The Big 6 Foodborne Illnesses: What Texas Food Handlers Must Report

If you work in food service in Texas, there are six specific illnesses you are legally required to report to your manager before clocking in. These are not just workplace policies — they are state requirements designed to stop dangerous pathogens from reaching customers through the food supply.

What are the Big 6 foodborne illnesses?

The "Big 6" are six pathogens that pose the highest risk of causing widespread foodborne illness outbreaks when a food handler is infected. Texas DSHS requires food handlers to report any of these illnesses — or symptoms associated with them — to a manager before beginning work:

Norovirus — the most common cause of foodborne illness outbreaks in restaurants. Spreads through contaminated food, surfaces, and person-to-person contact. Symptoms include sudden vomiting and diarrhea.
Hepatitis A — a viral liver infection spread through fecal-oral contamination. An infected food handler can unknowingly contaminate food before symptoms appear. Can cause liver damage lasting weeks.
Shigella — a bacterial infection causing severe, often bloody diarrhea. Extremely contagious — ingesting as few as 10 organisms can cause illness.
Non-typhoidal Salmonella — commonly linked to raw poultry and eggs. An infected food handler can spread it even while feeling only mildly ill. Especially dangerous for children under 5 and elderly individuals.
Shiga Toxin-Producing E. coli (STEC) — produces toxins that can cause life-threatening kidney failure (hemolytic uremic syndrome), particularly in young children. Even trace contamination can cause serious harm.
Typhoid Salmonella (Salmonella Typhi) — causes high fever and can become life-threatening without treatment. Spread through contaminated food and water.

What symptoms must a food handler report?

You must notify your manager before your shift starts if you experience:

Vomiting — even one episode
Diarrhea — loose or watery stools
Jaundice — yellowing of the skin or eyes (possible sign of Hepatitis A)
Sore throat with fever

You should also report if you have received a diagnosis of any of the Big 6, even if you currently feel fine.

Who is most at risk from these illnesses?

Certain groups face the most serious consequences from foodborne illness:

Young children (under 5) — immune systems still developing
Adults over 65 — weakened immune response
Pregnant women — some foodborne illnesses can harm the fetus directly
Immunocompromised individuals — those with HIV, undergoing chemotherapy, or on immunosuppressants

When a food handler comes to work sick with one of the Big 6, these are the people most likely to experience severe or life-threatening complications.

The rule is simple

If you have symptoms — or a confirmed diagnosis — of any of the Big 6, tell your manager before your shift. Your employer is required to have a plan for handling this. Missing a shift is inconvenient. Causing a foodborne illness outbreak can be catastrophic.

Know the Big 6 Before Your Certification Exam

The Big 6 are covered in detail in our Texas Food Handler course — along with every other topic tested on the final exam. Get certified in about 2 hours, entirely on your phone.