Food Safety

For

Transplant 

Recipients

A need-to-know guide for 

bone marrow and solid organ 

transplant recipients

U.S. Department of Agriculture 

Food and Drug Administration
Thank you to Lydia Medeiros, Ph.D., R.D., Patricia A. Kendall, 

Ph.D., R.D., and Val Hillers, Ph.D., R.D., for their assistance and 

groundbreaking research and outreach to the at-risk community. 
Food safety is important for everyone—but it’s 

especially important for you. That’s why the 

U.S. Department of Agriculture’s Food Safety 

and Inspection Service and the U.S. Department

of Health and Human Services’ Food and Drug 

Administration have prepared this booklet.

It is designed to provide practical guidance on

how to reduce your risk of foodborne illness.

In addition to this guide, we encourage you to

check with your physician or health care provider

to identify foods and other products that you should

avoid. You have a special need for this important 

information . . . so read on! 
 

 

 

 

What’s Inside:
	

Food Safety: It’s Especially Important for You................................................ 3
	

Major Pathogens That Cause Foodborne Illness ..........................................4-5
	

Eating at Home: Making Wise Food Choices................................................... 6
	

Common Foods: Select the Lower Risk Options.............................................. 7
	

Taking Care: Handling and Preparing Food Safely ...................................8-10
	

Cold Storage Chart ........................................................................................... 11
	

In the Know: Becoming a Better Shopper...................................................... 12
	

Food Product Dating ........................................................................................ 13
	

Transporting Your Groceries ........................................................................... 13
	

Being Smart When Eating Out........................................................................ 14
	

Tips for Transporting Food.............................................................................. 15
	

Foodborne Illness: Know the Symptoms ........................................................ 16
	

Foodborne Illness Action Plan ......................................................................... 17
	

For More Information on Food Safety............................................................ 18
	

Additional Food Safety Resources .................................................................. 19
	

Check out the handy Check Your Steps Clip-out Info Cards between pages 

10 and 11 of this booklet! 

Foodborne Illness in the United States 

When certain disease-causing bacteria, viruses or parasites contaminate

food, they can cause foodborne illness. Another word for such a bacteria,

virus, or parasite is “pathogen.” Foodborne illness, often called food poisoning, is an illness that comes from a food you eat. 

• The food supply in the United States is among the safest in the world—

but it can still be a source of infection for all persons. 

• According to the Centers for Disease Control and Prevention, 48 million

persons get sick, 128,000 are hospitalized, and 3,000 die from foodborne

infection and illness in the United States each year. Many of these people

are children, older adults, or have weakened immune systems and may not

be able to fight infection normally. 

Since foodborne illness can be serious—or even fatal—it is important for

you to know and practice safe food-handling behaviors to help reduce your

risk of getting sick from contaminated food. 

2 
Food Safety:

It’s Especially Important for You
	

As a transplant recipient, you are probably familiar with the topic of 

transplant rejection. It’s the body’s natural reaction or immune system’s 

response to “foreign invasion.” 

• A properly functioning immune system will try to reject or destroy

your new solid organ and/or bone marrow transplant—in the same way 

that your immune system works to clear infection from your body. 

• Because of this natural rejection possibility, it’s common for transplant 

recipients to take medications to keep rejection from happening. 

These drugs are called immunosuppressive medications because they 

suppress your immune system to keep it from attacking, or rejecting,

your transplanted organ or bone marrow. Over 

the past few decades, substantial progress has

been made in the development of these drugs

that help prevent you from experiencing a

transplant rejection. 

• Immunosuppressive medications are important, 

as they can protect your transplanted solid organ 

and/or bone marrow. But a side effect of these 

immunosuppressants is that they leave you

more susceptible to developing infections—

like those that can be brought on by diseasecausing bacteria and other pathogens that cause

foodborne illness. 

• Because you are a transplant recipient, you are 

more likely to have a lengthier illness, undergo 

hospitalization, or even die, should you contract a foodborne illness. 

• To avoid contracting a foodborne illness, you must be especially 

vigilant when handling, preparing, and consuming foods. 

Make safe food handling a lifelong commitment

to minimize your risk of foodborne illness.

Be aware that as you age, your immunity 

to infection naturally is weakened. 

3 
Major Pathogens That Cause Foodborne Illness
	

Campylobacter 

Associated Foods 

• Untreated or contaminated water 

• Unpasteurized (“raw”) milk

• Raw or undercooked meat,

poultry, or shellfish 

Symptoms and Potential Impact 

• Fever, headache, and muscle pain followed by

diarrhea (sometimes bloody), abdominal pain,

and nausea. Symptoms appear 2 to 5 days after

eating and may last 2 to 10 days. May spread

to the bloodstream and cause a life-threatening

infection. 

Cryptosporidium 

Associated Foods/Sources 

• Swallowing contaminated water, 

including that from recreational 

sources, (e.g., a swimming pool 

or lake) 

• Eating uncooked or 

contaminated food 

• Placing a contaminated object in

the mouth 

• Soil, food, water, and 

contaminated surfaces 

Symptoms and Potential Impact 

• Watery diarrhea, dehydration, weight loss,

stomach cramps or pain, fever, nausea, and

vomiting; respiratory symptoms may also be

present.

• Symptoms begin 7 to 10 days after becoming

infected, and may last 2 to 14 days. In those 

with a weakened immune system, including

bone marrow and solid organ transplant

recipients, symptoms may subside and return

over weeks to months. 

Clostridium perfringens 

Associated Foods/Sources 

• Many outbreaks result from food

left for long periods in steam 

tables or at room temperature 

and time and/or temperature 

abused foods. 

• Meats, meat products, poultry, 

poultry products, and gravy 

Symptoms and Potential Impact 

• Onset of watery diarrhea and abdominal

cramps within about 16 hours. The illness

usually begins suddenly and lasts for 12 to

24 hours. In the elderly, symptoms may last

1 to 2 weeks. 

• Complications and/or death occur only very

rarely. 

Listeria monocytogenes

Can grow slowly at refrigerator temperatures 

Associated Foods 

• Improperly reheated hot dogs,

luncheon meats, cold cuts,

fermented or dry sausage,

and other deli-style meat and

poultry 

• Unpasteurized (raw) milk

and soft cheeses made with 

unpasteurized (raw) milk 

• Smoked seafood and salads 

made in the store such as ham 

salad, chicken salad, or seafood

salads 

• Raw vegetables 

Symptoms and Potential Impact 

• Fever, chills, headache, backache, sometimes

upset stomach, abdominal pain, and diarrhea. 

May take up to 2 months to become ill.

• Gastrointestinal symptoms may appear within a few

hours or 2 to 3 days, and disease may appear 2 to 6

weeks after ingestion. The duration is variable. 

• Those at-risk (including bone marrow and solid

organ transplant recipients and others with

weakened immune systems) may later develop

more serious illness; death can result from this

bacteria. 

• Can cause problems with pregnancy, including

miscarriage, fetal death, or severe illness or death

in newborns. 

4 
Escherichia coli O157:H7 

One of several strains of E. coli that can cause human illness 

Associated Foods 

• Undercooked beef,

especially hamburger 

• Unpasteurized milk and juices,

like “fresh” apple cider

• Contaminated raw fruits and 

vegetables, and water

• Person-to-person contact 

Symptoms and Potential Impact 

• Severe diarrhea that is often bloody,

abdominal cramps, and vomiting.

Usually little or no fever. 

• Can begin 1 to 9 days after contaminated food

is eaten and lasts about 2 to 9 days.

• Some, especially the very young, may

develop hemolytic-uremic syndrome (HUS),

which can cause acute kidney failure, and can

lead to permanent kidney damage or even death. 

Noroviruses (and other caliciviruses)

Associated Foods 

• Shellfish and fecallycontaminated foods or water 

• Ready-to-eat foods touched

by infected food workers; for

example, salads, sandwiches,

ice, cookies, fruit 

Symptoms and Potential Impact 

• Nausea, vomiting, and stomach pain usually

start between 24 and 48 hours, but cases

can occur within 12 hours of exposure.

Symptoms usually last 12 to 60 hours.

• Diarrhea is more prevalent in adults and

vomiting is more prevalent in children. 

Salmonella (over 2,300 types) 

Associated Foods 

• Raw or undercooked eggs,

poultry, and meat 

• Unpasteurized (raw) milk or

juice

• Cheese and seafood 

• Fresh fruits and vegetables 

Symptoms and Potential Impact 

• Stomach pain, diarrhea (can be bloody),

nausea, chills, fever, and/or headache usually

appear 6 to 72 hours after eating; may last 4

to 7 days.

• In people with a weakened immune system,

such as bone marrow and solid organ transplant

recipients the infection may be more severe and

lead to serious complications including death. 

Toxoplasma gondii 

Associated Foods/Sources 

• Accidental contact of cat feces 

through touching hands to

mouth after gardening, handling

cats, cleaning cat’s litter box, or

touching anything that has come

in contact with cat feces. 

• Raw or undercooked meat. 

Symptoms and Potential Impact 

• Flu-like illness that usually appears 10 to 13

days after eating, may last months. Those with 

a weakened immune system, including bone

marrow and solid organ transplant recipients,

may develop more serious illness.

• Can cause problems with pregnancy, including 

miscarriage and birth defects. 

Vibrio vulnificus 

Associated Foods 

• Undercooked or raw seafood 

(fish or shellfish) 

Symptoms and Potential Impact

• Diarrhea, stomach pain, and vomiting may appear

within 4 hours and to several days and last 2 to

8 days. May result in a blood infection. May

result in death for those with a weakened immune 

system, including people with bone marrow and

solid organ transplants, cancer or liver disease. 

5 
CLEAN SEPARATE CHILL

 

 

 

Eating at Home:

Making Wise Food Choices
	

Some foods are more risky for you than

others. In general, the foods that are most

likely to contain harmful bacteria or

viruses fall into two categories: 

• Uncooked fresh fruits and 

vegetables 

• Some animal products, such

as unpasteurized (raw) milk; soft

cheeses made with raw milk; and

raw or undercooked eggs, raw

meat, raw poultry, raw fish, raw 

shellfish and their juices; luncheon 

meats and deli-type salads (without

added preservatives) prepared on site

in a deli-type establishment. 

Interestingly, the risk these foods 

may actually pose depends on the origin

or source of the food and how the food is 

processed, stored, and prepared. Follow these 

guidelines (see chart at right) for safe selection

and preparation of your favorite foods. 

If You Have Questions . . .

 . . . about Wise Food Choices: 

Be sure to consult with your doctor or health care provider. He or she 

can answer any specific questions or help you in your choices. 

. . . about Particular Foods: 

If you are not sure about the safety

of a food in your refrigerator, 

don’t take therisk. 

When in doubt, throw it out! 

Wise choices in your food selections 

are important. 

All consumers need to follow the Four 

Basic Steps to Food Safety: 

Clean, Separate, Cook, and Chill. 

KEEP YOUR FAMILY SAFER FROM FOOD POISONING 

CLEAN SEPARATE

WASH HANDS AND 

SURFACES OFTEN 

SEPARATE RAW MEATS 

FROM OTHER FOODS 

oF

COOK TO THE RIGHT 

TEMPERATURE 

CHILL

REFRIGERATE FOOD 

PROMPTLY 

Check your steps at FoodSafety.gov 

6 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Common Foods: Select the Lower Risk Options
	 

Type of Food Higher Risk Lower Risk 

Meat and 

Poultry 

Tip: Use a food thermometer to check the internal temperature on the “Is It Done 

Yet?” chart on page 10 for specific safe minimum internal temperature. 

• Raw or undercooked 

meat or poultry 

• Meat or poultry cooked to a

safe minimum internal temperature (see chart on p. 10) 

Seafood • Any raw or undercooked fish, or

shellfish, or food containing raw or

undercooked seafood e.g., sashimi,

found in some sushi or ceviche. 

Refrigerated smoked fish

• Partially cooked seafood, such as

shrimp and crab 

• Previously cooked seafood

heated to 165 °F 

• Canned fish and seafood 

• Seafood cooked to 145 °F 

Milk • Unpasteurized (raw) milk • Pasteurized milk 

Eggs 

*Tip: Most pre-made foods from grocery stores, such as Caesar dressing, 

pre-made cookie dough, or packaged eggnog are made with pasteurized eggs. 

Foods that contain raw/undercooked

eggs, such as:

• Homemade Caesar salad dressings*

• Homemade raw cookie dough*

• Homemade eggnog* 

At home: 

• Use pasteurized eggs/egg

products when preparing

recipes that call for raw or

undercooked eggs

When eating out:

• Ask if pasteurized eggs

were used 

Sprouts • Raw sprouts (alfalfa, bean, or

any other sprout) 

• Cooked sprouts 

Vegetables • Unwashed fresh vegetables,

including lettuce/salads 

• Washed fresh vegetables, 

including salads

• Cooked vegetables 

Cheese • Soft cheeses made from 

unpasteurized (raw) milk, such as:

— Feta 

— Brie 

— Camembert 

— Blue-veined 

— Queso fresco 

• Hard cheeses 

• Processed cheeses 

• Cream cheese 

• Mozzarella 

• Soft cheeses that are 

clearly labeled “made from

pasteurized milk” 

Hot Dogs and

Deli Meats 

Tip: You need to reheat hot dogs, deli meats, and luncheon meats before eating them because the bacteria

Listeria monocytogenes grows at refrigerated temperatures (40 °F or below). This bacteria may cause

severe illness, hospitalization, or even death. Reheating these foods until they are steaming hot

destroys these dangerous bacteria and makes these foods safe for you to eat. 

• Hot dogs, deli meats, and

luncheon meats that have not 

been reheated 

• Hot dogs, luncheon meats,

and deli meats reheated to 

steaming hot or 165 °F 

Pâtés • Unpasteurized, refrigerated

pâtés or meat spreads 

• Canned or shelf-stable 

pâtés or meat spreads 

7 
 

 

 

 

Taking Care:

Handling and Preparing Food Safely 

Foodborne pathogens are sneaky. Food that appears completely fine can contain 

pathogens—disease-causing bacteria, viruses, or parasites—that can make you 

sick. You should never taste a food to determine if it is safe to eat. 

As a transplant recipient, it is especially

important that you—or those preparing

your food—are always careful with food

handling and preparation. The easiest way 

to do this is to Check Your Steps – clean,

separate, cook, and chill – from the Food 

Safe Families Campaign. 

Four Basic Steps to Food Safety 

1. Clean: Wash hands and surfaces often 

Bacteria can spread throughout the kitchen and get onto

cutting boards, utensils, counter tops, and food. 

To ensure that your hands and surfaces are clean, 

be sure to: 

• Wash hands in warm soapy water for at least 20 seconds before and 

after handling food and after using the bathroom, changing diapers, or 

handling pets. 

• Wash cutting boards, dishes, utensils, and counter tops with hot soapy water between the preparation of raw meat, poultry, and seafood products and preparation

of any other food that will not be cooked. As an added precaution, sanitize cutting boards and countertops by rinsing them in a solution made of one tablespoon

of unscented liquid chlorine bleach per gallon of water, or, as an alternative, you

may run the plastic board through the wash cycle in your automatic dishwasher. 

• Use paper towels to clean up kitchen surfaces. If using cloth

towels, you should wash them often in the hot cycle of the washing machine. 

• Wash produce. Rinse fruits and vegetables, and rub firm-skin fruits and 

vegetables under running tap water, including those with skins and rinds 

that are not eaten. 

• With canned goods: remember to clean lids before opening. 

8 
 

 

 

 

 

 

2. Separate: Don’t cross-contaminate 

Cross-contamination occurs when bacteria are spread

from one food product to another. This is especially 

common when handling raw meat, poultry, seafood, 

and eggs. The key is to keep these foods—and their 

juices—away from ready-to-eat foods. 

To prevent cross-contamination, remember to: 

• Separate raw meat, poultry, seafood, and eggs from other foods in your 

grocery shopping cart, grocery bags, and in your refrigerator. 

• Never place cooked food on a plate that previously held raw meat, 

poultry, seafood, or eggs without first washing the plate with hot soapy water. 

• Don’t reuse marinades used on raw foods unless you bring them to a boil first. 

• Consider using one cutting board only for raw foods and another only for

ready-to-eat foods, such as bread, fresh fruits and vegetables, and cooked meat. 

3. Cook: Cook to safe temperatures 

Foods are safely cooked when they are heated to the

USDA-FDA recommended safe minimum internal 

temperatures, as shown on the “Is It Done Yet?” chart 

(see next page). 

To ensure that your foods are cooked safely, always: 

• Use a food thermometer to measure the internal temperature of cooked foods.

Check the internal temperature in several places to make sure that the meat, poultry, seafood, or egg product is cooked to safe minimum internal temperatures. 

• Cook ground beef to at least 160 °F and ground poultry to a safe minimum 

internal temperature of 165 °F. Color of food is not a reliable indicator of safety

or doneness. 

• Reheat fully cooked hams packaged at a USDA-inspected plant to 140 °F. For

fully cooked ham that has been repackaged in any other location or for leftover

fully cooked ham, heat to 165 °F. 

• Cook seafood to 145 °F. Cook shrimp, lobster, and crab until they turn red and

the flesh is pearly opaque. Cook clams, mussels, and oysters until the shells 

open. If the shells do not open, do not eat the seafood inside. 

• Cook eggs until the yolks and whites are firm. Use only recipes in which the eggs

are cooked or heated to 160 °F. 

• Cook all raw beef, lamb, pork, and veal steaks, roasts, and chops to 145 °F 

with a 3-minute rest time after removal from the heat source. 

9 
 

 

 

3. Cook: Cook to safe temperatures (cont.) 

• Bring sauces, soups, and gravy to a boil when reheating. Heat other leftovers

to 165 °F. 

• Reheat hotdogs, luncheon meats, bologna, and other deli meats until steaming hot or 165 °F 

• When cooking in a microwave oven, cover food, stir, and rotate for even 

cooking. If there is no turntable, rotate the dish by hand once or twice during 

cooking. Always allow standing time, which completes the cooking, before

checking the internal temperature with a food thermometer. Food is done when 

it reaches the USDA-FDA recommended safe minimum internal temperature. 

Is It Done Yet? 

Use a food thermometer to be most accurate. You can’t always tell by looking. 

USDA-FDA Recommended Safe Minimum Internal Temperatures 

Beef, Pork, Veal, Lamb Fish Beef, Pork, Veal, Lamb Egg Dishes Turkey, Chicken & Duck 

Steaks, Roasts & Chops Ground Whole, Pieces & Ground 

with 3-minute 145 °F rest time 145 °F 160 °F 160 °F 165 °F 

4. Chill: Refrigerate promptly 

Cold temperatures slow the growth of harmful bacteria. Keeping a constant refrigerator temperature of 40 °F or below is 

one of the most effective ways to reduce risk of foodborne 

illness. Use an appliance thermometer to be sure the refrigerator temperature is consistently 40 °F or below and the freezer

temperature is 0 °F or below. 

To chill foods properly: 

• Refrigerate or freeze meat, poultry, eggs, seafood, and other perishables within 

2 hours of cooking or purchasing. Refrigerate within 1 hour if the temperature 

outside is above 90 °F. 

• Never thaw food at room temperature, such as on the counter top. It is safe to 

thaw food in the refrigerator, in cold water, or in the microwave. If you thaw 

food in cold water or in the microwave, you should cook it immediately. 

• Divide large amounts of food into shallow containers for quicker cooling 

in the refrigerator. 

• Follow the recommendations in the abridged USDA-FDA Cold Storage Chart 

(see page 11). The USDA-FDA Cold Storage Chart in its entirety may be found 

at www.fsis.usda.gov/Fact_Sheets/Refrigeration_&_Food_Safety/index.asp. 

10 
 

 

 

 

 

 

Check Your Steps
	

•		Check “Sell-By” date

•		Put raw meat, poultry, or seafood in 

plastic bags

•		Buy only pasteurized milk, soft cheeses

made with pasteurized milk, and pasteurized

or juices that have been otherwise treated to

control harmful bacteria. 

•		When buying eggs: 

– Purchase refrigerated shell eggs 

– If your recipe calls for raw eggs, purchase

pasteurized, refrigerated liquid eggs

•		Don’t buy food displayed in unsafe or 

unclean conditions 

Is It Done Yet? 

You can’t tell by looking. Use a food thermometer to be sure. 

USDA-FDA Recommended Safe Minimum Internal Temperatures 

Beef, Pork, Veal, Lamb Fish Beef, Pork, Veal, Lamb Egg Dishes Turkey, Chicken & Duck 

Steaks, Roasts & Chops Ground Whole, Pieces & Ground 

with 3-minute 145 °F rest time 145 °F 160 °F 160 °F 165 °F 

Ordering “Smart” When Eating Out
	

Higher Risk: 

✘ Cheese made from 

unpasteurized (raw) milk. 

✘ Raw or undercooked 

seafood. 

✘ Cold hot dogs. 

✘ Sandwiches with cold deli 

or luncheon meat. 

✘ Raw or undercooked fish, 

such as sashimi or some 

kind of sushi. 

✘ Soft-boiled or “over-easy” 

eggs, as the yolks are not 

fully cooked. 

Lower Risk: 

✔Hard or processed cheeses. Soft cheeses 

only if made from pasteurized milk. 

✔Fully cooked smoked fish or seafood. 

✔Hot dogs reheated to steaming hot. If the 

hot dogs are served cold or lukewarm, 

ask to have the hot dogs reheated until 

steaming, or else choose something else. 

✔Grilled sandwiches in which the meat or 

poultry is heated until steaming. 

✔Fully cooked fish that is firm and flaky; 

vegetarian sushi. 

✔Fully cooked eggs with firm yolk and 

whites. 

Clip out these handy Info Cards and carry them for quick reference when shopping, cooking, and eating out! 

USDA-FDA Cold Storage Chart 

These time limit guidelines will help keep refrigerated food safe to eat. Because

freezing keeps food safe indefinitely, recommended storage times for frozen foods

are for quality only.

 Product Refrigerator (40 °F) Freezer (0 °F) 

Eggs 

Fresh, in shell 3 to 5 weeks Don’t freeze
	

Hard cooked 1 week Don’t freeze well 

Liquid Pasteurized Eggs, Egg Substitutes 

Opened 3 days Don’t freeze well 

Unopened 10 days 1 year 

Deli and Vacuum-Packed Products 

Egg, chicken, ham, tuna, 

& macaroni salads 3 to 5 days Don’t freeze well 

Hot Dogs 

Opened package 1 week 1 to 2 months 

Unopened package 2 weeks 1 to 2 months 

Luncheon Meat 

Opened package 3 to 5 days 1 to 2 months
	

Unopened package 2 weeks 1 to 2 months 

Bacon & Sausage 

Bacon 7 days 1 month 

Sausage, raw—from 

chicken, turkey, pork, beef 1 to 2 days 1 to 2 months 

Hamburger and Other Ground Meats 

Hamburger, ground beef, 

turkey, veal, pork, lamb, & 

mixtures of them 1 to 2 days 3 to 4 months 

Fresh Beef, Veal, Lamb, Pork 

Steaks 3 to 5 days 6 to 12 months 

Chops 3 to 5 days 4 to 6 months 

Roasts 3 to 5 days 4 to 12 months 

Fresh Poultry 

Chicken or turkey, whole 1 to 2 days 1 year 

Chicken or turkey, pieces 1 to 2 days 9 months 

Seafood 

Lean fish (flounder, haddock, 

halibut, etc.) 1 to 2 days 6 to 8 months 

Fatty fish (salmon, tuna, etc.) 1 to 2 days 2 to 3 months 

Leftovers 

Cooked meat or poultry 3 to 4 days 2 to 6 months 

Chicken nuggets, patties 3 to 4 days 1 to 3 months 

Pizza 3 to 4 days 1 to 2 months 

 

 
In the Know: 

Becoming a Better Shopper 

Follow these safe food-handling

practices while you shop. 

• Carefully read food labels while

in the store to make sure food 

is not past its “sell by” date.

(See Food Product Dating

on page 13) 

• Put raw packaged meat,

poultry, or seafood into a 

plastic bag before placing it

in the shopping cart, so that

its juices will not drip on—

and contaminate—other foods. 

If the meat counter does not offer 

plastic bags, pick some up from

the produce section before you select

your meat, poultry, and seafood. 

• Buy only pasteurized milk,

cheese, and other dairy products

from the refrigerated section. When buying fruit juice from the

refrigerated section of the store, be sure that the juice label says it is 

pasteurized. 

• Purchase eggs in the shell from the refrigerated section of the store. 

(Note: store the eggs in their original carton in the main part of your 

refrigerator once you are home.) For recipes that call for eggs that are 

raw or undercooked when the dish is served—homemade Caesar salad 

dressing and ice cream are two examples—use either shell eggs that have

been treated to destroy Salmonella by pasteurization, or pasteurized egg

products. When consuming raw eggs, using pasteurized eggs is the safer

choice.

 • Never buy food that is displayed in unsafe or unclean conditions. 

• When purchasing canned goods, make sure that they are free of dents, 

cracks, or bulging lids. (Once you are home, remember to clean each lid 

before opening the can.) 

• Purchase produce that is not bruised or damaged. 

When shopping for food,

it is important to read the label carefully.
	

12 
 

Food Product Dating
	

Read the “Safe Handling Label” for food safety information on 

raw foods. 

Types of Open Dates 

Open dating is found primarily on perishable foods such as meat, 

poultry, eggs, and dairy products. 

• A “Sell-By” date tells the store how 

long to display the product for sale. You 

should buy the product before the date

expires. 

• A “Best If Used By (or Before)” date is 

recommended for best flavor or quality. 

It is not a purchase or safety date. 

• A “Use-By” date is the last date 

recommended for the use of the product

while at peak quality. The date has been 

determined by the manufacturer of the

product. 

BEST IF USED BY

10 NOV 06

“Closed or coded dates” are packing numbers for use by the

manufacturer. “Closed” or “coded” dating might appear on shelf-stable 

products such as cans and boxes of food. 

CHICKEN SAMPLER PACK 

TOTAL PRICE 

MEAT DEPT. 

PRICE/LB NET WT LB 

SELL BY 

270567 005093 

P—7903 

JAN 13.06 

1.99 2.56 lb 

576 

$5.09 

Transporting Your Groceries 

Follow these tips for safe transporting

of your groceries: 

• Pick up perishable foods last, and

plan to go directly home from the

grocery store. 

• Always refrigerate perishable foods

within 2 hours of cooking or

purchasing. 

• Refrigerate within 1 hour if the

temperature outside is above 90 °F. 

• In hot weather, take a cooler with ice 

or another cold source to transport

foods safely. 

13 
 

Being Smart 

When Eating Out 

Eating out can be lots of fun—so

make it an enjoyable experience

by following some simple

guidelines to avoid foodborne illness. Remember 

to observe your food

when it is served, and

don’t ever hesitate to ask 

questions before you order. 

Waiters and waitresses can 

be quite helpful if you ask how a

food is prepared. Also, let them know 

you don’t want any food item containing 

raw meat, poultry, seafood, sprouts, or eggs. 

Basic Rules for Ordering 

• Ask whether the food contains uncooked ingredients such as eggs, 

sprouts, meat, poultry, or seafood. If so, choose something else. 

• Ask how these foods have been cooked. If the server does not know 

the answer, ask to speak to the chef to be sure your food has been 

cooked to a safe minimum internal temperature. 

• If you plan to get a “doggy bag” or save leftovers to eat at a later time, 

refrigerate perishable foods as soon as possible—and always within 

2 hours after purchase or delivery. If the leftover food is in air 

temperatures above 90 °F, refrigerate it within 1 hour. 

If in doubt, make another selection! 

14 
 

 

 

 

Smart Menu Choices 

Higher Risk: 

✘ Soft cheese made from 

unpasteurized (raw) milk. 

Lower Risk: 

✔ Hard or processed cheeses. Soft cheeses 

only if they are made from pasteurized

milk. 

✘ Refrigerated smoked seafood

and raw or undercooked seafood. 

✔ Fully cooked fish or seafood. 

✘ Cold or improperly heated hot

dogs. 

✔ Hot dogs reheated to steaming hot.

If the hot dogs are served cold or

lukewarm, ask to have them reheated until

steaming, or else choose something else. 

✘ Sandwiches with cold deli 

or luncheon meat. 

✔ Grilled sandwiches in which the meat 

or poultry is heated until steaming. 

✘ Raw or undercooked fish, 

such as sashimi, non-vegetarian

sushi, or cerviche. 

✔ Fully cooked fish that is firm and flaky 

✘ Soft-boiled or “over-easy”

eggs, as the yolks are not

fully cooked. 

✔ Fully cooked eggs with firm yolk and 

whites. 

✘ Salads, wraps, or sandwiches

containing raw (uncooked) or

lightly cooked sprouts 

✔ Salads, wraps, or sandwiches containing

cooked sprouts. 

Ask questions about how your food is cooked. 

Tips for Transporting Food 

• Keep cold food cold, at 40 °F or below. To be safest,

place cold food in cooler with ice or frozen gel packs.

Use plenty of ice or frozen gel packs. Cold food

should be at 40 °F or below the entire time you are

transporting it. 

• Hot food should be kept hot at 140 °F or above.

Wrap the food well and place in an insulated container. 

Stay “Food Safe” When Traveling Internationally

Discuss your travel plans with your physician before traveling to other

countries. Your physician may have specific recommendations for the

places you are visiting, and may suggest extra precautions or medications

to take on your travels. 

For more information about safe food and water while traveling abroad,

access the Centers for Disease Control and Prevention Web site at 

www.cdc.gov/travel. 

15 
 

 

 

Foodborne Illness: 

Know the Symptoms 

Despite your best efforts, you may find yourself in a situation where you 

suspect you have a foodborne illness. Foodborne illness often presents 

itself with flu-like symptoms. 

These symptoms include: 

• Nausea 

• Vomiting

• Diarrhea 

• Fever 

If you suspect that you

could have a foodborne 

illness, there are four

key steps that you should

take. Follow the guidelines

in the Foodborne Illness Action 

Plan on page 17, which begins

with contacting your physician or

healthcare provider right away. 

When in doubt—contact your physician

or healthcare provider! 

My Physicians: Quick Reference List 

Name: 

Phone: Specialty: 

Name: 

Phone: Specialty: 

Name: 

Phone: Specialty: 

16 
 

 

 

 

Foodborne Illness Action Plan 

If you suspect you have a foodborne illness,

follow these general guidelines: 

1.		 Consult your transplant coordinator or physician, or seek 

medical treatment as appropriate. 

As a transplant recipient on immunosuppressive medications,

you are at increased risk for severe infection. 

• Contact your physician immediately if you develop

symptoms or think you may be at risk. 

• If you develop signs of infection as discussed with your

physician, seek out medical advice and/or treatment

immediately. 

2.		 Preserve the food. 

• If a portion of the suspect food is available,

wrap it securely, label it to say “DANGER,” 

and freeze it. 

• The remaining food may be used in

diagnosing your illness and in preventing

others from becoming ill.
	

DANGER

3. Save all the packaging materials, such as cans or cartons. 

• Write down the food type, the date and time consumed, and 

when the onset of symptoms occurred. Write down as many 

foods and beverages you can recall consuming in the past week

(or longer), since the onset time for various foodborne illnesses 

differ. 

• Save any identical unopened products. 

• If the suspect food is a USDA-inspected meat, poultry, 

or egg product, call the USDA Meat and Poultry Hotline, 

1-888-MPHotline (1-888-674-6854). For all other foods, call

the FDA Office of Emergency Operations at 1-866-300-4374 

or 301-796-8240. 

4.		 Call your local health department . . .

. . . if you believe you became ill from food you ate in a

restaurant or other food establishment. 

• The health department staff will be able to assist you in determining whether any further investigation is warranted. 

• To locate your local health department, visit 

http://healthguideusa.org/local_health_departments.htm. 

17 
 

 

 

 

 

 

 

 

 

 

For More Information on Food Safety
	

You may contact the USDA Food Safety and Inspection Service and

the HHS Food and Drug Administration to obtain additional food safety

information in both English and Spanish. 

Online: 

Information can be accessed on the FSIS Website 

at www.fsis.usda.gov or at the FDA Website at 

www.fda.gov/food. 

• Food Safety Questions? “Ask Karen”— 

The FSIS Virtual Representative—

an automated response

system is available 24/7 at AskKaren.gov. 

• Send e-mail inquiries to mphotline.fsis@usda.gov or to

 consumer@FDA.gov. 

By Phone: 

Call the USDA Meat and Poultry Hotline at 1-888-MPHotline 

(1-888-674-6854) or call the FDA Food Information Line 

1-888-SAFE FOOD (1-888-723-3366) 

• These year-round, toll-free Hotlines are available Monday through 

 Friday from 10 a.m. to 4 p.m. Eastern Time. 

• An extensive selection of timely food safety messages is also available 

at these same numbers, 24 hours a day. 

Local Resources: 

State Department of Agriculture: 

State or Local Health Department: 

Other: 

18 
 Additional Food Safety Resources
	

Gateway to Government Food Safety Information, including

all recalls and alerts www.foodsafety.gov 

Centers for Disease Control and Prevention 

1-800-232-4636 (24-hour recorded information)

www.cdc.gov/foodsafety 

• National Center for Infectious Diseases/Traveler’s Health

http://wwwnc.cdc.gov/travel

• National Center for Infectious Diseases/Healthy Water

www.cdc.gov/healthywater/

 U.S. Environmental Protection Agency Office of Water

 http://water.epa.gov

 Partnership for Food Safety Education (Fight BAC!®)

 www.fightbac.org 

19
To order this and/or other At-risk booklets, contact the
	

USDA Meat and Poultry Hotline
	

1-888-MPHotline
	

(1-888-674-6854)
	

E-mail: mphotline.fsis@usda.gov
	

or
	

fsis.outreach@usda.gov
	

At-risk Food Safety Booklets for:

 Older Adults
	

Pregnant Women
	

People with Cancer
	

People with Diabetes
	

People with HIV/AIDS
	

Transplant Recipients
	

To chat with our food safety virtual representative, contact 

“Ask Karen” 

FSIS’s Web-based automated response system – available 24/7
	

Askkaren.gov 

PregunteleaKaren.gov
	

Food Safety and Inspection Service
	

www.fsis.usda.gov
	
U.S. Department of Agriculture

Food Safety and Inspection Service 

U.S. Department of Health and Human Services

Food and Drug Administration 

The U.S. Departments of Agriculture and Health and Human Services are equal 

opportunity providers and employers. 

September 2006 

Slightly revised September 2011 
Food Safety for 

Transplant Recipients