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National outbreak of Salmonella serotype saintpaul infections: importance of Texas restaurant investigations in implicating jalapeño peppers.

Mody RK, Greene SA, Gaul L, Sever A, Pichette S, Zambrana I, Dang T, Gass A, Wood R, Herman K, Cantwell LB, Falkenhorst G, Wannemuehler K, Hoekstra RM, McCullum I, Cone A, Franklin L, Austin J, Delea K, Behravesh CB, Sodha SV, Yee JC, Emanuel B, Al-Khaldi SF, Jefferson V, Williams IT, Griffin PM, Swerdlow DL - PLoS ONE (2011)

Bottom Line: In both studies, illness was independently associated with only one menu item, fresh salsa (Restaurant A: matched odds ratio [mOR], 37; 95% confidence interval [CI], 7.2-386; Restaurant B: mOR, 13; 95% CI 1.3-infinity).Our investigations, critical in understanding the broader multistate outbreak, exemplify an effective approach to investigating large foodborne outbreaks.Additional measures are needed to reduce produce contamination.

View Article: PubMed Central - PubMed

Affiliation: Scientific Education and Professional Development Program Office, Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. rmody@cdc.gov

ABSTRACT

Background: In May 2008, PulseNet detected a multistate outbreak of Salmonella enterica serotype Saintpaul infections. Initial investigations identified an epidemiologic association between illness and consumption of raw tomatoes, yet cases continued. In mid-June, we investigated two clusters of outbreak strain infections in Texas among patrons of Restaurant A and two establishments of Restaurant Chain B to determine the outbreak's source.

Methodology/principal findings: We conducted independent case-control studies of Restaurant A and B patrons. Patients were matched to well controls by meal date. We conducted restaurant environmental investigations and traced the origin of implicated products. Forty-seven case-patients and 40 controls were enrolled in the Restaurant A study. Thirty case-patients and 31 controls were enrolled in the Restaurant Chain B study. In both studies, illness was independently associated with only one menu item, fresh salsa (Restaurant A: matched odds ratio [mOR], 37; 95% confidence interval [CI], 7.2-386; Restaurant B: mOR, 13; 95% CI 1.3-infinity). The only ingredient in common between the two salsas was raw jalapeño peppers. Cultures of jalapeño peppers collected from an importer that supplied Restaurant Chain B and serrano peppers and irrigation water from a Mexican farm that supplied that importer with jalapeño and serrano peppers grew the outbreak strain.

Conclusions/significance: Jalapeño peppers, contaminated before arrival at the restaurants and served in uncooked fresh salsas, were the source of these infections. Our investigations, critical in understanding the broader multistate outbreak, exemplify an effective approach to investigating large foodborne outbreaks. Additional measures are needed to reduce produce contamination.

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Related in: MedlinePlus

Restaurant A-associated cases by date of meal (top) and diarrhea onset (bottom).Black bars represent 25 confirmed cases. Grey bars represent 22 probable cases. The exact dates of diarrhea onset are not available for 4 probable cases.
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pone-0016579-g001: Restaurant A-associated cases by date of meal (top) and diarrhea onset (bottom).Black bars represent 25 confirmed cases. Grey bars represent 22 probable cases. The exact dates of diarrhea onset are not available for 4 probable cases.

Mentions: Among enrolled case-patients, dates of dining at Restaurant A and dates of diarrhea onset were similar for culture-confirmed and probable cases (Figure 1). The median incubation period was 2 days for both culture-confirmed (range, <1–7 days) and probable (range, 1–5 days) cases. Case-patients ranged in age from 2 to 63 years; 51 percent were female, four (9%) were hospitalized, and none died.


National outbreak of Salmonella serotype saintpaul infections: importance of Texas restaurant investigations in implicating jalapeño peppers.

Mody RK, Greene SA, Gaul L, Sever A, Pichette S, Zambrana I, Dang T, Gass A, Wood R, Herman K, Cantwell LB, Falkenhorst G, Wannemuehler K, Hoekstra RM, McCullum I, Cone A, Franklin L, Austin J, Delea K, Behravesh CB, Sodha SV, Yee JC, Emanuel B, Al-Khaldi SF, Jefferson V, Williams IT, Griffin PM, Swerdlow DL - PLoS ONE (2011)

Restaurant A-associated cases by date of meal (top) and diarrhea onset (bottom).Black bars represent 25 confirmed cases. Grey bars represent 22 probable cases. The exact dates of diarrhea onset are not available for 4 probable cases.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3044132&req=5

pone-0016579-g001: Restaurant A-associated cases by date of meal (top) and diarrhea onset (bottom).Black bars represent 25 confirmed cases. Grey bars represent 22 probable cases. The exact dates of diarrhea onset are not available for 4 probable cases.
Mentions: Among enrolled case-patients, dates of dining at Restaurant A and dates of diarrhea onset were similar for culture-confirmed and probable cases (Figure 1). The median incubation period was 2 days for both culture-confirmed (range, <1–7 days) and probable (range, 1–5 days) cases. Case-patients ranged in age from 2 to 63 years; 51 percent were female, four (9%) were hospitalized, and none died.

Bottom Line: In both studies, illness was independently associated with only one menu item, fresh salsa (Restaurant A: matched odds ratio [mOR], 37; 95% confidence interval [CI], 7.2-386; Restaurant B: mOR, 13; 95% CI 1.3-infinity).Our investigations, critical in understanding the broader multistate outbreak, exemplify an effective approach to investigating large foodborne outbreaks.Additional measures are needed to reduce produce contamination.

View Article: PubMed Central - PubMed

Affiliation: Scientific Education and Professional Development Program Office, Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. rmody@cdc.gov

ABSTRACT

Background: In May 2008, PulseNet detected a multistate outbreak of Salmonella enterica serotype Saintpaul infections. Initial investigations identified an epidemiologic association between illness and consumption of raw tomatoes, yet cases continued. In mid-June, we investigated two clusters of outbreak strain infections in Texas among patrons of Restaurant A and two establishments of Restaurant Chain B to determine the outbreak's source.

Methodology/principal findings: We conducted independent case-control studies of Restaurant A and B patrons. Patients were matched to well controls by meal date. We conducted restaurant environmental investigations and traced the origin of implicated products. Forty-seven case-patients and 40 controls were enrolled in the Restaurant A study. Thirty case-patients and 31 controls were enrolled in the Restaurant Chain B study. In both studies, illness was independently associated with only one menu item, fresh salsa (Restaurant A: matched odds ratio [mOR], 37; 95% confidence interval [CI], 7.2-386; Restaurant B: mOR, 13; 95% CI 1.3-infinity). The only ingredient in common between the two salsas was raw jalapeño peppers. Cultures of jalapeño peppers collected from an importer that supplied Restaurant Chain B and serrano peppers and irrigation water from a Mexican farm that supplied that importer with jalapeño and serrano peppers grew the outbreak strain.

Conclusions/significance: Jalapeño peppers, contaminated before arrival at the restaurants and served in uncooked fresh salsas, were the source of these infections. Our investigations, critical in understanding the broader multistate outbreak, exemplify an effective approach to investigating large foodborne outbreaks. Additional measures are needed to reduce produce contamination.

Show MeSH
Related in: MedlinePlus