{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:30:53Z","timestamp":1789536653454,"version":"build-2803163510"},"reference-count":25,"publisher":"Cambridge University Press (CUP)","issue":"14","license":[{"start":{"date-parts":[[2015,2,20]],"date-time":"2015-02-20T00:00:00Z","timestamp":1424390400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["journals.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:title>SUMMARY<\/jats:title><jats:p>Leafy vegetables are an essential component of a healthy diet; however, they have been associated with high-profile outbreaks causing severe illnesses. We reviewed leafy vegetable-associated outbreaks reported to the Centers for Disease Control and Prevention between 1973 and 2012. During the study period, 606 leafy vegetable-associated outbreaks, with 20\u00a0003 associated illnesses, 1030 hospitalizations, and 19 deaths were reported. On average, leafy vegetable-associated outbreaks were larger than those attributed to other food types. The pathogens that most often caused leafy vegetable-associated outbreaks were norovirus (55% of outbreaks with confirmed aetiology), Shiga toxin-producing<jats:italic>Escherichia coli<\/jats:italic>(STEC) (18%), and<jats:italic>Salmonella<\/jats:italic>(11%). Most outbreaks were attributed to food prepared in a restaurant or catering facility (85%). An ill food worker was implicated as the source of contamination in 31% of outbreaks. Efforts by local, state, and federal agencies to control leafy vegetable contamination and outbreaks should span from the point of harvest to the point of preparation.<\/jats:p>","DOI":"10.1017\/s0950268815000047","type":"journal-article","created":{"date-parts":[[2015,2,20]],"date-time":"2015-02-20T06:18:59Z","timestamp":1424413139000},"page":"3011-3021","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":205,"title":["Outbreaks attributed to fresh leafy vegetables, United States, 1973\u20132012"],"prefix":"10.1017","volume":"143","author":[{"given":"K. M.","family":"HERMAN","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. J.","family":"HALL","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. H.","family":"GOULD","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2015,2,20]]},"reference":[{"key":"S0950268815000047_ref11","unstructured":"United States Census Bureau. American community survey data and documentation (http:\/\/www2.census.gov\/acs2011_5yr\/summaryfile\/?C=M;O=A). Accessed 29 May 2013."},{"key":"S0950268815000047_ref5","first-page":"1","article-title":"Surveillance for foodborne-disease outbreaks\u00a0\u2013\u00a0United States, 1988\u20131992","volume":"45","author":"Bean","year":"1996","journal-title":"Morbidity and Mortality Weekly Report. Surveillance Summaries"},{"key":"S0950268815000047_ref14","doi-asserted-by":"crossref","DOI":"10.2807\/ese.15.06.19484-en","article-title":"Outbreaks of gastroenteritis linked to lettuce, Denmark, January 2010","volume":"15","author":"Ethelberg","year":"2010","journal-title":"Eurosurveillance"},{"key":"S0950268815000047_ref12","unstructured":"Centers for Disease Control and Prevention. Guide to confirming a diagnosis in foodborne disease (http:\/\/www.cdc.gov\/foodsafety\/outbreaks\/investigating-outbreaks\/confirming_diagnosis.html). Accessed 29 May 2013."},{"key":"S0950268815000047_ref24","doi-asserted-by":"publisher","DOI":"10.3201\/eid1101.040334"},{"key":"S0950268815000047_ref4","doi-asserted-by":"publisher","DOI":"10.4315\/0362-028X-67.10.2342"},{"key":"S0950268815000047_ref6","unstructured":"United States Government Accountability Office. Fruits and vegetables: enhanced federal efforts to increase consumption could yield health benefits for Americans (http:\/\/www.gao.gov\/products\/gao-02-657). Washington, DC, USA: United States Government Accountability Office General Accounting Office, 2002 (Report No.: GAO-02-657)."},{"key":"S0950268815000047_ref1","unstructured":"Centers for Disease Control and Prevention. Surveillance for foodborne disease outbreaks\u00a0\u2013\u00a0United States, 2012: Annual Report (http:\/\/www.cdc.gov\/foodsafety\/fdoss\/data\/annual-summaries\/index.html). Accessed 14 June 2014."},{"key":"S0950268815000047_ref21","doi-asserted-by":"publisher","DOI":"10.3201\/eid0703.017303"},{"key":"S0950268815000047_ref22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1541-4337.2003.tb00029.x"},{"key":"S0950268815000047_ref8","first-page":"1","article-title":"Surveillance for foodborne disease outbreaks\u00a0\u2013\u00a0United States, 1998\u20132008","volume":"62","author":"Gould","year":"2013","journal-title":"Morbidity and Mortality Weekly Report. Surveillance Summaries"},{"key":"S0950268815000047_ref20","doi-asserted-by":"publisher","DOI":"10.3201\/eid1101.040426"},{"key":"S0950268815000047_ref3","doi-asserted-by":"publisher","DOI":"10.1086\/597399"},{"key":"S0950268815000047_ref13","doi-asserted-by":"publisher","DOI":"10.3201\/eid1810.120833"},{"key":"S0950268815000047_ref19","first-page":"285","article-title":"Outbreaks of Shigella sonnei infection associated with eating fresh parsley\u00a0\u2013\u00a0United States and Canada, July\u2013August 1998","volume":"48","year":"1999","journal-title":"Morbidity Mortality Weekly Report"},{"key":"S0950268815000047_ref9","doi-asserted-by":"publisher","DOI":"10.3201\/eid1908.130482"},{"key":"S0950268815000047_ref23","doi-asserted-by":"publisher","DOI":"10.1016\/S1286-4579(02)01555-1"},{"key":"S0950268815000047_ref7","unstructured":"Food and Drug Administration. Commodity specific food safety guidelines for the lettuce and leafy greens supply chain, 1st edn (http:\/\/www.fda.gov\/downloads\/Food\/FoodSafety\/Product-SpecificInformation\/FruitsVegetablesJuices\/GuidanceComplianceRegulatoryInformation\/UCM169008.pdf). Accessed 11 December 2013."},{"key":"S0950268815000047_ref2","doi-asserted-by":"publisher","DOI":"10.3201\/eid1903.111866"},{"key":"S0950268815000047_ref25","unstructured":"Food and Drug Administration. Produce safety standards. Food Safety Modernization Act (FSMA) (http:\/\/www.fda.gov\/Food\/GuidanceRegulation\/FSMA\/ucm304045.htm). Accessed 29 March 2013."},{"key":"S0950268815000047_ref15","unstructured":"Food and Drug Administration Center for Food Safety and Applied Nutrition. FDA guide to minimize microbial food safety hazards for fresh fruits and vegetables (http:\/\/www.fda.gov\/downloads\/Food\/GuidanceComplianceRegulatoryInformation\/GuidanceDocuments\/ProduceandPlanProducts\/UCM169112.pdf). Accessed 11 December 2013."},{"key":"S0950268815000047_ref17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa050855"},{"key":"S0950268815000047_ref18","first-page":"1045","article-title":"Ongoing multistate outbreak of Escherichia coli serotype O157:H7 infections associated with consumption of fresh spinach\u00a0\u2013\u00a0United States, September 2006","volume":"55","year":"2006","journal-title":"Morbidity Mortality Weekly Report"},{"key":"S0950268815000047_ref16","unstructured":"United States Department of Health and Human Services. Analysis and evaluation of preventive control measures for the control and reduction\/elimination of microbial hazards on fresh and fresh-cut produce (http:\/\/www.fda.gov\/Food\/FoodScienceResearch\/SafePracticesforFoodProcesses\/ucm090977.htm). Accessed 11 December 2013."},{"key":"S0950268815000047_ref10","unstructured":"United States Department of Agriculture Economic Research Service. Food availability (per capita) data system (http:\/\/www.ers.usda.gov\/Data\/FoodConsumption). Accessed 18 July 2013."}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268815000047","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,30]],"date-time":"2022-04-30T08:12:31Z","timestamp":1651306351000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268815000047\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,2,20]]},"references-count":25,"journal-issue":{"issue":"14","published-print":{"date-parts":[[2015,10]]}},"alternative-id":["S0950268815000047"],"URL":"https:\/\/doi.org\/10.1017\/s0950268815000047","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,2,20]]},"assertion":[{"value":"Copyright \u00a9 Cambridge University Press 2015\u00a0","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}