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Identify what to do when a food handler is diagnosed with a communicable disease

Many communicable diseases can be transmitted by infected food handlers to consumers through food or food-contact surfaces. Proper management of a food establishment begins with employing healthy people and instituting a system of identifying employees who present a risk for transmitting foodborne pathogens to food or to other employees. In order to protect the health of both consumers and employees, information concerning the health status of job applicants and currently employed foodservice workers must be disclosed to the foodservice manager. It is the responsibility of the manager to convey to job applicants and food employees the importance of notifying them about changes in their health status. Once notified, the manager can take action to prevent the transmission of foodborne illness.

 Illnesses that Require Reporting

The Centers for Disease Control and Prevention (CDC) publishes a list of infectious and communicable diseases transmitted through food each year. The list is divided into two parts: pathogens often transmitted and pathogens occasionally transmitted by infected persons who handle food. It is important to note that CDC has no evidence that HIV is transmissible through food. Therefore, a food employee who has tested positive for HIV is not of concern unless he or she is suffering from a disease caused by on of the pathogens in the list below.

Pathogens often transmitted to food by infected persons

1

Calciviruses (Norwalk and Norwalk-like virsues)

D

F

V

-

-

2

Hepatitis A virus

-

F

-

J

-

3

Salmonella Typhi

-

F

-

-

-

4

Shigella species

D

F

V

-

-

5

Staphylococcus aureus

D

-

V

-

-

6

Streptococcus pyogenes

-

F

-

-

S

Pathogens Occasionally Transmitted by Food Contaminated by Infected Persons

1

Campylobacter jejuni

D

F

V

-

-

2

Cryptosporodium parvum

D

-

-

-

-

3

Entamoeba histolytica

D

F

-

-

-

4

Enterohemorrhagic Escherichia coli

D

-

-

-

-

5

Enterotoxigenic Escherichia coli

D

-

V

-

-

6

Giardia lamblia

D

-

-

-

-

7

Non-typhoidal Salmonella

D

F

V

-

-

8

Taenia solium

-

-

-

-

-

9

Vibrio cholerae 01

D

-

V

-

-

10

Yersinia enterocolitica

D

F

V

-

-

KEY: D=Diarrhea V=Vomiting S=Sore throat with fever F=Fever J=Jaundice

 Reporting of Diseases by Job Applicants

Title I of the Americans with Disabilities Act of 1990 (ADA) prohibits medical examinations and inquiries about the existence, nature, or severity of a disability before a conditional offer of employment is extended. In order for the manager of a foodservice establishment to not violate this aspect of the ADA, a conditional job offer must be made before he or she can make inquiries about the applicant's health status. The information required from applicants is designed to identify employees who may be suffering from a disease that can be transmitted through food.

Furthermore, an applicant to whom an employment offer is conditionally made must be accommodated to the extent provided under the ADA. That is, if there is an accommodation that will not pose an undue hardship to the establishment and that will prevent the transmission of the disease(s) of concern through food, such accommodation must be made.

Job applicants and currently employed food workers are required to report information about their health as it relates to diseases that are transmissible through food. The individual would need to report the information about their health status if:

  1. They have been diagnosed with an illness due to Salmonella Typhi, Shigella spp., Shiga-toxin-producing Escherichia coli, or Hepatitis A virus.
  2. They have at least one symptom caused by illness, infection, or other source that is associated with an acute gastrointestinal illness such as diarrhea, fever, vomiting, jaundice, or sore throat with fever.
  3. They have a lesion containing pus, such as a boil or infected wound, that is open or draining and is on the hands or wrists or on exposed portions of the arms.
  4. They have had Salmonella Typhi within the past three months, Shigella spp. with the past month, Shiga-toxin producing Escherichia coli with the past month, or Hepatitis A virus ever.
  5. They are suspected of causing or being exposed to a confirmed disease outbreak caused by Salmonella Typhi, Shigella spp., Shiga-toxin-producing Escherichia coli, or Hepatitis A virus. This would include outbreaks associated with events such as a family meal, church supper, or festival because the food employee or food implicated in the outbreak ate food implicated in the outbreak, or ate food at the event prepared by a person who is infected or who is suspected of being a shedder of the infectious agent.
  6. They live in the same household as, and have knowledge about, a person who is diagnosed with Salmonella Typhi, Shigella spp., Shiga-toxin-producing Escherichia coli, or Hepatitis A virus.
  7. They live in the same household as, and have knowledge about, a person who attends or works in a setting where there is a confirmed disease outbreak caused by Salmonella Typhi, Shigella spp., Shiga-toxin-producing Escherichia coli, or Hepatitis A virus.

  Exclusions and Restrictions

After a food employee reports information about their health to their manager, they might be restricted from working with food or excluded from working within the establishment. If this is not handled properly, then an outbreak could occur.

To restrict a food employee means to limit their activities so there is no risk of transmitting a disease that is transmissible through food. Therefore, the individual cannot work with exposed food, clean equipment, utensils, linens, and unwrapped single-service or single-use articles. Excluding an employee means to prevent them from working as a food employee or entering a food establishment except for those areas open to the general public.

Below is a table identifying under what conditions a food employee needs to be excluded or restricted from working with exposed food, clean equipment, utensils, linens, and unwrapped single-service and single-use articles.

Health Status

Facilities Serving Highly Susceptible Population

Facilities Not Serving Highly Susceptible Population

Diagnosed with Salmonella Typhi, Shigella spp., Shiga-toxin-producing Escherichia coli, or Hepatitis A virus

Exclude

Exclude

Experiencing diarrhea, fever, vomiting, jaundice, or sore throat with fever.

Restrict

Restrict

Experiencing diarrhea, fever, vomiting, jaundice, or sore throat with fever and meet one of the three high-risk conditions*

Exclude

Restrict

Asymptomatic but stools positive for Salmonella Typhi, Shigella spp., or Shiga toxin-producing Escherichia coli

Exclude

Restrict

Past illness from Salmonella Typhi within the last three months

Exclude

No restrictions

Past illness from Shigella spp. Or Shiga toxin-producing Escherichia coli within the last month

Exclude

No restrictions

Onset of jaundice within the last seven days

Exclude

Exclude

* High-risk conditions include:

  1. They are suspected of causing or being exposed to a confirmed disease outbreak caused by Salmonella Typhi, Shigella spp., Shiga-toxin-producing Escherichia coli, or Hepatitis A virus. This would include outbreaks associated with events such as a family meal, church supper, or festival because the food employee or food implicated in the outbreak ate food implicated in the outbreak, or ate food at the event prepared by a person who is infected or who is suspected of being a shedder of the infectious agent.
  2. They live in the same household as, and have knowledge about, a person who is diagnosed with Salmonella Typhi, Shigella spp., Shiga-toxin-producing Escherichia coli, or Hepatitis A virus.
  3. They live in the same household as, and have knowledge about, a person who attends or works in a setting where there is a confirmed disease outbreak caused by Salmonella Typhi, Shigella spp., Shiga-toxin-producing Escherichia coli, or Hepatitis A virus.

Source:
U.S. Food and Drug Administration. 2001. Food Code. Washington, DC. The complete publication is available on-line at: http://www.fda.gov/food/foodsafety/retailfoodprotection/foodcode/foodcode2001/default.htm