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Craig W. Hedberg, PhD; Kristine L. MacDonald, MD, MPH; Michael T. Osterholm, PhD, MPH
Minnesota Department of Health Minneapolis

JAMA. 1993;269(21):2737-2738.

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In Reply.

—We appreciate the comments from Drs Archer, Kessler, and Young. We believe that the epidemiology of foodborne disease in the 1990s is vastly different from that in earlier decades. At least three major factors have contributed to changing the epidemiology of foodborne disease.¹ First, there has been a change in the type and source of food we consume. The new American diet emphasizes fruits, vegetables, and grains. Meeting the increased demand for fresh fruits and vegetables has led to the widespread availability of salad bars in restaurants and has required the importation of produce from Mexico, Central America, and other tropical areas. These dietary changes have increased the potential for exposure to a wide variety of enteric pathogens, both foreign and domestic.

Second, there are new methods of food production and distribution. Sporadic or low-level contamination of massproduced cold food items in large and complex distribution networks . . . [Full Text PDF of this Article]

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