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Foodborne illnesses are a risk only if the disease carrier prepares or serves the food. Typhoid is the classic foodborne illness. Casual contact with a typhoid carrier will not spread the disease. Typhoid is spread when the carrier prepares food on which the typhoid organisms can grow. The typhoid carrier infects the food, which infects the person who eats it. The proposed administrative regulations for the ADA define what the CDC considers illnesses that are commonly foodborne: hepatitis A virus, Norwalk and Norwalk-like viruses, Salmonella typhi, Shigella species, Staphylococcus aureus, and Streptococcus pyogenes. The CDC has also identified a group of diseases that can be but are not commonly foodborne: Campylobacter jejuni, Entamoeba histolytica, enterohemorrhagic Escherichia coli, enterotoxigenic Escherichia coli, Giardia lamblia, nontyphoidal Salmonella, rotavirus, Vibrio cholerae 01, and Yersinia enterocolitica.

These proposed rules will prove troubling if they are not modified. The first problem is that the list will make it difficult to exclude a person with an unusual disease that is not on the list. A greater problem is that the rules imply that foodborne illness can be prevented by enforcing hand washing and the wearing of clean gloves or by excluding persons when they have diarrheal diseases. It is true that meticulous attention to hand washing and sanitation can reduce or eliminate the risk of transmission of foodborne illnesses. It also is impossible to ensure that such high levels of sanitation are observed. Even studies of physicians, who are much more sensitive to the need for hand washing than most food handlers, demonstrate frequent lapses in hand washing, with the resultant transmission of disease. Infected food handlers can promise to wear gloves and wash their hands, thus rendering themselves otherwise qualified to work with food. The employer will not be able to exclude the infected employee until it is proved that the employee has failed to abide by the agreement to wash properly. If the breach is discovered through the infection of a customer, the employer will be liable for not preventing the spread of the disease.

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