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Large Salmonella Enteritidis outbreak with prolonged transmission attributed to an infected food handler, Texas, 2002

  • M. E. BEATTY (a1) (a2), G. SHEVICK (a3), K. SHUPE-RICKSECKER (a3), E. BANNISTER (a4), A. TULU (a4), K. LANCASTER (a4), N. ALEXANDER (a1), D. E. ZELLNER (a1), E. LYSZKOWICZ (a1) and C. R. BRADEN (a1)...

In March 2002, an outbreak of Salmonella Enteritidis (SE) infections occurred at a convention centre in Dallas, Texas and continued for 6 weeks. We conducted epidemiological studies, obtained clinical and environmental cultures, and interviewed employees to identify risk factors for infection. From 17 March–25 April 2002, the implicated hotel kitchen catered 41 multi-day conferences attended by 9790 persons. We received 617 illness reports from residents of 46 states. Sauces or items served with sauces were implicated in three cohort studies. SE phage-type 8 was identified as the agent. Eleven food service employees, including one who prepared sauces and salsa, had stool cultures that yielded SE. Although the original source was not determined, prolonged transmission resulted in the largest food handler-associated outbreak reported to date, affecting persons from 46 US states. Transmission ended with implementation of policies to screen food handlers and exclude those whose stool cultures yielded salmonellas.

Corresponding author
*Author for correspondence: M. Beatty, M.D., M.P.H., Pediatric Dengue Vaccine Initiative, International Vaccine Institute, SNU Research Park, San 4-8 Bongcheon-7-dong, Kwanak-gu, Seoul, Republic of Korea151-919. (Email:
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1. Hedberg C, et al. An outbreak of Salmonella Enteritidis infection at a fast-food restaurant: implications for foodhandler-associated transmission. Journal of Infectious Disease 1991; 164: 11351140.
2. Hundy R, Cameron S. An outbreak of infections with a new Salmonella phage type linked to a symptomatic food handler. Communicable Diseases Intelligence 2002; 26: 562567.
3. Blaser M, et al. An outbreak of salmonellosis involving multiple vehicles. American Journal of Epidemiology 1981; 114: 663670.
4. Khuri-Bulos N, et al. Foodhandler-associated Salmonella outbreak in a University Hospital despite routine surveillance cultures of kitchen employees. Infection Control and Hospital Epidemiology 1994; 15: 311314.
5. Faustini A, et al. An outbreak of Salmonella hadar associated with food consumption at a building site canteen. European Journal of Epidemiology 1998; 14: 99106.
6. Patrick ME, et al. Salmonella Enteritidis infections, United States, 1985–1999. Emerging Infectious Diseases 2004; 10: 17.
7. Centers for Disease Control and Prevention. Outbreak of Salmonella serotype Muenchen infections associated with unpasteurized orange juice – United States and Canada, June 1999. Morbidity & Mortality Weekly Report 1999; 48: 582585.
8. Grasmick A. Processing and interpretation of bacterial fecal cultures. In: Isenber Ded. Clinical Microbiology Procedures Handbook, vol. 1. Washington, D.C.: American Society for Microbiology, 1992.
9. Centers for Disease Control and Prevention. Standardized molecular subtyping of Escherichia coli by pulsed-field gel. Atlanta, GA: CDC, 1998.
10. Skibsted U, et al. Random amplification of polymorphic DNA, pulsed-field electrophoresis and phage-typing in the analysis of a hospital outbreak of Salmonella Enteritidis. Journal of Hospital Infection 1998; 38: 207216.
11. Hickman-Brenner FW, Stubbs AD, Farmer III JJ. Phage typing of Salmonella Enteritidis in the United States. Journal of Clinical Microbiology 1991; 29: 28172833.
12. Ward LR, De Sa J, Rowe B. A phage-typing scheme for Salmonella Enteritidis. Epidemiology & Infection 1987; 99: 291294.
13. Hickman-Brenner FW, Stubbs AD, Farmer JJ 3rd. Phage-typing of Salmonella enteritidis in the United States. Journal of Clinical Microbiology 1991; 29: 28172823.
14. Food and Drug Administration. Bacteriological Analytical Manual, 7th edn.Arlington, VA.: Association of Official Agricultural Chemists, 1992.
15. American Public Health Association. Standard Methods for the Examination of Water and Wastewater, 20th edn.Washington, D.C.: American Public Health Association, 1998.
16. SAS Institute. SAS/STAT User's Guide, version 8. Cary, NC: SAS Institute, Inc., 1999.
17. Campbell JV, et al. An outbreak of Salmonella serotype Thompson associated with fresh cilantro. Journal of Infectious Disease 2001; 183: 984987.
18. Adachi JA, et al. Enteric pathogens in Mexican sauces of popular restaurants in Guadalajara, Mexico, and Houston, Texas. Annals of Internal Medicine 2002; 136: 884887.
19. Hennessy TW, et al. A national outbreak of Salmonella Enteritidis infections from ice cream. New England Journal of Medicine 1996; 334: 12811286.
20. McQuigge M, et al. Institutional outbreak of Salmonella gastroenteritis in Owen Sound, 1991/92. Public Health and Epidemiology Report (PHERO), May 1992, pp. 157159.
21. Buchwald DS, Blaser MJ. A review of human Salmonellosis II. Duration of excretion following infection with nontyphi Salmonella. Reviews of Infectious Diseases 1984; 6: 345355.
22. Braden CR. Salmonella enterica serotype Enteritidis and eggs: a national epidemic in the United States. Clinical Infectious Diseases 2006; 43: 512517.
23. Tsang TH, et al. Large Shigella sonnei outbreak linked to salsa in California, 1998 (abstract P10). In: Program and Abstracts of the 48th Annual Epidemic Intelligence Service Conference (Atlanta). Atlanta: Centers for Disease Control and Prevention, 1999, p. 51.
24. Wheeler C, et al. An outbreak of Hepatitis A associated with green onions. New England Journal of Medicine 2005; 353: 890897.
25. Estrada-Garcia T, et al. Faecal contamination and enterotoxigenic Escherichia coli in street-vended chili sauces in Mexico and its public health relevance. Epidemiology & Infection 2002; 129: 223226.
26. Centers for Disease Control and Prevention. Multistate outbreaks of Salmonella infections associated with raw tomatoes eaten in restaurants – United States, 2005–2006. Morbidity & Mortality Weekly Report 2007; 56: 909911.
27. Hedberg CW, et al. Outbreaks of salmonellosis associated with eating uncooked tomatoes: implications for public health. Epidemiology & Infection 1999; 122: 385393.
28. Bower CK, Daeschel MA. Resistance responses of microorganisms in food environments. International Journal of Food Microbiology 1999; 50: 3344.
29. Brudzinski L, Harrison MA. Influence of incubation conditions on survival and acid tolerance response of Escherichia coli O157:H7 and non-O157:H7 isolates exposed to acetic acid. Journal of Food Protection 1998; 61: 542546.
30. Kimura AC, et al. A multi-state outbreak of Salmonella serotype Thompson infection from commercially distributed bread contaminated by an ill food handler. Epidemiology & Infection 2005; 133: 823828.
31. Dryden MS, et al. Asymptomatic food handlers as the source of nosocomial salmonellosis. Journal of Hospital Infections 1994; 28: 195208.
32. Blaser MJ, et al. An outbreak of salmonellosis involving multiple vehicles. American Journal of Epidemiology 1981; 114: 663670.
33. Pether JVS, Scott RJD. Salmonella carriers are the dangerous? A study to identify finger contamination with salmonellae by convalescent carriers. Journal of Infection 1982; 5: 8185.
34. Pether JVS, Gilbert RJ. The survival of Salmonella on finger tips and transfer of the organisms to food. Journal of Hygiene 1971; 69: 673681.
35. Imhoff B, et al. Burden of self-reported acute diarrheal illness in FoodNet surveillance areas, 1998–1999. Clinical Infectious Diseases 2004; 38 (Suppl.): 219226.
36. Kuusi M, et al. Internet use and epidemiologic investigation of gastroenteritis outbreak. Emerging Infectious Diseases 2004; 10: 447450.
37. Fox LM, et al. Emergency survey methods in acute cryptosporidiosis outbreak. Emerging Infectious Diseases 2005; 11: 729731.
38. Srikantiah P, et al. Web-based investigation of multistate salmonellosis outbreak. Emerging Infectious Diseases 2005; 11: 610612.
39. Schleyer TK, Forrest JL. Methods for the design and administration of web-based surveys. Journal of the American Medical Informatics Association 2000; 7: 416425.
40. Ghosh TS, et al. Internet- versus telephone-based local outbreak investigations. Emerging Infectious Diseases 2008; 14: 975977.
41. Duffy J. 20% of U.S. has never sent e-mail. PC World. ( Accessed 7 June 2008.
42. Pryor JH, et al. Rapid response to a conjunctivitis outbreak: the use of technology to leverage information. Journal of American College Health 2002; 50: 267271.
43. Viney KA, McAnulty JM. The evaluation of web-based data collection for enhanced surveillance of cryptosporidiosis. NSW Public Health Bulletin 2008; 19: 1519.
44. Raat H, et al. Feasibility, reliability, and validity of adolescent health status measurement by the Child Health Questionnaire Child Form (CHQ-CF): internet administration compared with the standard paper version. Quality of Life Research 2007; 16: 675685.
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