Staphylococcal food poisoning in the United States. New facts and old misconceptions.

To determine the current epidemiologic characteristics of staphylococcal food-borne disease (SFD), we reviewed 131 outbreaks reported to the Centers for Disease Control, Atlanta, from 1977 through 1981. Staphylococcal food-borne disease was the second most common cause of reported food-borne illness, affecting more than 7,000 persons during the five-year period; 10% of these patients visited or were admitted to hospitals for their illnesses. The proportion of outbreaks attributable to Staphylococcus aureus enterotoxins A through E has changed, with enterotoxin A being the only toxin incriminated during the last three years of this review. Milk--the most common source of enterotoxin C- and D-producing strains--and commercially packed foods are less common causes of SFD outbreaks now than they were before 1960. However, previously cooked, proteinaceous foods remain preeminent in causing SFD. The presence or absence of fever in infected persons, skin lesions in food handlers, or large numbers of staphylococci in food were unreliable as diagnostic criteria. Thorough epidemiologic investigation remains crucial to identifying SFD and its sources.