Table 1.
Guidelines for the Confirmation of Foodborne Disease Outbreaks Caused by Bacillus cereus, Clostridium perfringens, and Staphylococcus aureus, United States, 1998–2008
| Etiologic Agent | Confirmationa |
|---|---|
| Bacillus cereus | Isolation of organism from stool of 2 or more ill persons and not from stool of control patients |
| OR | |
| Isolation of 105 organisms per gram from epidemiologically implicated foodb, provided specimen is properly handled | |
| Clostridium perfringens | Isolation of 106 organisms per gram from stool of 2 or more ill persons, provided specimen is properly handled |
| OR | |
| Demonstration of enterotoxin in the stool of 2 or more ill persons | |
| OR | |
| Isolation of 105 organisms per gram from epidemiologically implicated food, provided specimen is properly handled | |
| Staphylococcus aureus | Isolation of organism of same phage type from stool or vomitus of 2 or more ill persons |
| OR | |
| Detection of enterotoxin in epidemiologically implicated food | |
| OR | |
| Isolation of 105 organisms per gram from epidemiologically implicated food, provided specimen is properly handled |
Source: Centers for Disease Control and Prevention[10].
Laboratory findings that meet or exceed the listed confirmation criteria are reported as confirmed etiology; laboratory findings below these criteria are reported as suspect etiology. In the absence of laboratory data, the etiologic agent may be reported as a suspect etiology if the reporting agency has a reasonable suspicion, based on other data available (eg, incubation period, clinical syndromes, implicated foods), that one of these pathogens was the causal agent.
Although not part of confirmation guidelines during the study period, testing for B. cereus enterotoxins in implicated foods is encouraged.