505
--------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
========================================================================================================================================================

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Table_23A
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TABLE  23. Number of reported foodborne-disease outbreaks, by etiology and vehicle of transmission -- United States, * 1990
===============================================================================================================================================
                                                                          Vehicle of transmission
                                  -------------------------------------------------------------------------------------------------------------
Etiology                           Beef      Ham     Pork   Sausage    Chicken    Turkey    Other meats and   Shellfish  Other fish     Milk
                                                                                                      stews
-----------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                      --       --       --        --         --        --                 --          --          --       --
Campylobacter                        --       --       --        --         --        --                 --          --          --        1
Clostridium botulinim                --       --       --         1         --        --                 --          --           3       --
Clostridium perfringens               2       --       --        --          1         1                 --          --          --       --
Escherichia coli                      1       --       --        --         --        --                 --          --          --       --
Salmonella                            2       --       --        --          3         3                  2           2           1       --
Shigella                             --       --       --        --         --        --                 --           1           1       --
Staphylococcus aureus                 2        3        1        --          1        --                 --          --          --       --
Vibrio cholerae                      --       --       --        --         --        --                 --          --          --       --
Vibrio                               --       --       --        --         --        --                 --           4          --       --
parahemolyticus
Vibrio vulnificus                    --       --       --        --         --        --                 --           1          --       --

Total bacterial                       7        3        1         1          5         4                  2           8           5        1

Chemical
Ciguatoxin                           --       --       --        --         --        --                 --          --          11       --
Mushroom poisoning                   --       --       --        --         --        --                 --          --          --       --
Paralytic shellfish                  --       --       --        --         --        --                 --           2          --       --
Scombrotoxin                         --       --       --        --         --        --                 --          --          11       --
Other chemical                       --       --       --        --         --        --                 --          --          --       --

Total chemical                       --       --       --        --         --        --                 --           2          22       --

Parasitic
Giardia lamblia                      --       --       --        --         --        --                 --          --          --       --
Trichinella spiralis                 --       --        2        --         --        --                 --          --          --       --

Total parasitic                      --       --        2        --         --        --                 --          --          --       --

Viral
Hepatitis A                          --       --       --        --         --        --                 --          --          --       --

Confirmed etiology                    7        3        3         1          5         4                  2          10          27        1

Unknown etiology                      6        1       --        --          2         2                 --           1           4        2

Total 1990                           13        4        3         1          7         6                  2          11          31        3
-----------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
===============================================================================================================================================

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Table_23B
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TABLE  23. Number of reported foodborne-disease outbreaks, by etiology and vehicle of transmission -- United States, * 1990, continued
================================================================================================================================================================
                                                                                Vehicle of transmission
                              ----------------------------------------------------------------------------------------------------------------------------------
                                Cheese     Eggs   Ice cream    Other/multiple  Baked foods       Fruits and    Potato salad   Poultry,   Other    Chinese
                                                                        dairy                    vegetables                   fish, egg
Etiology                                                                                                                      salad
----------------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                     --       --          --                --            1               --             --        --      --           4
Campylobacter                       --       --          --                --           --               --             --        --      --          --
Clostridium botulinim               --       --          --                --           --                4             --        --      --          --
Clostridium                         --       --          --                --           --               --             --        --      --          --
perfringens
Escherichia coli                    --       --          --                --           --               --             --        --      --          --
Salmonella                           2        5           4                --            1                3             --         2       4          --
Shigella                            --       --          --                --           --               --             --         1      --          --
Staphylococcus aureus               --       --          --                --            1               --             --        --       1           1
Vibrio cholerae                     --       --          --                --           --               --             --        --      --          --
Vibrio                              --       --          --                --           --               --             --        --      --          --
parahemolyticus
Vibrio vulnificus                   --       --          --                --           --               --             --        --      --          --

Total bacterial                      2        5           4                --            3                7             --         3       5           5

Chemical
Ciguatoxin                          --       --          --                --           --               --             --        --      --          --
Mushroom poisoning                  --       --          --                --           --               --             --        --      --          --
Paralytic shellfish                 --       --          --                --           --               --             --        --      --          --
Scombrotoxin                        --       --          --                --           --               --             --        --      --          --
Other chemical                      --       --           1                --           --               --             --        --      --          --

Total chemical                      --       --           1                --           --               --             --        --      --          --

Parasitic
Giardia lamblia                     --       --          --                --           --                1             --        --       1          --
Trichinella spiralis                --       --          --                --           --               --             --        --      --          --

Total parasitic                     --       --          --                --           --                1             --        --       1          --

Viral
Hepatitis A                          1       --          --                --           --                2             --        --      --          --

Confirmed etiology                   3        5           5                --            3               10             --         3       6           5

Unknown etiology                    --       --           1                 1            4                5              1         3      14          --

Total 1990                           3        5           6                 1            7               15              1         6      20           5
----------------------------------------------------------------------------------------------------------------------------------------------------------------
* Imcludes Guam, Puerto Rico, and the U.S. Virgin Islands.
================================================================================================================================================================

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Table_23C
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TABLE 23. Number of reported foodborne-disease outbreaks, by etiology and vehicle of transmission -- United States, * 1990, continued
=======================================================================================================================================================
                                                       Vehicle of transmission
                            ---------------------------------------------------------------------------
Etiology                     Mexican food      Carbonated        Non-dairy         Multiple  Mushrooms       Total known      Total unknown
                                                    drink         beverage         vehicles                      vehicle            vehicle    Total
-------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                        --              --               --               --         --                 5                 --        5
Campylobacter                          --              --               --               --         --                 1                  2        3
Clostridium botulinim                  --              --               --               --         --                 8                  4       12
Clostridium                             2              --               --                4         --                10                  1       11
perfringens
Escherichia coli                       --              --               --               --         --                 1                  1        2
Salmonella                              2              --               --               28         --                64                 72      136
Shigella                               --              --               --               --         --                 3                  5        8
Staphylococcus aureus                   1              --               --                1         --                12                  1       13
Vibrio cholerae                        --              --               --                1         --                 1                 --        1
Vibrio                                 --              --               --               --         --                 4                 --        4
parahemolyticus
Vibrio vulnificus                      --              --               --               --         --                 1                 --        1

Total bacterial                         5              --               --               34         --               110                 86      196

Chemical
Ciguatoxin                             --              --               --               --         --                11                 --       11
Mushroom poisoning                     --              --               --               --          1                 1                 --        1
Paralytic shellfish                    --              --               --               --         --                 2                 --        2
Scombrotoxin                           --              --               --               --         --                11                 --       11
Other chemical                         --               1               --               --         --                 2                 --        2

Total chemical                         --               1               --               --          1                27                 --       27

Parasitic
Giardia lamblia                        --              --               --               --         --                 2                  1        3
Trichinella spiralis                   --              --               --               --         --                 2                 --        2

Total parasitic                        --              --               --               --         --                 4                  1        5

Viral
Hepatitis A                            --              --               --                3         --                 6                  3        9

Confirmed etiology                      5               1               --               37          1               147                 90      237

Unknown etiology                        5               1               --               42         --                95                200      295

Total 1990                             10               2               --               79          1               242                290      532
-------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=======================================================================================================================================================

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Table_24A
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TABLE  24. Number of reported foodborne-disease outbreaks, by etiology and vehicle of transmission -- United States, * 1991
==============================================================================================================================================

                                                                          Vehicle of transmission
                                   -----------------------------------------------------------------------------------------------------------
                                   Beef     Ham     Pork  Sausage   Chicken   Turkey    Other meats and  Shellfish      Other     Milk
Etiology                                                                                          stews                  fish
----------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                      --      --        1       --        --       --                 --         --         --       --
Campylobacter                        --      --       --       --        --       --                  1         --         --       --
Clostridium                          --      --       --       --        --       --                  3         --          3       --
botulinum
Clostridium                           1       1       --       --        --        2                  1         --         --       --
perfringens
Escherichia coli                     --      --       --       --        --       --                 --         --         --       --
Salmonella                            1      --        1       --         6       --                 --          1          1        1
Shigella                             --      --       --       --        --       --                  1          1         --       --
Staphylococcus aureus                --      --       --       --        --       --                 --         --         --       --
Streptococcus Group A                --      --       --       --        --       --                 --         --         --       --
Vibrio cholerae                      --      --       --       --        --       --                 --          1         --       --

Total bacterial                       2       1        2       --         6        2                  6          3          4        1

Chemical
Ciguatoxin                           --      --       --       --        --       --                 --         --          7       --
Mushroom poisoning                   --      --       --       --        --       --                 --         --         --       --
Paralytic shellfish                  --      --       --       --        --       --                 --          2         --       --
Scombrotoxin                         --      --       --       --        --       --                  1         --         16       --
Other chemical                       --      --       --       --        --       --                 --         --         --       --

Total chemical                       --      --       --       --        --       --                  1          2         23       --

Parasitic
Giardia lamblia                      --      --       --       --        --       --                 --         --         --       --
Trichinella                          --      --       --        1        --       --                 --         --         --       --
spiralis

Total parasitic                      --      --       --        1        --       --                 --         --         --       --

Viral
Hepatitis A                          --      --       --       --        --       --                 --         --         --       --

Confirmed etiology                    2       1        2        1         6        2                  7          5         27        1

Unknown etiology                     11       1        1       --         4        7                  2          2          2       --

Total 1991                           13       2        3        1        10        9                  9          7         29        1
----------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
==============================================================================================================================================

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Table_24B
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TABLE 24. Number of reported foodborne-disease outbreaks, by etiology and vehicle of transmission -- United States, * 1991, continued
=====================================================================================================================================================
                                                                Vehicle of transmission
                           --------------------------------------------------------------------------------------------------------------------------
                            Cheese     Eggs  Ice cream         Other/                                          Poultry,
                                                             multiple       Baked    Fruits and       Potato   fish, egg      Other    Chinese
Etiology                                                        dairy       foods    vegetables        salad   egg salad      salad    food
-----------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                 --       --         --             --          --            --           --        --      --          2
Campylobacter                   --       --         --             --          --            --           --        --      --         --
Clostridium                     --       --         --             --          --             4           --        --      --         --
botulinum
Clostridium                     --       --         --             --          --            --           --        --      --         --
perfringens
Escherichia coli                --       --         --             --          --            --           --        --      --         --
Salmonella                      --        1          3             --           2             3            1         1       4         --
Shigella                        --       --         --             --          --            --           --        --      --         --
Staphylococcus                  --       --         --              1           2            --            1         1      --          1
aureus
Streptococcus Group A           --       --         --             --          --            --           --        --      --         --
Vibrio cholerae                 --       --         --             --          --             1           --        --      --         --

Total bacterial                 --        1          3              1           4             8            2         2       4          3

Chemical
Ciguatoxin                      --       --         --             --          --            --           --        --      --         --
Mushroom poisoning              --       --         --             --          --            --           --        --      --         --
Paralytic shellfish             --       --         --             --          --            --           --        --      --         --
Scombrotoxin                    --       --         --             --          --            --           --        --      --         --
Other chemical                  --       --          1             --          --            --           --        --      --         --

Total chemical                  --       --          1             --          --            --           --        --      --         --

Parasitic
Giardia lamblia                 --       --         --             --          --             1           --        --      --         --
Trichinella                     --       --         --             --          --            --           --        --      --         --
spiralis

Total parasitic                 --       --         --             --          --             1           --        --      --         --

Viral
Hepatitis A                     --       --         --             --           1            --           --        --       1         --

Confirmed etiology              --        1          4              1           5             9            2         2       5          3

Unknown etiology                 1        1         --              1           6             3           --         1      12          1

Total 1991                       1        2          4              2          11            12            2         3      17          4
-----------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=====================================================================================================================================================

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Table_24C
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TABLE 24. Number of reported foodborne-disease outbreaks, by etiology and vehicle of transmission -- United States, * 1991, continued
======================================================================================================================================================
                                                           Vehicle of transmission
                            -----------------------------------------------------------------------------
Etiology                    Mexican food      Carbonated        Non-dairy         Multiple    Mushrooms       Total known     Total unknown   Total
                                                   drink         beverage         vehicles                        vehicle           vehicle
------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                       --              --               --                2           --                 5                --       5
Campylobacter                         --              --               --                1           --                 2                 4       6
Clostridium                           --              --               --               --           --                10                 1      11
botulinum
Clostridium                            1              --               --                3           --                 9                 1      10
perfringens
Escherichia coli                      --              --                1                1           --                 2                 1       3
Salmonella                             1              --               --               30           --                57                65     122
Shigella                              --              --               --               --           --                 2                 2       4
Staphylococcus                         1              --               --                2           --                 9                --       9
aureus
Streptococcus Group A                 --              --               --                1           --                 1                --       1
Vibrio cholerae                       --              --               --               --           --                 2                --       2

Total bacterial                        3              --                1               40           --                99                74     173

Chemical
Ciguatoxin                            --              --               --               --           --                 7                --       7
Mushroom poisoning                    --              --               --               --            2                 2                --       2
Paralytic shellfish                   --              --               --               --           --                 2                --       2
Scombrotoxin                          --              --               --               --           --                17                --      17

Other chemical                        --               1                1               --           --                 3                --       3

Total chemical                        --               1                1               --            2                31                --      31

Parasitic
Giardia lamblia                       --              --               --               --           --                 1                 1       2
Trichinella                           --              --               --               --           --                 1                --       1
spiralis

Total parasitic                       --              --               --               --           --                 2                 1       3

Viral
Hepatitis A                           --              --               --               --           --                 2                 5       7

Confirmed etiology                     3               1                2               40            2               134                80     214

Unknown etiology                       4              --                1               40           --               101               213     314

Total 1991                             7               1                3               80            2               235               293     528
------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
======================================================================================================================================================

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Table_25A
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TABLE 25. Number of reported foodborne-disease outbreaks, by etiology and vehicle of transmission -- United States, * 1992
==========================================================================================================================================
                                                                 Vehicle of transmission
                                   -------------------------------------------------------------------------------------------------------
Etiology                            Beef    Ham   Pork   Sausage  Chicken   Turkey        Other meats  Shellfish  Other fish     Milk
                                                                                            and stews
------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                       --     --     --        --        1       --                 --         --          --       --
Campylobacter                         --     --     --        --       --       --                 --         --          --        2
Campylobacter/Salmon                  --     --     --        --        1       --                 --         --          --       --
ella
Clostridium                           --     --     --        --       --       --                 --         --           2       --
botulinum
Clostridium                            2     --     --        --        1        1                  1         --          --       --
perfringens
Escherichia coli                      --     --     --        --       --       --                 --         --          --        1
Salmonella                            --     --     --        --       --       --                 --         --          --       --
Shigella                              --     --     --        --       --       --                 --         --          --       --
Staphylococcus                         2      1     --        --       --       --                 --         --          --       --
aureus
Vibrio cholerae                       --     --     --        --       --       --                 --         --          --       --

Total bacterial                        4      1     --        --        3        1                  1         --           2        3

Chemical
Ciguatoxin                            --     --     --        --       --       --                 --         --           1       --
Scombrotoxin                          --     --     --        --       --       --                 --         --          14       --
Other chemical                        --     --     --        --       --       --                 --         --           1       --

Total chemical                        --     --     --        --       --       --                 --         --          16       --

Parasitic
Giardia lamblia                       --     --     --        --       --       --                 --         --          --       --

Viral
Hepatitis A                           --     --     --        --       --       --                 --         --          --       --
Norwalk-like virus                    --     --     --        --       --       --                 --         --          --       --

Total viral                           --     --     --        --       --       --                 --         --          --       --

Confirmed etiology                     4      1     --        --        3        1                  1         --          18        3

Unknown etiology                       5      1     --        --        4        2                  2          5           2       --

Total 1992                             9      2     --        --        7        3                  3          5          20        3
------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
==========================================================================================================================================

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Table_25B
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TABLE 25. Number of reported foodborne-disease outbreaks, by etiology and vehicle of transmission -- United States, * 1992, continued
===============================================================================================================================================

                                                                   Vehicle of transmission
                         ----------------------------------------------------------------------------------------------------------------------
Etiology                   Cheese     Eggs  Ice cream        Other/       Baked    Fruits and   Potato salad   Poultry,   Other   Chinese
                                                           multiple       foods    vegetables                 fish, egg   salad      food
                                                              dairy                                              salad
-----------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                --       --         --            --          --            --             --        --      --          1
Campylobacter                  --       --         --            --          --            --             --        --      --         --
Campylobacter/Salm             --       --         --            --          --            --             --        --      --         --
onella
Clostridium                    --       --         --            --          --            --              1        --      --         --
botulinum
Clostridium                    --       --         --            --          --            --             --         1      --         --
perfringens
Escherichia coli               --       --         --            --          --            --             --        --      --         --
Salmonella                     --        3          2             1           3            --              1         2       3         --
Shigella                       --       --         --            --          --            --             --        --      --         --
Staphylococcus                 --       --         --            --          --            --             --        --      --         --
aureus
Vibrio cholerae                --       --         --            --          --            --             --        --      --         --

Total bacterial                --        3          2             1           3            --              2         3       3          1

Chemical
Ciguatoxin                     --       --         --            --          --            --             --        --      --         --
Scombrotoxin                   --       --         --            --          --            --             --        --      --         --
Other chemical                 --       --         --            --          --            --             --        --      --         --

Total chemical                 --       --         --            --          --            --             --        --      --         --

Parasitic
Giardia lamblia                --       --         --            --          --            --             --        --      --         --

Viral
Hepatitis A                    --       --         --            --          --            --             --        --      --         --
Norwalk-like virus             --       --         --            --          --            --             --        --      --         --

Total viral                    --       --         --            --          --            --             --        --      --         --

Confirmed etiology             --        3          2             1           3            --              2         3       3          1

Unknown etiology               --       --          1            --           3             2              1         2       8          1

Total 1992                     --        3          3             1           6             2              3         5      11          2
-----------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
===============================================================================================================================================

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Table_25C
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TABLE  25. Number of reported foodborne-disease outbreaks, by etiology and vehicle of transmission -- United States, * 1992, continued
======================================================================================================================================================

                                                        Vehicle of transmission
                            ---------------------------------------------------------------------------
Etiology                    Mexican food      Carbonated         Non-dairy        Multiple   Mushrooms       Total known      Total unknown   Total
                                                   drink          beverage        vehicles                       vehicle            vehicle
------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                       --              --                --               1          --                 3                 --       3
Campylobacter                         --              --                --               1          --                 3                  3       6
Campylobacter/Salmon                  --              --                --              --          --                 1                 --       1
ella
Clostridium                           --              --                --              --          --                 3                  1       4
botulinum
Clostridium                            2              --                --               1          --                 9                  3      12
perfringens
Escherichia coli                      --              --                --              --          --                 1                  2       3
Salmonella                             1              --                --              19          --                35                 45      80
Shigella                              --              --                --              --          --                --                  1       1
Staphylococcus                        --              --                --               3          --                 6                 --       6
aureus
Vibrio cholerae                       --              --                --              --          --                --                  1       1

Total bacterial                        3              --                --              25          --                61                 56     117

Chemical
Ciguatoxin                            --              --                --              --          --                 1                 --       1
Scombrotoxin                          --              --                --              --          --                14                  1      15
Other chemical                        --              --                --               2          --                 3                 --       3

Total chemical                        --              --                --               2          --                18                  1      19

Parasitic
Giardia lamblia                       --              --                --              --          --                --                  1       1

Total parasitic                       --              --                --              --          --                --                  1       1

Viral
Hepatitis A                           --              --                --               1          --                 1                  7       8
Norwalk-like virus                    --              --                --               1          --                 1                 --       1

Total viral                           --              --                --               2          --                 2                  7       9

Confirmed etiology                     3              --                --              29          --                81                 65     146

Unknown etiology                       5              --                 1              25          --                70                191     261

Total 1992                             8              --                 1              54          --               151                256     407
------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
======================================================================================================================================================

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Table_26
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TABLE  26. Number of reported foodborne-disease outbreaks, by etiology and contributing factors -- United States, * 1988
=======================================================================================================================================================================
                                                                                                    Contributing factors

                                                            -----------------------------------------------------------------------------------------------------------
                                         No. of outbreaks         Improper        Inadequate        Contaminated    Food from unsafe     Poor personal     Other
                      No. of reported    in which factors          holding           cooking           equipment              source           hygiene
Etiology                    outbreaks            reported     temperatures
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                     5                   4                4                 1                  --                  --                --        --
Campylobacter                       4                   2               --                 2                  --                  --                 1        --
Clostridium                        20                   2               --                --                  --                   2                --        --
botulinum
Escherichia coli                    2                   2                1                 2                  --                   2                --        --
Salmonella                         94                  73               40                35                  15                   9                37        12
Shigella                            6                   5                3                --                   1                  --                 4        --
Staphylococcus                      8                   7                6                 1                   1                  --                 5         2
aureus

Total bacterial                   139                  95               54                41                  17                  13                47        14

Chemical
Ciguatoxin                          4                   1               --                --                  --                  --                --         1
Heavy metals                        2                   2                1                --                  --                  --                 1         2
Mushroom poisoning                  2                   2               --                --                  --                   2                --        --
Paralytic shellfish                 1                   1               --                --                  --                   1                --        --
Scombrotoxin                       16                   8                8                --                  --                   2                --        --
Other chemical                      4                   4                1                --                   1                   2                --         1

Total chemical                     29                  18               10                --                   1                   7                 1         4

Parasitic
Trichinella spiralis                3                   2               --                --                  --                   2                --        --

Viral
Hepatitis A                        12                  11                1                --                  --                   3                 8         2

Confirmed etiology                183                 126               65                41                  18                  25                56        20

Unknown etiology                  268                 145               94                29                  18                   4                62        30

Total 1988                        451                 271              159                70                  36                  29               118        50
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=======================================================================================================================================================================

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Table_27
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TABLE  27. Number of reported foodborne-disease outbreaks, by etiology and contributing factors -- United States, * 1989
=======================================================================================================================================================================

                                                                                                          Contributing factors
                                      No. of outbreals    -------------------------------------------------------------------------------------------------------------
Etiology            No. of reported   in which factors    Improper holding         Inadequate       Contaminated    Food from unsafe     Poor personal     Other
                          outbreaks           reported        temperatures            cooking          equipment              source           hygiene
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                   3                  1                   1                  1                 --                  --                --        --
Campylobacter                     8                  7                   3                  4                  5                   1                 3        --
Clostridium                      13                  8                   4                  6                 --                  --                --
botulinum
Clostridium                       7                  5                   5                  1                 --                  --                --         1
perfringens
Escherichia coli                  1                 --                  --                 --                 --                  --                --        --
Listeria                          1                 --                  --                 --                 --                  --                --        --
monocytogenes
Salmonella                      117                 72                  39                 36                 21                  11                26         7
Shigella                          6                  4                   2                 --                  1                  --                 4        --
Staphylococcus                   14                 13                  11                  4                 --                   2                 7         2
aureus
Streptococcus                     1                  1                  --                 --                 --                  --                --         1
Group A

Total bacterial                 171                111                  65                 52                 27                  14                40        11

Chemical
Ciguatoxin                       19                  8                  --                 --                 --                   6                --         2
Heavy metals                      1                  1                  --                 --                 --                   1                --
Scombrotoxin                     17                 10                   7                  1                 --                   1                --         1

Total chemical                   37                 19                   7                  1                 --                   8                --         3

Parasitic
Giardia lamblia                   1                 --                  --                 --                 --                  --                --        --
Trichinella                       4                 --                  --                 --                 --                  --                --        --
spiralis

Total parasitic                   5                 --                  --                 --                 --                  --                --        --

Viral
Hepatitis A                       7                  4                  --                 --                 --                  --                 4        --
Norwalk                           1                  1                  --                 --                 --                  --                 1        --

Total viral                       8                  5                  --                 --                 --                  --                 5        --

Confirmed etiology              221                135                  72                 53                 27                  22                45        14

Unknown etiology                284                136                  82                 27                 22                  13                56        24

Total 1989                      505                271                 154                 80                 49                  35               101        38
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
=======================================================================================================================================================================

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Table_28
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TABLE 28. Number of reported foodborne-disease outbreaks, by etiology and contributing factors -- United States, * 1990
======================================================================================================================================================================

                                                                                                            Contributing factors
                                          No. of outbreaks -----------------------------------------------------------------------------------------------------------
Etiology                No. of reported   in which factors  Improper holding       Inadequate       Contaminated    Food from unsafe     Poor personal     Other
                              outbreaks           reported      temperatures          cooking          equipment              source           hygiene
----------------------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                       5                  4                 4                1                  1                  --                 1        --
Campylobacter                         3                  3                 1               --                 --                   1                --         1
Clostridium                          12                  6                 3                4                 --                  --                --         1
botulinum
Clostridium                          11                 11                 9                6                  2                  --                --         1
perfringens
Escherichia coli                      2                  2                 1                2                  1                  --                --        --
Salmonella                          136                 86                51               49                 21                  13                34         3
Shigella                              8                  4                 1               --                  1                  --                 4        --
Staphylococcus                       13                  9                 9                4                  1                   2                 4        --
aureus
Vibrio cholerae                       1                  1                 1                1                 --                   1                 1        --
Vibrio                                4                  3                --                3                 --                   2                --        --
parahemolyticus
Vibrio vulnificus                     1                 --                --               --                 --                  --                --        --

Total bacterial                     196                129                80               70                 27                  19                44         6

Chemical
Ciguatoxin                           11                  5                 1               --                 --                   3                --         1
Mushroom poisoning                    1                 --                --               --                 --                  --                --        --
Paralytic shellfish                   2                  2                --               --                 --                   2                --        --
Scombrotoxin                         11                  7                 7               --                  1                   1                --        --
Other chemical                        2                  2                --               --                 --                  --                --         2

Total chemical                       27                 16                 8               --                  1                   6                --         3

Parasitic
Giardia lamblia                       3                  2                --               --                 --                  --                 2        --
Trichinella spiralis                  2                  2                --                2                 --                  --                --        --

Total parasitic                       5                  4                --                2                 --                  --                 2        --

Viral
Hepatitis A                           9                  9                --               --                 --                   1                 8        --

Confirmed etiology                  237                158                88               72                 28                  26                54         9

Unknown etiology                    295                160                89               20                 22                  16                61        14

Total 1990                          532                318               177               92                 50                  42               115        23
----------------------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
======================================================================================================================================================================

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Table_29
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TABLE 29. Number of reported foodborne-disease outbreaks, by etiology and contributing factors -- United States, * 1991
======================================================================================================================================================================

                                                                                                                    Contrubiting factors
                                         No. of outbreaks  -----------------------------------------------------------------------------------------------------------
Etiology               No. of reported   in which factors   Improper holding         Inadequate       Contaminated   Food from unsafe      Poor personal    Other
                             outbreaks           reported       temperatures            cooking          equipment             source            hygiene
----------------------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                      5                  4                  4                 --                 --                  1                 --        1
Campylobacter                        6                  5                  2                  1                  4                 --                 --        1
Clostridium                         11                  2                 --                  2                 --                 --                 --       --
botulinum
Clostridium                         10                  9                  9                  2                 --                 --                  1       --
perfringens
Escherichia coli                     3                  3                  2                  2                 --                 --                 --        1
Salmonella                         122                 84                 52                 40                 23                 15                 31        1
Shigella                             4                  3                  1                  1                 --                 --                  1       --
Staphylococcus                       9                  8                  7                  2                 --                 --                  1       --
aureus
Streptococcus Group                  1                  1                  1                  1                 --                 --                  1       --
A
Vibrio cholerae                      2                  1                  1                  1                 --                 --                 --       --

Total bacterial                    173                120                 79                 52                 27                 16                 35        4

Chemical
Ciguatoxin                           7                  4                 --                 --                 --                  1                 --        3
Mushroom poisoning                   2                  2                 --                 --                 --                  2                 --       --
Paralytic shellfish                  2                  2                 --                 --                 --                  2                 --       --
Scombrotoxin                        17                 14                 13                 --                 --                  5                 --        1
Other chemical                       3                  2                 --                 --                  1                 --                 --        1

Total chemical                      31                 24                 13                 --                  1                 10                 --        5

Parasitic
Giardia lamblia                      2                  2                  1                 --                  1                 --                  1       --
Trichinella                          1                  1                 --                  1                 --                 --                 --       --
spiralis

Total parasitic                      3                  3                  1                  1                  1                 --                  1       --

Viral
Hepatitis A                          7                  5                  1                 --                 --                 --                  5       --

Confirmed etiology                 214                152                 94                 53                 29                 26                 41        9

Unknown etiology                   315                183                115                 36                 21                 12                 69       12

Total 1991                         529                335                209                 89                 50                 38                110       21
----------------------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
======================================================================================================================================================================

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Table_30
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TABLE 30. Number of reported foodborne-disease outbreaks, by etiology and contributing factors -- United States, * 1992
======================================================================================================================================================================

                                                                                                                  Contributing Factors
                                          No. of outbreaks ------------------------------------------------------------------------------------------------------------
Etiology               No. of reported    in which factors      Improper holding        Inadequate        Contaminated   Food from unsafe       Poor personal    Other
                             outbreaks            reported          temperatures           cooking           equipment             source             hygiene
----------------------------------------------------------------------------------------------------------------------------------------------------------------------
Bacterial
Bacillus cereus                      3                   3                     3                 1                   1                 --                   1       --
Campylobacter                        6                   4                     1                --                   2                  2                  --        1
Campylobacter/Salmonella             1                   1                     1                --                   1                 --                  --       --
Clostridium                          4                   1                    --                 1                  --                 --                  --       --
botulinum
Clostridium                         12                   8                     8                 4                   1                 --                  --      197
perfringens
Escherichia coli                     3                   2                     1                 1                   1                 --                  --       --
Salmonella                          80                  57                    33                31                  12                  4                  15        3
Shigella                             1                   0                    --                --                  --                 --                  --       --
Staphylococcus                       6                   5                     4                 4                   2                 --                   1       --
aureus
Vibrio cholerae                      1                   1                    --                --                  --                  1                  --       --

Total bacterial                    117                  82                    51                42                  20                  7                  17        4

Chemical
Ciguatoxin                           1                   0                    --                --                  --                 --                  --       --
Scombrotoxin                        15                  12                    10                 1                  --                  2                  --        2
Other chemical                       3                   3                    --                --                  --                  1                  --        2

Total chemical                      19                  15                    10                 1                  --                  3                  --        4

Parasitic
Giardia lamblia                      1                   0                    --                --                  --                 --                  --       --

Viral
Hepatitis A                          8                   8                    --                --                  --                 --                   7        1
Norwalk-like virus                   1                   1                    --                --                  --                 --                   1       --

Total viral                          9                   9                    --                --                  --                 --                   8        1

Confirmed etiology                 146                 106                    61                43                  20                 10                  25        9

Unknown etiology                   261                 134                    88                27                  24                  7                  45       14

Total 1992                         407                 240                   149                70                  44                 17                  70       23
----------------------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes Guam, Puerto Rico, and the U.S. Virgin Islands.
======================================================================================================================================================================

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