Epidemiology and Outbreak
Report
Josh Rounds, MPH Epidemiologist
Minnesota Department of Health
Salmonella Heidelberg Ground Turkey
• 111 persons infected with the outbreak strain of
Salmonella Heidelberg have been reported from 31
states between February 27 and August 9, 2011
• 27 (37%) hospitalized, one death
• Resistant to ampicillin and tetracycline
S. Heidelberg Ground Turkey
• One MN case; did not report consuming
ground turkey
S. Heidelberg Ground Turkey
• Four ground turkey samples purchased from
four retail locations between March 7 and
June 27, 2011
• July 29, 2011 USDA-FSIS released a public
health alert for frozen or fresh ground turkey
products
S. Heidelberg Ground Turkey
• USDA Recommendations for Preventing Salmonellosis:
Wash hands with warm, soapy water for at least 20 seconds before and after
handling raw meat and poultry. Also wash cutting boards, dishes and utensils
with hot soapy water. Clean up spills right away.
Keep raw meat, fish and poultry away from other food that will not be
cooked. Use separate cutting boards for raw meat, poultry and egg products
and cooked foods.
Cook raw meat and poultry to safe internal temperatures before eating. The
safe internal temperature for meat such as ground beef and pork is 160° F,
and 165° F for poultry, as determined with a food thermometer.
Refrigerate raw meat and poultry within two hours after purchase (one hour
if temperatures exceed 90° F). Refrigerate cooked meat and poultry within
two hours after cooking.
S. Heidelberg Ground Turkey
• August 3, 2011, Cargill Meat Solutions recalled
approximately 36 million pounds of ground
turkey products
• September 11, 2011 recalls an additional
185,000 pounds
S. Heidelberg Ground Turkey
• Salmonella not considered an adulterant in
raw meat products
– Different than E. coli 0157:H7
• 2010, 10.2% of ground turkey tested by USDA
was positive for Salmonella
– 10.7% in 2009 and 15.4% in 2008
• What is the appropriate public health
response?
S. Heidelberg Ground Turkey
• Public health alert or consumer advisory
– Are these effective?
• Generate very little media attention
• Recall implicated product
– Does going public with the outbreak vehicle force
the company to do a recall?
• Why the increase in illness?
– Highly contaminated product?
Multiple enteric pathogens associated
with drinking untreated spring water
• Church canoe trip on the Root and Upper Iowa
Rivers
• Local ICP noticed increase in # of patients
presenting with GI illness and called MDH
• Group reported drinking untreated water from
multiple springs on both rivers and at
campsite in Iowa
Spring water
• Drinking from the “Rootbeer Spring” was the
only exposure significantly associated with
illness
• 8 of 10 cases vs. 1 of 11 controls, odds ratio
40, 95% confidence interval 2.32-1943, p
value = 0.002
Spring water
• Stool specimens from 4 individuals
– One individual positive for both Campylobacter
jejuni and coli
– Enterotoxigenic E. coli and non-O157 shiga toxinproducing E. coli
– Two non-O157 STEC
Spring water
• Karst topography
– Geologic formation characterized by soluble
bedrock such as limestone
– Southwestern Wisconsin, southeastern
Minnesota, northeastern Iowa and northwestern
Illinois
– Very permeable, surface water and can easily
contaminate ground water
Spring water
• Combination of animal production in the area
and karst geology likely led to the spring water
being contaminated
Multi-state outbreak of Listeria
associated with Cantaloupe
• 100 cases
• 20 states
• 18 deaths
Listeria Cantaloupe
Listeria Cantaloupe
• Median age 79
• Most are over age 60
• 98% of cases hospitalized
• First time cantaloupes have been the source
of a Listeria outbreak
• FDA is working on the root cause analysis to
determine how this happened
Questions?