Infectious Disease

Sick workers implicated in 40% of foodborne outbreaks, CDC data show

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The authors report no relevant financial disclosures.

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Key takeaways:

  • Nearly two-thirds of foodborne outbreaks reported between 2017 and 2019 were caused by norovirus or Salmonella.
  • The most common cause of foodborne outbreaks is a sick worker.

Roughly 40% of foodborne illness outbreaks in the United States are caused by a sick or infectious food worker despite most food establishments having policies against employees coming to work when ill, data show.

According to a study published Tuesday in MMWR, the top five contributing factors to foodborne outbreaks between 2017 and 2019 were related to contamination, with the most common contributing factor being a worker believed to have an infectious illness.

IDN0523Moritz_Graphic_01_WEB

Data derived from Moritz ED, et al. MMWR Morb Mortal Wkly Rep. 2023;doi:10.15585/mmwr.ss7206a1.

The most common pathogens linked to outbreaks were norovirus and salmonella, which caused nearly two-thirds of foodborne outbreaks during the same timeframe.

The CDC has previously found that most norovirus outbreaks in the United States are linked to food service workers.

The FDA Food Code, created in 1992, requires that food workers tell their manager when they are sick and specify if they are experiencing vomiting, diarrhea, jaundice, sore throat with fever and/or lesions with pus. Establishments are required to prevent sick workers from handling food or from working.

Since the code was created, the FDA has undertaken studies to improve its efficacy.

Although the overall majority of food establishments included in the new study had policies requiring food workers to notify their manager if they were sick, most did include the five symptoms.

“These findings are consistent with findings from other national outbreak data sets and highlight the role of ill workers in foodborne illness outbreaks,” the authors wrote. “Although a majority of managers reported their establishment had an ill worker policy, often these policies were missing components intended to reduce foodborne illness risk.”

Erin D. Moritz, PhD, an officer in the CDC’s Epidemic Intelligence Service, and colleagues analyzed data on 800 foodborne illness outbreaks linked to 875 retail food establishments and reported to the National Environmental Assessment Reporting System (NEARS) by state and local health authorities between 2017 and 2019.

According to the study, 69.4% of outbreaks had a confirmed or suspected agent, with norovirus and salmonella accounting for 47% and 18.6% of outbreaks, respectively. Overall, about half of the outbreaks reported to NEARS were caused by a bacteria existing either in unsafe levels in foods or somewhere along the food production chain. Roughly 40% of the outbreaks had at least one reported factor linked to a sick or infectious food worker, the researchers reported.

Among retail food establishment managers interviewed after an outbreak, 91.7% said their establishment had a policy requiring employees to tell their manager when they were sick and 66% said the policies were written.

Just 23% of managers, however, said their policy required the five symptoms in the food code be reported. In all, 85.5% of establishments restricted sick people from working and 62.4% said their policies were written down. Just 17.8% said their policy listed that the symptoms would exclude them from work.

According to the researchers, previous research suggests that written policies are more effective than verbal policies, and that “the existence of written policies alone is unlikely to markedly reduce incidence of foodborne illness outbreaks in retail establishments.”

The researchers noted that food workers reported a variety of reasons for working when they were sick, most notably loss of pay and social pressure, and data showed that less than half of food establishments offered sick leave.

“Contamination of food by ill or infectious food workers is an important cause of outbreaks,” the researchers wrote. “Therefore, the content and enforcement of existing policies might need to be re-examined and refined.”

References:

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