Big Six Pathogens
The Big Six pathogens are six highly infectious microorganisms identified by the FDA Food Code that require food workers to be excluded from or restricted in food service operations when diagnosed: Norovirus, Hepatitis A, Salmonella Typhi, Shigella spp., Shiga toxin-producing E. coli (STEC), and non-typhoidal Salmonella.
Exam Tip
Big Six: Norovirus, Hepatitis A, Salmonella Typhi, Shigella, STEC (E. coli O157:H7), non-typhoidal Salmonella. Exclusion = cannot work at all. Restriction = cannot handle food. Must report all to health department. Norovirus = #1 cause of foodborne illness.
What Are the Big Six Pathogens?
The Big Six (also called the Big 6) are the six most infectious foodborne pathogens that pose the greatest risk of being transmitted through food workers. The FDA Food Code requires managers to exclude or restrict food workers diagnosed with any of these illnesses.
The Big Six Pathogens
| Pathogen | Type | Common Sources | Key Symptoms |
|---|---|---|---|
| Norovirus | Virus | Contaminated water, ready-to-eat foods, shellfish | Vomiting, diarrhea, nausea (highly contagious) |
| Hepatitis A | Virus | Contaminated water, shellfish, ready-to-eat foods | Jaundice, fever, fatigue, abdominal pain |
| Salmonella Typhi | Bacteria | Contaminated water, ready-to-eat foods | Typhoid fever, high fever, weakness |
| Shigella spp. | Bacteria | Food contaminated by infected handler, flies | Bloody diarrhea, fever, abdominal cramps |
| STEC (E. coli O157:H7) | Bacteria | Undercooked ground beef, contaminated produce | Bloody diarrhea, severe cramps, kidney failure risk |
| Non-typhoidal Salmonella | Bacteria | Poultry, eggs, produce, unpasteurized dairy | Diarrhea, fever, abdominal cramps |
Exclusion vs. Restriction
| Action | Definition | When Applied |
|---|---|---|
| Exclusion | Food worker cannot work in the establishment at all | Diagnosed with a Big Six illness; serving high-risk populations |
| Restriction | Food worker cannot work with exposed food, equipment, or utensils | Symptoms present but not yet diagnosed |
High-Risk Populations (Require Exclusion)
| Population | Examples |
|---|---|
| Immunocompromised | Hospital patients, HIV/AIDS patients |
| Preschool-age children | Daycare centers, preschools |
| Elderly | Nursing homes, assisted living |
Manager Responsibilities
| Responsibility | Action |
|---|---|
| Report to health department | When a food worker is diagnosed with a Big Six illness |
| Exclude or restrict | Remove infected workers from food handling duties |
| Return to work | Only after medical clearance or meeting FDA Food Code criteria |
| Monitor symptoms | Track employee health daily |
Exam Alert
The Big Six pathogens are heavily tested on the ServSafe Manager exam. Memorize all six and know the difference between exclusion (cannot be in the establishment) and restriction (cannot handle food). Norovirus is the most common cause of foodborne illness. All Big Six illnesses must be reported to the local health department.
Study This Term In
Related Terms
Foodborne Illness
A foodborne illness (food poisoning) is a disease transmitted to people through contaminated food or beverages, caused by biological hazards (bacteria, viruses, parasites), chemical hazards (toxins, cleaning agents), or physical hazards (foreign objects). The CDC estimates 48 million cases occur annually in the United States.
Active Managerial Control
Active managerial control is a food safety management approach where the person in charge (PIC) proactively anticipates, identifies, and corrects food safety risks rather than reacting to problems after they occur. It is the FDA-recommended strategy for preventing foodborne illness in food service establishments.
Person in Charge (PIC)
The Person in Charge (PIC) is the individual present at a food service establishment who is responsible for managing the operation and ensuring compliance with the FDA Food Code. The PIC must demonstrate knowledge of food safety principles, including foodborne illness prevention, HACCP, proper temperatures, and allergen management.
Biological Hazard
A biological hazard in food safety refers to harmful microorganisms or their toxins that can contaminate food and cause foodborne illness. Biological hazards include bacteria, viruses, parasites, and fungi, and they are the most common cause of foodborne illness outbreaks.
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