Epidemiologic Notes and Reports Multiple Outbreaks of Staphylococcal Food Poisoning Caused by Canned Mushrooms

Recent outbreaks of staphylococcal foodborne disease have been associated with consumption of canned mushrooms from the People's Republic of China (PRC). These outbreaks have prompted multistate recalls of mushrooms produced by certain canneries in the PRC and a Food and Drug Administration (FDA) order to prohibit entry into the United States of all incoming shipments of institution-sized cans of mushrooms from the PRC. The following reported outbreaks in 1989 led to these actions.

Starkville, Mississippi. On February 13, 22 persons became ill with gastroenteritis several hours after eating at a university cafeteria. Symptoms included nausea, vomiting, diarrhea, and abdominal cramps. Nine persons were hospitalized. Canned mushrooms served with omelets and hamburgers were associated with illness. No deficiencies in food handling were found. Staphylococcal enterotoxin was identified in a sample of implicated mushrooms from the omelet bar and in unopened cans from the same lot.

Queens, New York. On February 28, 48 persons became ill a median of 3 hours after eating lunch in a hospital employee cafeteria. One person was hospitalized. Canned mushrooms served at the salad bar were epidemiologically implicated. Two unopened cans of mushrooms from the same lot as the implicated can contained staphylococcal enterotoxin.

McKeesport, Pennsylvania. On April 17, 12 persons became ill with gastroenteritis a median of 2 hours after eating lunch or dinner at a restaurant. Two persons were hospitalized. Canned mushrooms, consumed on pizza or with a parmigiana sauce, were associated with illness. No deficiencies were found in food preparation or storage. Staphylococcal enterotoxin was found in samples of remaining mushrooms and in unopened cans from the same lot.

Philipsburg, Pennsylvania. On April 22, 20 persons developed illness several hours after eating food from a take-out pizzeria. Four persons were hospitalized. Only pizza served with canned mushrooms was associated with illness. Staphylococcal enterotoxin was found in a sample of mushrooms from the pizzeria and in unopened cans with the same lot number.

Three other outbreaks possibly associated with mushrooms from the PRC have been reported to CDC; cans associated with these outbreaks have codes similar to those in the four confirmed outbreaks. Reported by: RK Collins, Mississippi State University, Starkville; MN Henderson, Oktibbeha County Health Dept; DE Conwill, MD, MM Currier, MD, FE Thompson, MD, State Epidemiologist, Mississippi State Dept of Health. ME Garland, Peninsula Hospital Center, Queens; S Schultz, MD, New York City Health Department; JJ Campana, Monroe County Dept of Health; LD Budnick, MD, JJ Guzewich, MPH, DL Morse, MD, State Epidemiologist, New York State Dept of Health; MJ Diskin, MPH, TL Hays, JA Kail, JR Rager, MPH, RR Willenpart, Allegheny County Health Dept; G Wells, Dept of Environmental Resources; AS Trentini, JM Zimmerman, J Crumrine, GE Ware, M Dorman, DR Tavris, MD, State Epidemiologist, Pennsylvania State Dept of Health. Atlanta, Buffalo, Nashville, New Orleans, Newark, New York District Offices; Div of Emergency and Epidemiologic Operations; Div of Food Chemistry and Technology; Div of Microbiology; Office of Compliance, Food and Drug Administration. Div of Field Svcs, Epidemiology Program Office; Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Staphylococcal enterotoxin typically causes an acute illness 2-4 hours after ingestion; illness is characterized by severe nausea and vomiting, often accompanied by abdominal cramps, diarrhea, and low-grade fever, and resolves within 1-2 days. Staphylococcal enterotoxin is not inactivated by temperatures used in canning and cooking. Finding this toxin in cans means that staphylococci grew and produced enterotoxin in the mushrooms before canning or that staphylococci contaminated the mushrooms after canning, possibly through improperly formed seams. From 1982 to 1987, 75 confirmed staphylococcal outbreaks were reported to CDC's national foodborne disease surveillance system; none of these outbreaks were associated with deficiencies in canning.

All cans implicated in these mushroom-associated outbreaks were large institution-sized (68-ounce, drained weight (#10)) cans of pieces and stems of mushrooms produced in the PRC and shipped through Hong Kong. FDA is monitoring the voluntary recall of shipments of cans that have codes implicated in outbreaks. Cans from lots associated with illness have lids embossed with three-line codes with the plant identifiers "TM" on the first line or "T3" or "M2" on the second line. FDA is prohibiting entry into the United States of all shipments of mushrooms from the PRC in #10 cans because the source of contamination has not been identified and cans produced by other plants might also be involved. FDA has begun sampling mushrooms imported from the PRC in all can sizes, including consumer-sized cans. FDA has offered to assist the PRC in an investigation of the sources of contamination.

The United States imports approximately 50 million pounds of processed mushrooms from the PRC annually. Many other countries also import canned foods from the PRC. Since the canned mushrooms are widely distributed, other canned mushroom-associated outbreaks may have occurred. Possible outbreaks should be reported through state health departments to the Enteric Diseases Branch, Division of Bacterial Diseases, Center for Infectious Diseases, CDC ( FAX: (404) 639-3296, Telex: 549571 CDC ATL).

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