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currently used for individuals traveling to countries where yellow fever is endemic (some parts
of South America and Africa). The vaccine is currently available in the United States only at
approved vaccination centers.
Reporting. If viral encephalitis or yellow fever is suspected, contact your local and State health
departments. If they are unavailable, contact the CDC at 770-488-7100.
Clostridium perfringens
Food poisoning may be caused by a heat-labile toxin produced in vivo by C. perfringens type A;
type C causes enteritis necroticans. Spores of C. perfringens may survive cooking. Spores
germinate and multiply during slow cooling and storage at temperatures of 20°–60°C (68°–
140°F). Once ingested, an enterotoxin produced by the organisms in the lower intestine is
responsible for symptoms. Beef, poultry, gravies, and dried or precooked foods are common
sources. Infection usually is acquired when food is prepared in large quantities and kept warm
for prolonged periods (e.g., at banquets or institutions or from food provided by caterers or
restaurants).
Signs and symptoms. Onset of watery diarrhea and moderate to severe, crampy, midepigastric
pain is sudden. Vomiting and fever are uncommon. Symptoms usually resolve in 24 hours. The
incubation period is usually 8–12 hours.
Diagnosis. The short incubation, short duration, and absence of fever in most patients
differentiates C. perfringens foodborne disease from shigellosis and salmonellosis. The
infrequency of vomiting and longer incubation period contrast with the clinical features of
foodborne disease associated with heavy metals, Staphylococcus aureus enterotoxins, and fish
and shellfish toxins. Diarrheal disease caused by Bacillus cereus enterotoxin may be
indistinguishable from that caused by C. perfringens. Enteritis necroticans is a cause of severe
illness and death attributable to C. perfringens food poisoning among children in Papua, New
Guinea (where it is also known as pigbel).
Because the fecal flora of healthy people commonly includes C. perfringens, counts of 10 6 /gram
of feces obtained within 48 hours of onset of illness are required to support the diagnosis. The
diagnosis can be suggested by detection of C. perfringens enterotoxin in feces by commercially
available kits. To confirm C. perfringens as the cause, the concentration of organisms should be
at least 10 5 /gram in the epidemiologically implicated source of infection (food). Although C.
perfringens is an anaerobe, special transport conditions are unnecessary because the spores are
durable. Fecal samples, rather than rectal swab specimens, should be obtained.
Treatment. Oral rehydration or, occasionally, IV fluid and electrolyte replacement may be
indicated to prevent or treat dehydration. Antimicrobial agents are not indicated.
Control measures. Clostridium perfringens food poisoning is not transmissible from person to
person.
Reporting. If C. perfringens food poisoning is suspected, contact your local and State health
departments. If they are unavailable, contact the CDC at 770-488-7100.
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