Pathogens Spread by Food Handlers

The Big Six Pathogens and Managerial Reporting

Food service managers carry the primary responsibility for protecting guests from foodborne illness by maintaining active managerial control over staff hygiene and health. The FDA Food Code identifies six reportable pathogens commonly transmitted by food handlers, often referred to as the Big Six. These six biological hazards are Norovirus, Hepatitis A, Shigella spp., Shiga toxin-producing E. coli (STEC), Salmonella Typhi, and nontyphoidal Salmonella. Each of these organisms poses an exceptional threat in retail food operations because infected employees can easily spread them to ready-to-eat foods, clean utensils, and food-contact surfaces.

As a person in charge, you must establish clear employee health policies and know when an illness requires formal reporting. The FDA Food Code directs the person in charge to notify the regulatory authority when a food employee reports a diagnosis involving a Big Six pathogen. However, managers must recognize that state and local public health codes may have reporting and exclusion criteria that differ from the model FDA Food Code. Because state and local codes can vary depending on the jurisdiction, enforceable reporting requirements depend on the applicable state or local code, making it critical for managers to know their local rules.

When an employee tests positive for one of these organisms, managers must apply the FDA Food Code's pathogen-specific exclusion or restriction rules. An exclusion prohibits the employee from working in the food establishment entirely, while a restriction limits their activities so they do not work with exposed food, clean equipment, utensils, linens, or unwrapped single-service articles. Importantly, a diagnosis does not always require excluding an asymptomatic employee; rather, decisions depend strictly on the pathogen involved, the presence of symptoms, and whether the facility serves a highly susceptible population. Active managerial control means monitoring these staff reports daily and adjusting duties immediately to prevent widespread transmission.

For example, if a line cook mentions receiving a laboratory diagnosis for a Big Six pathogen but feels completely healthy, the manager cannot simply allow the cook to work as normal, nor should the manager immediately assume permanent termination is required. Instead, the manager reviews the specific pathogen rules under the local code, immediately notifies the regulatory authority, and places the employee on exclusion or restriction based on the standard criteria.