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William C. Levine, MD, MSc; Joanne F. Smart, MD; Douglas L. Archer, PhD; Nancy H. Bean, PhD; Robert V. Tauxe, MD, MPH

JAMA. 1991;266(15):2105-2109.

Abstract
Objective.
—To describe the epidemiology of foodborne disease outbreaks in nursing homes and to identify where preventive efforts might be focused.

Data Sources.
—Reports by state and local health departments of foodborne disease outbreaks occurring from January 1,1975, through December 31, 1987.

Study Selection.
—Foodborne disease outbreaks reported to the Centers for Disease Control, Atlanta, Ga, on standard investigation forms.

Data Extraction.
—Each foodborne disease outbreak report was examined by an epidemiologist or statistician. Outbreaks were considered to have a known pathogen if confirmed by laboratory tests, and a known vehicle when an epidemiologic investigation implicated a specific food item.

Data Synthesis.
—From 1975 through 1987, 26 states reported 115 outbreaks of foodborne disease in nursing homes, causing illness in 4944 persons and death in 51. These outbreaks represented 2% of all reported foodborne disease outbreaks and 19% of outbreak-associated deaths in this period. Of 52 outbreaks with a known cause, Salmonella was the most frequently reported pathogen, accounting for 52% of outbreaks and 81% of deaths. Salmonella enteritidis outbreaks accounted for 56% of the Salmonella-associated deaths since 1981. The implicated food vehicles in S enteritidis outbreaks were made with eggs or prepared with equipment contaminated with eggs. Staphylococcal foodborne disease was the next most commonly identified cause, accounting for 23% of outbreaks.

Conclusions.
—Since the elderly are at high risk for serious morbidity from foodborne disease, nursing homes should practice careful food handling, preparation, and storage procedures; provide education for food handlers; and have active infection control programs to rapidly detect and control outbreaks of foodborne disease.

(JAMA. 1991;266:2105-2109)

Author Affiliations
From the Enteric Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Ga (Drs Levine, Smart, Bean, and Tauxe), and the Division of Microbiology, Center for Food Safety and Applied Nutrition, Food and Drug Administration, Washington, DC (Dr Archer).

Footnotes
Dr Levine is now with the Clinical Research Branch, Division of STD/HIV Prevention, National Center for Prevention Services, Centers for Disease Control, Atlanta, Ga.

Reprint requests to Enteric Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control, Mailstop C09, Atlanta, GA 30333.

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