The Big Six Foodborne Illness Pathogens Food Handlers Must Report
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The FDA Food Code names six pathogens food employees must report to their manager if diagnosed: Norovirus, Hepatitis A virus, Salmonella Typhi, nontyphoidal Salmonella, Shigella species, and Shiga toxin-producing E. coli (STEC, also called EHEC). Reporting is required regardless of whether the employee currently has symptoms, and it also covers exposure through a household member’s diagnosis or through food linked to a confirmed outbreak.
These six get special regulatory attention because they share a dangerous combination: a low infectious dose, meaning it takes very few organisms to make someone sick, and easy fecal-to-food transmission even when an infected person is washing their hands correctly. The 2022 Food Code update added nontyphoidal Salmonella to what used to be called the “Big Five,” making it six.
What are the six pathogens specifically
Norovirus, Hepatitis A virus, Salmonella Typhi (which causes typhoid fever), nontyphoidal Salmonella, Shigella species, and Shiga toxin-producing E. coli, often written as STEC or referred to by the older term EHEC. Each is a distinct organism with different symptoms and incubation periods, but they’re grouped together in food code because they trigger the same reporting and exclusion response from a food establishment.
| Pathogen | Common name/notes |
|---|---|
| Norovirus | Most common cause of foodborne illness outbreaks |
| Hepatitis A virus | Causes liver infection; vaccine-preventable |
| Salmonella Typhi | Causes typhoid fever, distinct from common Salmonella |
| Nontyphoidal Salmonella | Added to the reportable list in the 2022 Food Code |
| Shigella spp. | Causes shigellosis, highly contagious at low doses |
| Shiga toxin-producing E. coli (STEC/EHEC) | Includes E. coli O157:H7 and related strains |
Why do these six pathogens get special reporting rules
Because a food employee infected with one of the Big Six can shed hundreds of thousands of pathogen particles in their feces, and it takes a very small number of those particles to make another person sick. That combination, low infectious dose plus heavy shedding, means normal good hygiene like handwashing reduces but doesn’t eliminate the transmission risk, which is why the Food Code treats these six differently from a typical stomach bug or cold that doesn’t carry the same reporting requirement.
What has to be reported, and to whom
A food employee must report a diagnosis of any of the six pathogens to the person in charge of the establishment, even if they aren’t currently showing symptoms. Reporting also covers two other situations: living with someone who has been diagnosed with one of the six, or having eaten food that’s been specifically linked to a confirmed outbreak of one of them. The person in charge is then responsible for deciding whether to exclude or restrict that employee from certain duties based on Food Code guidance.
What’s the difference between exclusion and restriction
Exclusion means the employee can’t work in the establishment at all for a period of time, typically until symptom-free for a set period or cleared by a health authority, and it’s the response used for the highest-risk situations like a confirmed diagnosis with active symptoms. Restriction is less severe: the employee can still work, but not in roles involving direct contact with exposed food, clean equipment, or unwrapped single-service items. Which response applies depends on the specific pathogen, symptom status, and the employee’s job duties.
Does this apply to every foodborne illness, or just these six
Just these six, specifically, plus general symptom-based reporting requirements like vomiting or diarrhea that apply regardless of a confirmed diagnosis. A food employee with a common cold or a non-foodborne illness isn’t subject to the same reporting and exclusion framework; the Big Six list exists because these particular pathogens combine low infectious dose with easy food-based transmission in a way most other illnesses don’t.
This is one of the most frequently tested topics on manager-level exams. FoodHandlerPass’s free practice quiz covers the Big Six alongside exclusion and restriction rules, since exam questions often test both the pathogen names and the correct employer response together.
For a full breakdown of employee health policy, symptom reporting, exclusion, restriction, and the Big Six, the FoodHandlerPass study guide covers it as one connected topic rather than isolated facts.
FAQ
How many pathogens are on the FDA’s reportable list, and did that number change recently? Six, as of the 2022 FDA Food Code, which added nontyphoidal Salmonella to what was previously called the “Big Five.” Some older training materials still reference five, so confirm which edition of the Food Code your local jurisdiction has adopted if the exact count matters for your exam.
Does a food employee have to report a Big Six diagnosis even without symptoms? Yes. Reporting is required based on diagnosis alone, regardless of current symptom status, because someone can still shed and transmit these pathogens without feeling sick.
What’s the difference between exclusion and restriction for an infected employee? Exclusion means the employee cannot work at the establishment at all for a period. Restriction means they can work but not in roles touching exposed food, clean equipment, or unwrapped single-service items. The correct response depends on the specific pathogen and symptom status.
Do employees have to report if a household member is diagnosed, not just themselves? Yes. Reporting requirements extend to household exposure to any of the Big Six pathogens, not just a personal diagnosis, since living with an infected person raises transmission risk even before the employee shows any symptoms themselves.
Why was nontyphoidal Salmonella added to the list in 2022? The FDA expanded the reportable pathogen list from five to six specifically to include nontyphoidal Salmonella, reflecting its role as a major cause of foodborne illness outbreaks that met the same low-infectious-dose, easy-transmission criteria as the original five.