Juice-associated outbreaks of human illness in the United States, 1995 through 2005

Outbreaks of illness associated with consumption of fruit juice have been a growing public health problem since the early 1990s. In response to epidemiologic investigations of outbreaks in which juice was implicated, the U.S. Food and Drug Administration implemented process control measures to regulate the production of fruit juice. The final juice regulation, which became effective in 2002, 2003, and 2004, depending on the size of the business, requires that juice operations comply with a hazard analysis critical control point (HACCP) plan. The Centers for Disease Control and Prevention (CDC) receives reports of food-associated outbreaks of illness. We reviewed fruit juice-associated outbreaks of illness reported to the CDC's Foodborne Outbreak Reporting System. From 1995 through 2005, 21 juice-associated outbreaks were reported to CDC; 10 implicated apple juice or cider, 8 were linked to orange juice, and 3 involved other types of fruit juice. These outbreaks caused 1,366 illnesses, with a median of 21 cases per outbreak (range, 2 to 398 cases). Among the 13 outbreaks of known etiology, 5 were caused by Salmonella, 5 by Escherichia coli O157:H7, 2 by Cryptosporidium, and one by Shiga toxin-producing E. coli O111 and Cryptosporidium. Fewer juice-associated outbreaks have been reported since the juice HACCP regulation was implemented. Some juice operations that are exempt from processing requirements or do not comply with the regulation continue to be implicated in outbreaks of illness.