Food Protection Trends - March/April 2020 - 97

Figure 1. Number of persons infected with the outbreak strain of Salmonella Typhimurium associated
with an online meal subscription service, by date of illness onset, Toronto, Ontario, July 2016 (N = 7)

Exposure history
The case investigation revealed that all six confirmed
cases interviewed had eaten food from the same online
meal subscription service within the three days preceding
symptom onset. The confirmed cases had one online meal
subscription service batch date in common ( July 11),
and one meal option in common (poultry). Two of the
cases lived in the same household; however, because
both consumed the poultry meal on July 11 and fell ill
on July 15, a common source exposure was considered
to be more likely than person-to-person transmission.
Food safety investigation
Toronto Public Health inspected commercial food
premises identified by the outbreak cases through the food
history questionnaire. The outbreak cases were able to
name the online meal subscription service, but did not
know where the food was produced, as there was no storefront. The business had not previously identified itself to the
Medical Officer of Health prior to commencing operations,
as per provincial food premises regulations (7), and therefore
had not been previously inspected by Toronto Public Health.
The online meal subscription service began operating in
January 2015, with food preparation taking place in a rental
kitchen. Food preparation moved to a commercial kitchen
in April 2016 to accommodate a rapidly expanding number
of subscribers. Typically, meal preparation for five different
meal options (poultry, beef, pork, and two vegetarian)

occurred in a single batch over three consecutive days.
Delivery to centralized customer pickup locations or directly
to the subscriber occurred on the fourth day. The prepared
meals were labelled with only a symbol indicating poultry,
beef, pork, or vegetarian, without production or "best before"
dates or re-heating instructions present on the package. Meal
contents and nutritional labelling were available online only.
At the time of the outbreak, the online meal subscription
service was preparing approximately 1,700 meals twice
weekly at a commercial base kitchen. Of those, 1,100 meals
were being delivered to four designated downtown Toronto
locations for centralized pickup by subscribers. Food delivery
to pickup locations were made by an employee of the online
meal subscription service, using cooler bags without ice
packs. Each pickup location was a food premise, such as a
coffee shop, with a sublease contract with the online meal
subscription service. An upright refrigerator owned by the
online meal subscription service was used to store meals
at the pickup location. Subscribers personally accessed the
refrigerator and chose their meals at the time of pickup;
there was no record of who took what meals when; only the
number of meals taken was recorded. All six of the confirmed
cases in this outbreak picked up their meals, three from
pickup location A and three from pickup location B.
The other 600 meals were delivered directly to subscribers'
home or workplace by a third-party delivery service. For
those deliveries, the meals were packaged in coolers with ice
packs. Depending on the subscribers' preference, the coolers

March/April Food Protection Trends

Food Protection Trends - March/April 2020

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