Skip Navigation












Intranet Login

Johns Hopkins University
5801 Smith Avenue
Davis Building · Suite 3220
Baltimore, MD 21209
Phone: 410.735.6450
Fax: 410.735.6440
Directions to CEPAR (PDF)

Support CEPAR

See more in:

Fighting Foodborne Illnesses

Credit: iStock

From turkey and ham to gravy-smothered mashed potatoes, no holiday gathering is often complete without food. But these taste bud tantalizers can also unknowingly harbor bacteria if not handled, served or stored properly. Foodborne illnesses can lurk in anything from meat to milk and seafood to sprouts. Most recently, the Centers for Disease Control and Prevention issued a warning advising people not to eat any romaine lettuce and restaurants and retailers not to serve or sell any due to an E. Coli outbreak believed to be linked to romaine lettuce.

E. coli is just one of more than 250 foodborne illness diseases. Each year, the CDC estimates 48 million people get sick from a foodborne illness—nearly 130,000 are hospitalized and about 3,000 die. Most illnesses come from infections caused by a variety of bacteria, viruses and parasites. Common symptoms can include diarrhea, vomiting, stomach pain or abdominal cramping, nausea and head and body aches.

Germs to Know

Some of the top germs to know that cause illnesses from food eaten in the United States include the following:

  • Campylobacter: Campylobacter causes about 1.3 million illnesses each year in the U.S. Most are attributed to eating raw or undercooked poultry, or food that touched it. Symptoms usually start within two to five days after exposure and last about a week.
  • Salmonella: Salmonellosis infection is caused by the bacteria salmonella. There are thousands of different types of salmonella that can make people ill. According to the CDC, salmonella leads to about 1.2 million illnesses, 23,000 hospitalizations, and 450 deaths in the U.S. every year—most illnesses are associated with food. Symptoms develop 12 to 72 hours after infection and usually last four to seven days.
  • Shigella: Shigella, a bacteria that leads to shigellosis, causes about 500,000 cases of diarrhea in the U.S. every year. Symptoms typically begin one to two days after contact with the bacteria and can last five to seven days.
  • Escherichia coli or E. coli: E. coli consists of a diverse group of bacteria, including some that normally live in the intestines of people and animals. Most of the bacteria are harmless and even help the intestinal tract; however, some can cause illness. One type of E. coli, Shiga toxin-producing E. coli, has been linked to the outbreak believed to be connected to romaine lettuce. This E. coli and other “bad” types can be transmitted through contaminated water or food, or through contact with animals or people. Some kinds of E. coli can cause diarrhea, while others cause urinary tract infections, respiratory illness and pneumonia, and other illnesses. When E. coli cause diarrhea, symptoms typically improve within five to seven days.
  • Norovirus: Norovirus causes inflammation of the stomach and/or intestines. It is the most common cause of diarrhea and vomiting in the U.S. While it can be linked to food, it is considerably less strongly linked to food, because of its incredibly infectious nature. “It rips through households,” says infectious diseases physician Cynthia Sears. “If one person in the household gets it, everybody is likely to get it.” Symptoms typically develop 12 to 48 hours after being exposed to norovirus. Most people with norovirus illness get better within one to three days.
  • Listeria: Each year, about 1,600 people get listeria infection in the U.S. While rarer than other foodborne illnesses, it is one of the more serious ones. About one in five people with the infection die. When listeria infection occurs during pregnancy, it can lead to miscarriage, stillbirth or newborn death. “That’s why they say pregnant women should stay away from the deli counter because deli food can be contaminated,” Sears says. “Also, pregnant women shouldn’t eat hot dogs, because hot dogs can be contaminated or should be cooked all the way through.”

When to See a Doctor

If symptoms are not severe, then the at-home treatment for foodborne illnesses, in general, is to drink plenty of fluids. However, “if you can’t take in fluids to replace what you are putting out either by vomiting or diarrhea, that’s when you should go to the doctor,” Sears says. Also, if you develop a high fever, blood in stools, diarrhea that lasts more than three to five days or dehydration—marked by a decrease in urination, dry mouth and throat or dizziness—then a trip to the doctor is also warranted. Sears says the people at highest risk for complications or even death are those who are young or older. “You may also need antibiotics depending on how sick you are, although the vast majority of people do not typically need antibiotics, and, for some types of foodborne illnesses, antibiotics are contraindicated,” Sears says.

Prevention at Johns Hopkins

Here at Johns Hopkins, keeping the food—whether for patients, visitors, staff or students—safe from contamination is a priority. “Hospital food service needs to maintain a very high standard because of the immunocompromised patients who are served,” says Angelo Mojica, senior director of food and dining at the Johns Hopkins Health System. “For example, we have cancer patients and burn patients who are at higher risk.” Food and dining services departments at the health system and The Johns Hopkins University have regular inspections by the state or local health department. They also work with a food safety auditing company that assesses our practices and helps ensure readiness for health inspections. Food service workers are also trained in proper food handling, cooking, storage and sanitation techniques, and managers receive additional certification in food safety measures.

Many food items, such as produce, at both the health system and university are also locally sourced. According to Ian Magowan, dining programs manager at The Johns Hopkins University, 30 percent of the university’s food comes from local producers within a 250-mile radius. “I take pride in the fact we know a lot of our producers,” says Magowan. “We go to that location and determine the food’s quality. We don’t just buy because of cost. It is a good sense of reassurance that we know our farmers, some on a first name basis.” Magowan also says food is often turned away before it gets through the doors at the university if the quality isn’t up to standards. “We turn away more food at the loading dock than we do in the facility,” Magowan says. “We will spot check temperatures of food, such as dairy products like milk. If anything is not at the right temperature, we turn the food away.”

In case of a food recall, vendors will contact the food and dining services departments at both the health system and university, and team members will, in turn, pull the food from their shelves. “We want to ensure that any potentially harmful food items are removed from production and discarded as necessary,” Mojica says. While Johns Hopkins hasn’t had any of the romaine lettuce believed to be associated with the recent E. coli outbreak, Mojica says his team received a number of phone calls from concerned people who wanted to know if the lettuce was safe.

Prevention at Home

Preventing foodborne illnesses in your own home also begins with practicing safe food handling, preparation and storage measures. The general rule is cool foods should be kept cool; warm food should be kept warm. Sears recommends not leaving food out for more than two hours—though, she says, you wouldn’t want to leave food in the direct sun for that long if you are at an outdoor barbecue, for example. “The bacteria that can contaminate and then make people sick can double their population in 20 minutes, so they really multiply fast” Sears says. “The potato salad at a picnic is a classic example of something that can cause what’s called staphylococcal food poisoning, a vomiting illness, predominantly.”

Here are additional tips to prevent foodborne illness:

  • Avoid eating undercooked chicken or hamburgers. Sears says the potential amount of bacteria inside could be enough to cause serious complications or even death. “Adults might get sick, but maybe you won’t get deathly ill,” says Sears about Shiga toxin-producing E. coli, which can be found in undercooked hamburgers. However, Sears adds, Shiga toxin-producing E. coli “is the number one cause of kidney failure now in children. So I consider it irresponsible for an adult to give a child an undercooked hamburger.”
  • Use a food thermometer to ensure your food is at the proper temperature. Always keep food below 40 degrees Fahrenheit or above 140 degrees Fahrenheit, says Mojica.
  • To thaw food, leave it in the refrigerator, or put it in the microwave or under a steady stream of clean water.
  • Wash your hands with warm water and soap for at least 20 seconds and thoroughly clean utensils and surfaces that may have come into contact with contaminated food before and after handling or touching the food.
  • Wash the inside of your refrigerator, cutting boards and countertops; then sanitize them with a solution of chlorine bleach and hot water; dry with a clean cloth or paper towel. 
  • Keep meat, poultry, seafood and eggs away from other foods when you prepare and store them. Prepare uncooked food such as salads first and then prepare meats.
  • Keep cold food refrigerated as long as possible, and put it on ice when serving it.

Visit the U.S. Department of Health & Human Services and the Centers for Disease Control and Prevention food safety websites for additional tips.