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A Mexican restaurant-associated outbreak of Salmonella Enteritidis type 34 infections traced to a contaminated egg farm

Published online by Cambridge University Press:  01 April 1999

M. M. McNEIL
Affiliation:
Epidemiology and Prevention Branch, Division of Public Health, Georgia Department of Human Resources, Atlanta, Georgia 30303
L. B. SWEAT
Affiliation:
Southeast Health Unit, Waycross, Georgia 31501
S. L. CARTER
Affiliation:
Ware County Health Department, Waycross, Georgia 31501
C. B. WATSON
Affiliation:
Southeast Health Unit, Waycross, Georgia 31501
J. T. HOLLOWAY
Affiliation:
Southeast Health Unit, Waycross, Georgia 31501
R. MANNING
Affiliation:
State Public Health Laboratory, Division of Public Health, Georgia Department of Human Resources, Atlanta, Georgia 30303
S. F. ALTEKRUSE
Affiliation:
Food and Drug Administration, Atlanta, Georgia, 30333
P. A. BLAKE
Affiliation:
Epidemiology and Prevention Branch, Division of Public Health, Georgia Department of Human Resources, Atlanta, Georgia 30303
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Abstract

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In May 1996, the Georgia Division of Public Health was notified about a cluster of persons with Salmonella Enteritidis (SE) infections in Waycross, Georgia. A matched pair case-control study to determine risk factors for illness found a statistically significant association of SE infection with a history of having eaten at Restaurant A during the 5 days before onset of illness (relative risk = 13 [95% confidence interval (CI)=3–62, P<0·01]). In a second case-control study, to determine specific food exposures, consumption of a deep-fried Mexican dish (chile relleno) (4 of 21 cases vs. 0 of 26 controls, odds ratio undefined, 95% CI>1·46, P=0·034) was found to be significantly associated with SE infection. An environmental investigation found evidence of suboptimal food storage and cooking temperatures at Restaurant A; cross contamination of foods may have contributed to the low attributable risk identified for chile rellenos. Five of 37 Restaurant A food and environment specimens yielded SE strains. All five positive specimens were from chiles rellenos. Of the seven outbreak-associated strains (six patient isolates and one food isolate from Restaurant A) for which phage typing was conducted, all were phage type 34. A FDA traceback investigation through Restaurant A's single-egg supplier identified the potential source as three interrelated farms in South Carolina. Environmental culture from one of these farms yielded SE phage type 34. As a result of this outbreak, FDA helped institute a statewide egg quality-assurance programme in South Carolina to minimize SE contamination of eggs.

Type
Research Article
Copyright
© 1999 Cambridge University Press