Outbreaks of Foodborne Disease Associated with Fruit and Vegetable Juices, 1922–20191
In response to several outbreaks of illness in the 1990s associated with raw juices processed at commercial facilities, the US Food and Drug Administration (FDA) introduced regulation (21 Code of Federal Regulations 120; FDA 2001) mandating that all 100% fruit/vegetable juices be produced under a Hazard Analysis and Critical Control Point (HACCP) plan. The juice HACCP regulation applies to domestic and imported 100% juice products and has implications for juice producers in countries that export juice to the United States.
HACCP plans must have supporting good manufacturing practices (GMPs) and sanitation standard operating procedures (SSOPs). In addition, the regulation requires juice processors apply a treatment that results in at least a 5-log reduction of the "pertinent microorganism," which is defined as "the most resistant microorganism of public health significance that is likely to occur in the juice." Identification of the pertinent microorganism for a particular juice may be based upon foodborne illness outbreak data or other appropriate information such as survey or recall reports involving isolation of pathogens from juices or the fruits or vegetables used to produce those juices. Currently, Salmonella is generally accepted as the pertinent pathogen in citrus juices, whereas Escherichia coli O157:H7 as well as Cryptosporidium parvum are both considered pertinent for apple juice (FDA 2001).
Outbreaks reported to the US Centers for Disease Control and Prevention (CDC) are compiled in the CDC National Outbreak Reporting System (NORS) database available at https://wwwn.cdc.gov/norsdashboard (CDC 2018). This tool was used, in part, for the preparation of the table presented here and may also be a useful resource when conducting a hazard analysis. A microbial risk assessment for unpasteurized fruit juices and cider prepared by Health Canada may also be a useful resource (Mihajlovic et al. 2013). This document is intended to highlight juice-related outbreaks, aid juice processors in the identification of "pertinent microorganisms," and review the locations, venues of juice preparations, and severity of juice-associated outbreaks.
Credit: Nathan Reading, CC BY-NC-ND 2.0 (http://flic.kr/p/9TtH1V)
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