A foodborne-related outbreak of group A pharyngitis occurred after an elementary school banquet. Banquet attendees who ate macaroni and cheese were three times more likely to develop pharyngitis than those who did not. None of the food handlers had group A streptococcus recovered by throat culture. However, the cook who prepared the macaroni and cheese had a hand wound which grew group A streptococcus that matched the group A streptococcus strains isolated from ill attendees. Under laboratory conditions, the macaroni and cheese supported rapid growth of the outbreak-associated strain. It seemed likely that the group A streptococcus from the hand wound contaminated the macaroni and cheese.