Highly Susceptible Populations: What Food Handlers Must Know

No one is immune from foodborne illnesses.

However, specific populations — known as highly susceptible populations — are more likely to develop a foodborne illness and experience severe symptoms or require hospitalization from them.

This article provides an overview of highly susceptible populations and what food handlers need to know to serve them safely.

What are foodborne illnesses?

Foodborne illnesses are caused by consuming foods or beverages contaminated with a food hazard.

The three types of food hazards include:

• Biological: These are disease-causing organisms known as pathogens and include bacteria, viruses, parasites, and fungi.
• Chemical: These include chemicals such as cleaning agents that get into foods or beverages.
• Physical: These include physical objects like hair, bandages, dirt, or pieces of cooking equipment that get into food.

Biological hazards — specifically bacteria and viruses — are responsible for most foodborne illnesses.

The most common symptoms of foodborne illnesses include:

• vomiting
• diarrhea
• nausea
• abdominal pain
• fever

The onset of these symptoms, the duration in which they last, and their severity vary depending on the bacteria or virus.

Populations most susceptible to foodborne illnesses

An estimated 48 million people in the United States — that’s 15% of the population — get sick from a foodborne illness each year (1).

No one is immune from them, but certain populations are more likely to develop one and experience severe symptoms and health complications as a result.

These populations are known as highly susceptible populations.

The four highly susceptible populations include (2):

• Preschool-aged children (age 5 years and younger): The immune systems of young children are still developing, and they cannot fight off infections like older children or adults.
• Older adults (age 65 years and older): As people age, their immune system becomes less robust, making it more challenging to fend off pathogens.
• Pregnant women: Changes in immune system function and hormones put pregnant women at a higher risk for foodborne illness.
• Immunocompromised people: Conditions like cancer, diabetes, and liver and kidney disease, and medical treatments like chemotherapy and radiation therapy weaken the immune system.

You can use the acronym YOPI — young, old, pregnant, immunocompromised — as way to remember these four highly susceptible populations.

Many people with increased susceptibility to foodborne illness will be in hospitals, nursing homes, and child or adult care centers. Others will be living at home in the community.

How to serve highly susceptible populations safely

You should always follow safe food handling practices, no matter who you serve.

But when it comes to serving highly susceptible populations, there are additional precautions you must take to keep them safe from foodborne illnesses.

Juice

You can only serve juice that has been pasteurized (heat-treated) or treated in a different way to kill harmful bacteria.

Most juice in the United States is pasteurized, but some grocery stores, health food stores, and farmers’ markets sell packaged juice that was made onsite without undergoing pasteurization or a different treatment method to ensure its safety.

This juice cannot be served or offered for sale to highly susceptible populations since harmful bacteria may be present.

These untreated juice products must carry the following warning on their label:

WARNING: This product has not been pasteurized and therefore may contain harmful bacteria that can cause serious illness in children, the elderly, and persons with weakened immune systems. 

However, this warning label is not required for juice or cider sold by the glass — for example, at apple orchards or farmers’ markets.

Pureed fruits and vegetables — which are commonly prepared for food service — are not considered juices, unless the purees are used in juices and beverages.

Eggs

Eggs can be contaminated with pathogens like Salmonella.

This is why cooking eggs and holding them at the proper temperature is important to prevent foodborne illnesses.

However, some foods rely on raw eggs as an ingredient.

Examples of raw egg products include:

• Sauces and dressings: mayonnaise, Caesar salad, and hollandaise sauce
• Desserts: tiramisu, mousse, eggnog, and fried-ice cream batter

Egg dishes that are not cooked through like poached eggs, over easy, and sunny-side-up are also considered raw egg products.

Because raw egg products may contain Salmonella, you cannot serve or sell them to highly susceptible populations unless the eggs have been pasteurized.

Meats, seafood, and raw seed sprouts

Raw meats and seafood can be contaminated with various types of pathogens like Salmonella and E. Coli.

For this reason, you cannot serve or sell raw meat and fish products like sushi or steak tartare to highly susceptible populations.

And because meats and seafood that are not cooked to their minimum safe internal temperatures can allow bacteria to survive, you also cannot serve or sell partially cooked animal foods.

Raw seed sprouts are also unsafe for highly susceptible populations.

They are seeds that have been allowed to germinate into young plants.

Raw seed sprouts must be grown in warm, humid conditions where harmful bacteria happen to thrive.

Reservice of food

The reservice of unopened packaged foods like crackers, granola bars, condiments, and other non-time-temperature control for safety (TCS) food is common.

However, if you work at a healthcare facility like a hospital or nursing home, you cannot reservice packaged food from patients who are in isolation or quarantine to anyone else.

This is because a patient in isolation or quarantine can contaminate the food packages with pathogens and spread them to other people if the package is reserved.

Once food packages come in contact with an isolation room, they must stay there until the patient uses or tosses them.

Similarly, you cannot reservice food packages from patients outside of isolation or quarantine to patients who are in isolation or quarantine.

This reduces the risk that pathogens are spread from the outside to the person in isolation or quarantine.

Reservice is a common mistake food handlers make in nursing homes, including the reservice of food brought in from outside sources.

The bottom line

Highly susceptible populations are more likely than the general public to develop foodborne illnesses and experience health complications from them.

Highly susceptible populations include preschool-aged children, older adults, pregnant women, and those who are immunocompromised due to a condition like cancer or because of a medical treatment like chemotherapy.

There are additional safety measures that you must take when serving these populations to keep them safe from foodborne illnesses.

You cannot serve highly susceptible populations untreated juice, unpasteurized raw egg products, raw or lightly cooked meats and seafood, or raw seed sprouts.

You also cannot reserve packaged food to patients who are in isolation or quarantine or from those patients to others.