Section 103(d) of the Americans with Disabilities Act directed the Secretary of Health and Human Services to annually review and publish a list of pathogens transmitted in food contaminated by infected food-handlers. Purposes of this project were to 1) determine the incidence of these pathogens in foodborne disease outbreaks attributed to food-handlers, 2) identify the foods most frequently involved in these outbreaks and 3) suggest ways to prevent the spread of these pathogens. Information was obtained from AGRICOLA, Food Science and Technology Abstracts, MEDLINE, and Science Citation Index and articles published in public health, medical and food science journals. Poor personal hygiene of food-handlers was the factor most frequently responsible for outbreaks of Shigella spp. (91%), hepatitis A (96%), Norwalk virus (78%) and Giardia lamblia (100%) reported between 1973 and 1987. The majority of outbreaks attributed to Shigella spp. and Norwalk virus have been associated with salads, while salads and sandwiches are usually the vehicles for outbreaks involving hepatitis A and G. lamblia. Most outbreaks of Staphylococcus aureus result from the combined effects of infected food-handlers and holding food at improper temperatures; protein-rich foods are usually implicated. The principle source of infection attributed to nontyphoidal Salmonella is contaminated poultry, beef or pork that had been improperly held or inadequately cooked. Streptococcus pyogenes, Escherichia coli 0157:H7, Enterotoxigenic Escherichia coli, rotavirus, Salmonella typhi, Campylobacter jejuni, Yersinia enterocolitica, Taenia solium, Entamoeba histolytica and Vibria cholera 01 are uncommonly reported. Good hygiene, both personal and in food-handling practices, coupled with education and training are needed to prevent the transmission of pathogens from food-handlers to food and ultimately to the consumer. The importance of proper and frequent hand-washing must be stressed by dietitians.