Foodborne illness affects an estimated 48 million people in the United States each year, resulting in 128,000 hospitalizations and 3,000 deaths. Causes of foodborne illnesses include viruses such as norovirus; bacteria such as Escherichia coli, Salmonella, Campylobacter, and Listeria; and parasites such as Giardia. Factors that contribute to foodborne illness include contamination of food by an animal or environmental source before final preparation, improper food handling by an ill worker, inadequate cooking, improper temperature control, and consumption of uncooked or unpasteurized foods. Common symptoms include vomiting, diarrhea, fever, and abdominal pain. Diagnosis and management of foodborne illness should be guided by epidemiologic context, host risk factors, and clinical severity. Empiric treatment includes symptom management, rehydration, and antibiotic therapy. Prevention of foodborne illnesses involves education on food recalls and proper storage, handling, and cooking of food. Foodborne illnesses should be reported to local and state health agencies.
Foodborne illness affects an estimated 48 million people in the United States each year, resulting in 128,000 hospitalizations and 3,000 deaths.1 Causes include viral, bacterial, and parasitic infections. Although outbreaks of foodborne illness are more often publicized, most cases are individual and not associated with an outbreak from a common source.2 Most of what is known about common-source outbreaks is from a small fraction of cases that are investigated by the Interagency Food Safety Analytics Collaboration formed by the Centers for Disease Control and Prevention (CDC), US Food and Drug Administration (FDA), US Department of Agriculture's Food Safety and Inspection Service, and state and local health authorities.3,4
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| Reduced osmolarity oral rehydration solution is recommended as first-line therapy for mild to moderate dehydration in patients with acute vomiting or diarrhea.14,19,27 | B | Consistent evidence from randomized controlled trials showing reduced morbidity and mortality |
| A single dose of ondansetron is recommended to maintain hydration in children with clinically significant vomiting from acute gastroenteritis.31 | A | Consistent evidence from a systematic review of randomized controlled trials |
| Empiric antibiotics should be reserved for patients with severe symptoms or high-risk comorbidities, including infants younger than 3 months with a suspected bacterial etiology; immunocompetent patients with fever, abdominal pain, bloody diarrhea, or abdominal cramps; those who recently traveled internationally and have fever or signs of sepsis; and immunocompromised individuals.14 | C | Consensus guidelines |
| Suspected outbreaks of foodborne illness should be reported to the local or state health department. Outbreaks are then reported and tracked through Centers for Disease Control and Prevention surveillance programs such as FoodNet and the National Outbreak Reporting System.4,39 | C | Expert opinion and consensus guidelines |
FoodNet = Foodborne Diseases Active Surveillance Network.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
According to the CDC, norovirus is one of the most common causes of confirmed, single-etiology outbreaks.5 Noroviruses are environmentally hardy and can be transmitted via food, water, person-to-person contact, and contact with contaminated surfaces. Concentrations of disinfectants that are commonly used against bacteria are not effective against noroviruses.6
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