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Investigating a Common-Source, Food-Borne Outbreak

David R. Snydman, MD; Jules L. Dienstag, MD; Bonnie Stedt; Edward W. Brink, MD; Dyan M. Ryan; Karim A. Fawaz, MD

JAMA. 1981;245(8):827-830.

Abstract
An outbreak of hepatitis, type A, affecting 30 employees of a large metropolitan department store was investigated using traditional case findings, a food preference questionnaire, and case-control methods. In addition, the new serological tests for IgM and IgG antibody to hepatitis A virus (anti-HAV) were employed to establish a serological diagnosis of hepatitis A infection, to define the control group, and to identify the index case, an asymptomatic food handler. Twenty-five of 25 cases tested had IgM anti-HAV, whereas none of 73 controls and one of 46 food handlers were IgM anti-HAV positive. This test eliminated three suspect cases that were diagnosed as hepatitis but that had atypical epidemiologic features. Epidemiologic and serological analysis confirmed the association of illness with eating in the employees' cafeteria and eating cold sandwiches.

(JAMA 1981;245:827-830)

Author Affiliations
From the Infectious Disease and Gastroenterology Services, Department of Medicine, Tufts-New England Medical Center, Tufts University School of Medicine (Drs Snydman and Fawaz); the Massachusetts Department of Public Health, Boston, and the Field Services Division, Centers for Disease Control, Atlanta (Dr Brink); and the Gastrointestinal Unit, Medical Services, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston (Dr Dienstag and Ms Ryan). Ms Stedt is a private citizen residing in Boston.

Footnotes
Reprint requests to Infectious Disease Service, New England Medical Center Hospital, 171 Harrison Ave, Boston, MA 02111 (Dr Snydman).

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