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Concept · under Foodborne illness

The Big 6 pathogens and what a diagnosis means at work

Norovirus, hepatitis A, Shigella, Shiga toxin-producing E. coli (STEC), Salmonella Typhi and nontyphoidal Salmonella: those are the Big 6, the pathogens the FDA Food Code singles out when a food worker gets sick. A diagnosis with any of them has to be reported to the person in charge, and it can keep the worker away from food or out of the building.

  • ExamPFH
  • Questions here7
  • UpdatedOct 14, 2026
On this page 5 sections
  1. The six, and what a diagnosis means
  2. Why these six get their own rules
  3. Questions on the six
  4. Big 6, quick answers
  5. Sources

The six, and what a diagnosis means

Norovirus
A virus. With vomiting or diarrhea, the worker is excluded. With no symptoms, excluded where the guests are a highly susceptible population, restricted everywhere else (2-201.12).
Hepatitis A
A virus that attacks the liver; jaundice, a yellow tint to skin or eyes, is the sign the code names. A diagnosed worker is excluded, with or without symptoms.
Shigella
Bacteria. Same pattern as norovirus: excluded with vomiting or diarrhea; with no symptoms, excluded at a highly susceptible site and restricted elsewhere.
Shiga toxin-producing E. coli (STEC)
Bacteria that make Shiga toxin. Not every E. coli is on the list, only this group. Same exclusion pattern as Shigella.
Salmonella Typhi
The cause of typhoid fever. A worker diagnosed with it, or who had it in the past 3 months without antibiotic treatment, is excluded.
Nontyphoidal Salmonella
The everyday kind of Salmonella. With vomiting or diarrhea, excluded. With no symptoms, restricted, whatever kind of place it is.

Why these six get their own rules

Plenty of germs cause foodborne illness. What sets these six apart is that a worker who carries one can pass it into food, so the Food Code adds worker-health rules (report, exclude, restrict) on top of the cooking and holding temperatures under time and temperature.

The duty to speak up sits with you, the worker. Under FDA Food Code 2022, 2-201.11, a food employee reports a diagnosis with any of the six to the person in charge, along with the symptoms on the list: vomiting, diarrhea, jaundice, sore throat with fever, or an open, draining infected wound.

Excluded means not working in the establishment as a food employee at all. Restricted means working, but away from exposed food, clean equipment and unwrapped single-service items. Who gets which, and how they come back, is on sick food worker exclusion.

A highly susceptible population means guests more likely to get seriously ill: children in day care, older adults in a care home, people with weakened immune systems. Where those are the guests, several “restrict” outcomes above become “exclude.”

Day to day, the defense is a scrub you do dozens of times a shift: handwashing steps. The 2026 edition of the Food Code changed one detail of the return-to-work rules, swapping two negative stool cultures for two negative results from a validated lab test (FDA summary of the 2026 changes, as of October 2026). The NEHA course is built on the 2022 edition.

Questions on the six

These go past the list itself.

Each question is a chit, an order ticket. Answer it and it flips to show why every option is right or wrong.

0 right · 0 missed · 7 to go

  1. No. 01

    What is the primary way Hepatitis A is transmitted in food service?

    Pick one. The chit flips to a note on every option.

    Notes on No. 01

    1. A

      Contaminated water Contaminated water can spread hepatitis A, but in food service the main route is a sick worker's unwashed hands.

    2. B

      Coughing Hepatitis A isn't spread by coughing; it moves from feces to mouth, usually on hands or food.

    3. C

      Poor hand hygiene Correct: Hepatitis A spreads from feces to mouth, so a worker who skips handwashing after the restroom can pass it through food.

    4. D

      Raw meat Raw meat isn't a typical source; hepatitis A is linked to infected workers, shellfish from polluted water, and produce.

  2. No. 02

    What is the most common source of norovirus contamination in food service?

    Pick one. The chit flips to a note on every option.

    Notes on No. 02

    1. A

      Infected food handlers Correct: Norovirus usually reaches food from workers who are sick or just recovering, which is why vomiting and diarrhea mean staying home.

    2. B

      Dirty equipment Dirty equipment can spread norovirus, but it usually got there from an infected person's hands or vomit.

    3. C

      Raw meat Raw meat isn't the main source; norovirus comes from people and is linked to ready-to-eat food and shellfish.

    4. D

      Contaminated water Contaminated water can carry norovirus, but in restaurants infected food handlers are by far the more common source.

  3. No. 03

    Which foodborne illness has the longest incubation period?

    Pick one. The chit flips to a note on every option.

    Notes on No. 03

    1. A

      E. coli E. coli O157:H7 usually causes symptoms within about 1 to 10 days, much sooner than hepatitis A.

    2. B

      Salmonella Salmonella typically causes symptoms within 6 hours to a few days.

    3. C

      Norovirus Norovirus strikes fast, often within 12 to 48 hours.

    4. D

      Hepatitis A Correct: Hepatitis A can take 15 to 50 days to cause symptoms, so a worker may spread it before ever feeling sick.

  4. No. 04

    What is the most common source of Shigella contamination in food service?

    Pick one. The chit flips to a note on every option.

    Notes on No. 04

    1. A

      Poor personal hygiene Correct: Shigella spreads from feces to mouth, mostly through workers who don't wash their hands well after the restroom.

    2. B

      Unpasteurized dairy Unpasteurized dairy is linked to Listeria and other bacteria, not mainly to Shigella.

    3. C

      Contaminated raw meat Raw meat is better known for Salmonella and E. coli; Shigella usually comes from people.

    4. D

      Unwashed vegetables Produce can carry Shigella, but most food service cases trace back to an infected worker's hands.

  5. No. 05

    Which foodborne pathogen is most likely to cause long-term complications?

    Pick one. The chit flips to a note on every option.

    Notes on No. 05

    1. A

      Staphylococcus Staphylococcus aureus causes fast, short-lived vomiting from its toxin, usually without lasting damage.

    2. B

      Bacillus cereus Bacillus cereus illness is usually brief vomiting or diarrhea that passes within a day.

    3. C

      E. coli O157:H7 Correct: E. coli O157:H7 can cause hemolytic uremic syndrome, a kind of kidney failure that is most dangerous for young children.

    4. D

      Common cold virus The common cold is a respiratory virus, not a foodborne pathogen, and it doesn't cause lasting complications.

  6. No. 06

    Which bacterial pathogen is commonly associated with raw or undercooked poultry?

    Pick one. The chit flips to a note on every option.

    Notes on No. 06

    1. A

      Vibrio vulnificus Vibrio vulnificus is tied to raw oysters and other seafood from warm waters, not poultry.

    2. B

      Clostridium perfringens Clostridium perfringens is a slow-cooling problem in big batches of meat and gravy, not the classic raw-poultry germ.

    3. C

      Salmonella Correct: Salmonella is common in raw poultry, which is why chicken is cooked to 165°F and kept away from ready-to-eat food.

    4. D

      Shigella Shigella usually comes from infected people's hands, not from raw poultry.

  7. No. 07

    Which statement about viral foodborne illness is correct?

    Pick one. The chit flips to a note on every option.

    Notes on No. 07

    1. A

      Viruses can be killed by freezing Freezing preserves viruses rather than killing them; they can survive in frozen food and cause illness later.

    2. B

      Viruses cannot multiply in food Correct: Viruses need a living host to multiply, so they don't grow in food, but a tiny amount on food is enough to make someone sick.

    3. C

      Viruses grow quickly in food Viruses don't grow in food at all; that's why personal hygiene, not temperature, is the main defense against them.

    4. D

      Viruses die quickly at room temperature Norovirus and hepatitis A can survive on surfaces and food for days at room temperature.

Big 6, quick answers

Do I have to tell my manager about a diagnosis if I feel fine?

Yes. The FDA Food Code 2022 (2-201.11) lists a diagnosis with any Big 6 pathogen as reportable whether or not you have symptoms. The person in charge then applies the exclusion or restriction the code sets for that diagnosis, and notifies the health department (2-201.11(B)).

Big 6 and Big 9: what's the difference?

The Big 6 are germs that keep a sick worker off the line. The Big 9 are food allergens, the ones on the Big 9 allergens page. Different lists, different rules.

Do servers and bartenders fall under these rules?

If the job touches unwrapped food, utensils, dishes or food-contact surfaces, the Food Code counts you as a food employee (1-201.10). A server plating desserts or a bartender cutting limes reports a Big 6 diagnosis the same way a line cook does.

Sources