Acute GI Illness from Eating Burritos in School Lunches
July 1, 1999
Brief Reports
Acute GI Illness from Eating Burritos in School Lunches
Sources: Holcomb G, et al. Outbreaks of gastrointestinal illness of unknown etiology associated with eating burritos-United States, October 1997-October 1998. MMWR Morb Mortal Wkly Rep 1999;48:2210-2213; JAMA 1999;281: 1263-1264.
A number of outbreaks of acute gastrointestinal illness that were associated with eating burritos in school lunches over a one-year period were investigated by the CDC and local health authorities. Symptoms including nausea, headache, abdominal cramps, vomiting, and diarrhea began within one hour of eating burritos and lasted less than 24 hours. In a Florida outbreak, the burrito fillings were made locally, suggesting that the offending agent was in the tortilla itself. All of the suspected tortillas were made in two food companies. When the possible relationship was noted, a national recall was instituted. The cause of the acute food poisoning was not identified, but the short incubation time suggested a preformed toxin in the tortillas was responsible. Possible causative agents considered included bacterial toxins, mycotoxins, trace metals, plant toxoids, alkaloids, pesticides, food additives, detergents, fat-soluble vitamins, spoilage factors, or an unknown toxin. The shortness of the observed incubation period and the prominence of headaches as well as bacteriologic studies in five outbreaks excluded usual bacterial toxins such as Bacillus cereus and Staphylococcus aureus and analyses also excluded alkaloids, biogenic amines, heavy metals, and pesticides as the causative agents. Mycotoxins including so-called vomitotoxin remain a possible cause. The CDC’s Foodborne and Diarrheal Division continues to investigate this characteristic GI syndrome, which occurred in at least 16 outbreaks throughout the United States in 1997-1998. (This Brief Report was written by Robert S. Baltimore, MD, a Professor of Pediatrics and Epidemiology and Public Health, Yale University School of Medicine.)
In reports of widespread outbreaks of a characteristic acute GI illness associated with eating burritos described by the CDC in 1997-1998:
a. the incubation period was 12-24 hours.
b. the duration of the illness was more than 48 hours.
c. the etiologic agent has been identified.
d. the etiologic agent is probably in the tortilla filling rather than in the tortilla.
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