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Publication #FSHN12-08

Outbreaks of Foodborne Diseases Associated with Tomatoes1

Matthew D. Krug, Angela M. Valadez, Travis K. Chapin, Keith R. Schneider, and Michelle D. Danyluk2

Fresh-market tomatoes are a popular commodity in homes and food service around the world. Because fresh-market tomatoes are intended to be consumed raw, there is no “kill-step” to eliminate pathogens in the event that tomatoes become contaminated (Maitland et al. 2011). Public health officials often meet numerous challenges when conducting traceback investigations of produce outbreaks. Fresh produce items have often reached the end of their shelf life by the time they have been linked to an outbreak; obtaining samples from these items is difficult because these items have typically been consumed or discarded (Lynch et al. 2009). It can be difficult for public health officials to determine where the implicated food was produced and prepared. As a consequence, the challenges of recognizing unusual food vehicles, such as specific lots of fresh produce, can delay the foodborne outbreak investigation (Lynch et al. 2009). The number of sporadic (i.e., isolated) illnesses linked to the consumption of contaminated fresh fruits and vegetables is unknown (Heaton and Jones 2008).

This document is intended to serve as a reference for everyone interested in the safety of fresh-market tomatoes by providing a comprehensive list of tomato-related outbreaks in the United States. Three tables are presented below, which include foodborne outbreaks where tomatoes were i) confirmed as the food vehicle (Table 1), ii) part of a complex food vehicle (Table 2), and iii) suspected, but not confirmed, as the food vehicle (Table 3). Of 38 outbreaks linked to fresh tomatoes in the United States since 1990, 4,028 illnesses and four deaths are reported (Table 1). Salmonella sp. was confirmed as the causative agent in 30 of 38 outbreaks linked to fresh tomatoes (Table 1).

Figure 1. 

Tomatoes.


Credit:

USDA Photo by Scott Bauer


[Click thumbnail to enlarge.]

References

CDC (Centers for Disease Control and Prevention). 2018. National Outbreak Reporting System (NORS). https://wwwn.cdc.gov/norsdashboard/. Accessed May 13, 2020

Cummings, K., E. Barrett, J. C. Mohle-Boetani, J. T. Brooks, J. Farrar, T. Hunt, A. Fiore, K. Komatsu, S. B. Werner, and L. Slutsker. 2001. “A Multistate Outbreak of Salmonella enterica Serotype Baildon Associated with Domestic Raw Tomatoes.” Emerging Infectious Disease 7 (6): 1046–1048.

US FDA (US Food and Drug Administration). 2009. “Outbreaks Tables 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/ScienceResearch/ResearchAreas/SafePracticesforFoodProcesses/ucm091270.htm. Accessed February 1, 2012.

Heaton, J. C., and K. Jones. 2008. “Microbial Contamination of Fruit and Vegetables and the Behaviour of Enteropathogens in the Phyllosphere: A Review.” Journal of Applied Microbiology 104:613–626.

Hedberg, C. W., F. J. Angulo, K. E. White, C. W. Langkop, W. L. Schell, M. G. Stobierski, A. Schuchat, J. M. Besser, S. Dietrich, L. Helsel, P. M. Griffin, J. W. McFarland, and M. T. Osterholm. 1999. “Outbreaks of Salmonellosis Associated with Eating Uncooked Tomatoes: Implications for Public Health.” Epidemiology and Infection 122:385–393.

Lynch, M. F., R. V. Tauxe, and C.W. Hedberg. 2009. “The Growing Burden of Foodborne Outbreaks Due to Contaminated Fresh Produce: Risks and Opportunities.” Epidemiology and Infection 137:307–315.

Maitland, J. E., R. R. Boyer, J. D. Eifert, and R. C. Williams. 2011. “High Hydrostatic Pressure Processing Reduces Salmonella enterica Serovars in Diced and Whole Tomatoes.” International Journal of Food Microbiology 149:113–117.

SSI (Statens Serum Institute). 2012. “Outbreak of Salmonella Strathcona.” https://en.ssi.dk/news/epi-news/2012/no-4---2012. Accessed February 23, 2012.

Tables

Table 1. 

Outbreaks of foodborne disease associated with tomatoes in the United States, 1990–2017.

Year

Month of Onset

Location

Pathogenb

Location of Consumption

Cases (Deaths)

Food Vehicle

Referencec

1990

NRa

US (multistate)

S. Javiana

Various

176 (0)

Round tomato

Hedberg et al. 1999

1993

NR

US (multistate)

S. Montevideo

Various

100 (0)

Round tomato

Hedberg et al. 1999

1994

NR

Arkansas

Hepatitis A

Restaurant

92 (0)

Diced tomato

FDA 2009

1998

December

US (multistate)

S. Baildon

Restaurant; Nursing home

86 (3)

Tomato

Cummings et al. 2001, CDC 2018

2000

November

US (multistate)

S. Thompson

Private home

43 (NR)

Tomato

CDC 2018

2000

December

Ohio

Norovirus

Restaurant

31 (0)

Tomato

CDC 2018

2001

May

New York

Shigella flexneri

Restaurant

886 (NR)

Tomato

CDC 2018

2002

February

Connecticut

S. Newport

Private home

8 (0)

Grape tomato

CDC 2018

2002

June

Massachusetts

S. Javiana

Restaurant

3 (0)

Tomato

CDC 2018

2002

June

Florida

S. Javiana

Restaurant

159 (0)

Tomato

CDC 2018

2002

July

US (multistate)

S. Newport

Hospital; Restaurant; School

510 (0)

Tomato

CDC 2018

2003

March

California

S. Virchow

NR

11 (0)

Tomato

CDC 2018

2004

May

Ohio

Campylobacter

Restaurant

13 (0)

Tomato

CDC 2018

2004

June

US (multistate)

S. Braenderup

Private home; Restaurant

137 (0)

Roma tomato

CDC 2018

2004

July

US (multistate)

S. Anatum; Javiana; Muenchen; Thompson; Typhimurium

Restaurant

429 (0)

Roma tomato

CDC 2018

2004

November

Connecticut

Norovirus

Camp

92 (0)

Tomato

CDC 2018

2005

March

Tennessee

Hepatitis A

Restaurant

23 (0)

Tomato

CDC 2018

2005

July

US (multistate)

S. Newport

Restaurant

72 (0)

Beefsteak tomato

CDC 2018

2005

September

Colorado

Norovirus

Unknown (caterer)

17 (0)

Tomato

CDC 2018

2005

November

US (multistate)

S. Braenderup

Restaurant

84 (0)

Roma tomato

CDC 2018

2006

January

Pennsylvania

S. Berta

Hospital; Nursing home; Restaurant

16 (0)

Tomato

CDC 2018

2006

June

US (multistate)

S. Newport

Restaurant

115 (0)

Tomato

CDC 2018

2006

September

Maine

S. Typhimurium

NR

8 (0)

Tomato

CDC 2018

2006

September

US (multistate)

S. Typhimurium

Private home; Restaurant

192 (0)

Tomato

CDC 2018

2007

June

US (multistate)

S. Newport

Restaurant

65 (0)

Beefsteak tomato

CDC 2018

2007

July

Colorado

Norovirus

Restaurant

33 (0)

Tomato

CDC 2018

2007

July

New York

S. Newport

NR

10 (1)

Tomato

CDC 2018

2007

October

Minnesota

S. Typhimurium

Restaurant

23 (0)

Tomato

CDC 2018

2009

May

Michigan

S. Saintpaul

Restaurant

21(0)

Tomato

CDC 2018

2010

May

US (multistate)

S. Newport

Private home; Restaurant

64 (NR)

Tomato

CDC 2018

2010

July

US (multistate)

S. Javiana

Private home; Restaurant

30 (NR)

Tomato

CDC 2018

2010

July

US (multistate)

S. Newport

NR

24 (NR)

Tomato

CDC 2018

2011

April

US (multistate)

S. Newport

Restaurant

166 (0)

Tomato

CDC 2018

2011

July

New York

S. Newport

NR

10 (0)

Tomato

CDC 2018

2012

June

Pennsylvania

S. Newport

Restaurant

102 (0)

Tomato

CDC 2018

2013

March

US (multistate)

S. Saintpaul

NR

131 (0)

Cherry tomato, grape tomato

CDC 2018

2013

May

California

S. Enteritidis

School/University

27 (0)

Tomato

CDC 2018

2015

May

US (multistate)

S. Hartford

Restaurant

19 (0)

Tomato

CDC 2018

a NR—Not reported.

b Pathogens abbreviated and associated with outbreaks include S.—Salmonella.

c References for each outbreak appear in the following reference list.

Table 2. 

Outbreaks of foodborne disease associated with multiple or complex foods including tomatoes in the United States, 1979–2017.

Year

Month

Location

Pathogenb

Location of Consumption

Cases (Deaths)

Food Vehicle

Referencec

1979

NRa

Massachusetts

L. monocytogenes

Hospital

20 (5)

Tomato, lettuce, and celery

FDA 2009

1989

NR

US (multistate)

G. lamblia

NR

21 (0)

Lettuce, onion, tomato

FDA 2009

1998

September

California

Shigella sonnei

Restaurant

318 (0)

Salsa

CDC 2018

1999

March

Georgia

Norovirus

NR

54 (0)

Bread, hot dog, tomato sauce

CDC 2018

1999

May

Wisconsin

C. perfringens

School

35 (0)

Tomato sauce

CDC 2018

1999

September

Washington

Norovirus

NR

115 (NR)

Leaf lettuce, tomato

CDC 2018

2000

January

California

C. botulinum

Private home

2 (NR)

Squash, tomato

CDC 2018

2000

October

Minnesota

Norovirus

Restaurant

34 (0)

Cherry tomato, dips, vegetable dips

CDC 2018

2000

October

California

Shigella sonnei

Restaurant

221 (1)

Salsa

CDC 2018

2002

January

Tennessee

Norovirus

Restaurant

11 (0)

Cheese, lettuce, tomato

CDC 2018

2002

March

Texas

S. Enteritidis

Restaurant

700 (0)

Salsa

CDC 2018

2002

June

Tennessee

S. Anatum

Restaurant

16 (0)

Salsa

CDC 2018

2002

July

North Carolina

Norovirus

Unknown (caterer)

11 (0)

Cake, tomato

CDC 2018

2002

August

California

Norovirus

Unknown (caterer)

50 (NR)

Lettuce, tomato

CDC 2018

2003

June

California

S. Saintpaul

Restaurant

17 (0)

Mango, tomato

CDC 2018

2003

June

Washington, DC

Norovirus

Unknown (caterer)

47 (NR)

Pastry, tomato, basil, and mozzarella salad

CDC 2018

2003

November

US (multistate)

S. Saintpaul

Restaurant

33 (NR)

Chicken, iceberg lettuce, tomato

CDC 2018

2004

April

Oregon

Norovirus

Restaurant

19 (0)

Iceberg lettuce, tomato

CDC 2018

2004

May

Ohio

Norovirus

Restaurant

9 (0)

Salsa

CDC 2018

2004

June

Illinois

S. Infantis

Private home

60 (0)

Salsa

CDC 2018

2004

August

Washington

E. coli O157:H7

Restaurant

6 (0)

Salsa

CDC 2018

2005

April

Virginia

Norovirus

Restaurant

38 (NR)

Burrito, enchilada, lettuce, tomato

CDC 2018

2005

April

Virginia

Norovirus

Restaurant

14 (0)

Chicken salad, coleslaw, potato salad, tomato

CDC 2018

2005

May

Washington

E. coli O157:H7

Restaurant

3 (0)

Salsa

CDC 2018

2005

June

California

S. Enteritidis

Restaurant

85 (0)

Salsa

CDC 2018

2005

June

Wyoming

S. Enteritidis

Restaurant

20 (0)

Eggs, tomato

CDC 2018

2005

July

New York

S. Newport

Private home;Restaurant

27 (0)

Onion, tomato

CDC 2018

2005

August

California

S. Enteritidis

Restaurant

30 (0)

Salsa

CDC 2018

2006

June

Maryland

S. Typhimurium

Private home, Restaurant

18 (0)

Lettuce, tomato

CDC 2018

2006

June

Oregon

Norovirus

Restaurant

17 (0)

Salsa

CDC 2018

2006

September

Pennsylvania

Norovirus

Private home

17 (0)

Tea, tomato

CDC 2018

2007

May

Washington

S. IV 50:z4,z23:-

Restaurant

2 (0)

Salsa

CDC 2018

2007

May

Florida

S. Baildon

Restaurant

2 (0)

Salsa

CDC 2018

2007

June

Washington, DC

S. Newport

Private home; Restaurant

46 (NR)

Avocado, cilantro, guacamole, tomato

CDC 2018

2007

June

Maryland

S. Javiana

Private home; Restaurant

5 (0)

Cheese, chicken, tomato, unspecified fruit

CDC 2018

2007

August

Minnesota

S. Enteritidis

Restaurant

18 (0)

Salsa

CDC 2018

2008

January

New York

Norovirus

Restaurant

10 (0)

Salsa

CDC 2018

2008

April

US (multistate)

S. Saintpaul

Private home; Restaurant

1500 (2)

Jalapeño and serrano peppers; tomato, plum, roma, roundd

CDC 2018

2008

April

Iowa

S. Braenderup

Restaurant

12 (0)

Green salad, tomato

CDC 2018

2008

May

Pennsylvania

B. cereus, C. perfringens

Restaurant

8 (0)

Chicken fajita, fried rice, refried beans, tomato, tortilla

CDC 2018

2008

July

California

S. Blockley

Private home

9 (0)

Mole; pasta with tomato sauce

CDC 2018

2008

July

US (multistate)

S. Hartford

NR

22 (0)

Salsa

CDC 2018

2008

October

Illinois

Norovirus

Restaurant

64 (0)

Lettuce-based salads, tomato relish

CDC 2018

2009

August

Kansas

Pesticides

Restaurant

39 (0)

Salsa

CDC 2018

2009

December

California

Norovirus

Workplace (not cafeteria)

14 (0)

Salsa

CDC 2018

2010

February

Illinois

Shigella sonnei

Restaurant

314 (1)

Bread, tomato

CDC 2018

2010

June

Connecticut

Norovirus

Restaurant

20 (0)

Ground beef, tomato

CDC 2018

2010

August

Florida

Shigella sonnei

Restaurant

15 (0)

Salsa

CDC 2018

2011

March

Georgia

S. Saintpaul

Private home; Restaurant

14 (0)

Cucumber, tomato

CDC 2018

2012

September

Illinois

Norovirus

Unknown (caterer)

22 (0)

Onions, tomato

CDC 2018

2013

May

Virginia

Norovirus

Restaurant

35 (0)

Tomato mozzarella sandwich, feta salad

CDC 2018

2013

July

Michigan

S. Enteritidis

Restaurant

15 (0)

Salsa

CDC 2018

2014

March

Wisconsin

Norovirus GI_3B

Unknown (caterer)

10 (0)

Lettuce, tomato, tortilla

CDC 2018

2014

April

Pennsylvania

B. cereus

NR

31 (0)

Grape tomato, blueberries, pancakes, chicken, carrots, whipped potato, lamb, peppers, coconut rice pudding

CDC 2018

2014

April

Tennessee

Norovirus

Restaurant

7 (0)

Lettuce, tomato

CDC 2018

2014

June

Arkansas

Shigella sonnei

Workplace

269 (0)

Salsa

CDC 2018

2014

November

Minnesota

E. coli O111

Restaurant

3 (0)

Salsa

CDC 2018

2015

February

Oregon

Norovirus

Restaurant

10 (0)

Salsa

CDC 2018

2015

May

Kansas

S. Typhimurium

Restaurant

10 (0)

Tomato, ground beef

CDC 2018

2015

June

Michigan

Norovirus GII_4 Sydney

Restaurant

11 (0)

Salsa

CDC 2018

2015

August

US (multistate)

S. Newport

Restaurant

119 (0)

Salsa

CDC 2018

2015

November

California

Shigella sonnei

Restaurant

19 (0)

Salsa

CDC 2018

2015

December

Wisconsin

Norovirus

Private home

16 (0)

Salsa

CDC 2018

2016

May

Colorado

E. coli O157:H7

Restaurant

9 (0)

Tomato, cucumber, lettuce

CDC 2018

2017

July

Pennsylvania

S. Javiana

Unknown

24 (0)

Salsa

CDC 2018

2017

October

New York

Shigella sonnei

Restaurant

2 (0)

Tomato, lettuce

CDC 2018

a NR—Not reported.

b Pathogens abbreviated and associated with outbreaks include S.—Salmonella; E.—Escherichia; L.—Listeria; B.Bacillus; G.—Giardia; and C.—Clostridium.

c References for each outbreak appear in the following reference list.

d Traceback investigations eventually confirmed the presence of the outbreak strain in jalapeño and serrano peppers but not tomatoes.

Table 3. 

Outbreaks of foodborne disease associated with tomatoes or multiple foods including tomatoes without a confirmed pathogen, 1998–2017.

Year

Month

Location

Suspected Pathogena

Location of Consumption

Cases (Deaths)

Food Vehicle

Referenceb

1998

January

Florida

Unknown

Restaurant

5 (0)

Tomato sauce

CDC 2018

1998

July

Michigan

Unknown

Restaurant

9 (NR)

Salsa

CDC 2018

1999

May

Colorado

Norovirus

Restaurant

20 (NR)

Lettuce, tomato

CDC 2018

1999

July

New York

Unknown

Restaurant

4 (NR)

Salsa

CDC 2018

1999

July

Maryland

Unknown

Restaurant

2 (NR)

Omelet, cheese, tomato

CDC 2018

1999

July

California

B. cereus, Staphylococcus aureus

NR

13 (0)

Salsa

CDC 2018

1999

August

Pennsylvania

Norovirus

School

14 (NR)

Green pea salad, roast beef, tomato

CDC 2018

1999

November

California

Norovirus

Restaurant

28 (0)

Lettuce, tomato

CDC 2018

2000

January

Washington

Unknown

Restaurant

3 (0)

Lettuce, tomato

CDC 2018

2000

March

Florida

Norovirus

Restaurant

6 (0)

Salsa

CDC 2018

2000

July

California

Unknown

Restaurant

16 (0)

Salsa

CDC 2018

2000

December

Washington

Norovirus

Restaurant

2 (NR)

Salsa, tostada

CDC 2018

2001

June

Massachusetts

Norovirus

Unknown (caterer)

20 (0)

Goat cheese, pastry, tomato

CDC 2018

2001

June

Florida

Norovirus

Restaurant

3 (NR)

Sandwich, bacon, lettuce, tomato

CDC 2018

2001

September

Florida

Unknown

Restaurant

4 (NR)

White fish, stuffed tomato

CDC 2018

2002

January

Florida

Norovirus

Restaurant

3 (NR)

Cherry tomato, iceberg lettuce

CDC 2018

2002

January

Indiana

Norovirus

Restaurant

22 (0)

Salsa

CDC 2018

2002

February

California

Norovirus

Restaurant

39 (0)

Lettuce, tomato

CDC 2018

2002

February

Michigan

Unknown

Restaurant

2 (NR)

Sandwich, bacon, lettuce, tomato

CDC 2018

2002

July

Florida

Unknown

NR

2 (NR)

Grape tomato, guacamole

CDC 2018

2002

August

Florida

Chemical/toxin

Restaurant

3 (0)

Salsa

CDC 2018

2002

September

California

Campylobacter, Salmonella

Restaurant

6 (0)

Salsa

CDC 2018

2002

September

California

B. cereus

Restaurant

8 (NR)

Salsa

CDC 2018

2003

September

California

B. cereus, C. perfringens

Restaurant

5 (0)

Salsa

CDC 2018

2003

December

California

Norovirus

Restaurant

15 (0)

Salsa

CDC 2018

2003

December

California

B. cereus, C. perfringens

Restaurant

3 (0)

Salsa

CDC 2018

2004

March

Michigan

Unknown

Restaurant

6 (0)

Salsa

CDC 2018

2004

April

Colorado

C. perfringens

Restaurant

3 (0)

Salsa

CDC 2018

2004

August

California

Norovirus

Restaurant

12 (0)

Sandwich, bacon, lettuce, tomato

CDC 2018

2004

September

Pennsylvania

Norovirus

Restaurant

8 (0)

Romaine lettuce, tomato, vidalia onion

CDC 2018

2004

October

Texas

Unknown

Restaurant

11 (NR)

Tomato

CDC 2018

2005

May

Utah

Unknown

Restaurant

29 (0)

Salsa

CDC 2018

2005

July

New York

Unknown

Unknown (caterer)

31 (0)

Green salad, tomato salad, tuna salad

CDC 2018

2005

September

Florida

Unknown

Restaurant

4 (NR)

Salsa

CDC 2018

2005

October

Florida

Unknown

Restaurant

2 (NR)

Iceberg lettuce, tomato

CDC 2018

2005

October

Pennsylvania

Norovirus

Restaurant

19 (0)

Tomato

CDC 2018

2006

February

California

Unknown

Restaurant

11 (0)

Salsa

CDC 2018

2006

December

California

Norovirus

NR

125 (0)

Salsa

CDC 2018

2007

December

New York

Unknown

Restaurant

20 (0)

Tomato, basil and mozzarella salad

CDC 2018

2008

June

Deleware

Unknown

Restaurant

17 (0)

Green salad, tomato

CDC 2018

2008

September

California

Unknown

Restaurant

9 (0)

Tomato salad

CDC 2018

2008

October

Colorado

Norovirus

Restaurant

5 (0)

Salsa

CDC 2018

2009

January

Massachusetts

Unknown

Banquet facility

32 (0)

Salads, tomato, vegetables

CDC 2018

2009

March

California

Norovirus

Restaurant

9 (0)

Salads, tomato

CDC 2018

2009

May

New York

Unknown

Restaurant

18 (0)

Bruschetta, roasted red peppers, prosciutto with melon, tomatoes with mozzarella, fried zucchini, marinated zucchini

CDC 2018

2009

September

Washington

Norovirus

Restaurant

4 (0)

Tomato

CDC 2018

2010

January

Pennsylvania

Unknown

Restaurant

15 (0)

Lettuce, tomato

CDC 2018

2011

August

New Jersey

Unknown

NR

8 (0)

Lettuce, onions, tomato

CDC 2018

2011

October

Michigan

Unknown

Banquet facility

33 (0)

Tomato

CDC 2018

2012

March

Pennsylvania

Unknown

Unknown (caterer)

55 (0)

Tomato

CDC 2018

2012

November

California

Norovirus

Restaurant

9 (0)

Salsa

CDC 2018

2013

June

Michigan

Unknown

Restaurant

7 (0)

Lettuce, tomato

CDC 2018

2013

October

California

Norovirus

Restaurant

4 (0)

Salsa

CDC 2018

2014

February

California

Unknown

Restaurant

13 (0)

Cherry tomato

CDC 2018

2015

April

Florida

Unknown

Restaurant

2 (0)

Tomato, basil and mozzarella salad

CDC 2018

2015

May

Washington

Unknown

Restaurant

8 (0)

Lettuce, tomato, tortilla

CDC 2018

2017

July

Colorado

Unknown

Restaurant

5 (0)

Salsa

CDC 2018

a Pathogens abbreviated and associated with outbreaks include S.—Salmonella, B.—Bacillus, and C.—Clostridium.

b References for each outbreak appear in the following reference list.

Footnotes

1.

This document is FSHN12-08, one of a series of the Food Science and Human Nutrition Department, UF/IFAS Extension. Original publication date April 2012. Revised June 2020. Visit the EDIS website at https://edis.ifas.ufl.edu for the currently supported version of this publication.

2.

Matthew D. Krug, state specialized agent, food science, UF/IFAS Southwest Florida Research and Education Center; Angela M. Valadez, graduate research assistant; Travis K. Chapin, state specialized agent, food science, UF/IFAS Citrus REC; Keith R. Schneider, professor, Food Science and Human Nutrition Department; and Michelle D. Danyluk, professor, Food Science and Human Nutrition Department, UF/IFAS Citrus REC; UF/IFAS Extension, Gainesville, FL 32611.

This review was supported by the Center for Produce Safety.


The Institute of Food and Agricultural Sciences (IFAS) is an Equal Opportunity Institution authorized to provide research, educational information and other services only to individuals and institutions that function with non-discrimination with respect to race, creed, color, religion, age, disability, sex, sexual orientation, marital status, national origin, political opinions or affiliations. For more information on obtaining other UF/IFAS Extension publications, contact your county's UF/IFAS Extension office.

U.S. Department of Agriculture, UF/IFAS Extension Service, University of Florida, IFAS, Florida A & M University Cooperative Extension Program, and Boards of County Commissioners Cooperating. Nick T. Place, dean for UF/IFAS Extension.