Food Safety Partnership:
Epi Update
October 15, 2008
Karen Everstine
[email protected]
2008 Outbreaks (so far - 45 total)
Etiologies
Pathogen
Norovirus
Salmonella
Suspected norovirus
Suspected toxin
Clostridium perfringens
Hepatitis A
No. (%)
26 (58%)
7 (16%)
7 (16%)
3 (7%)
1 (2%)
1 (2%)
Noro + suspected noro = 73% of outbreaks
so far this year
*Data are preliminary
2008 Outbreaks (so far - 45 total)
Settings
Setting
Restaurant
Contaminated Product
Private Event
Cruise (catered meal)
School
Church potluck
*Data are preliminary
No. (%)
31 (70%)
5 (11%)
5 (11%)
1 (2%)
1 (2%)
1 (2%)
Salmonella and Stuffed
Chicken Products (Again…)
Case Information
•
•
•
•
•
•
Sixteen cases to date
Salmonella I 4,12:i:- (subtype TM932)
Onset dates: June 24 – September 18
Nine (56%) male
Median age 19 years (range, 2 to 53 years)
Six (38%) hospitalized
Salmonella Associated with Consumption of
Stuffed Chicken Products, by Illness Onset Date
Milford Valley Farms
Other Brand
No Reported Consumption
Number of Cases
Secondary Case
4
3
2
1
23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 1112 13 14 1516 17 18 19 2021 22 23 24 25 26 27 2829 30 31 1 2 3 4 5 6 7 8 9 10 1112 13 1415 16 17 18 19 20 21 22 23 24 25 2627 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1718 19
June
July
August
Month
September
Product Testing Results
Product
Code
Where Collected
Result
Cordon Bleu
C8133
Home Sample
TM932
Cordon Bleu
C8133
Home Sample
TM932
Cordon Bleu
C8133
Home Sample
TM932
Cordon Bleu
C8133
Cub Foods
TM932
Cordon Bleu
C8126
Cub Foods
S. Enteritidis
Cordon Bleu
C8126
Cub Foods
S. Infantis
Chicken Kiev
K8142
Mackenthuns
S. Typhimirium
Chicken Kiev
K8142
Mackenthuns
S. Typhimirium
Chicken Kiev
K8149
Home Sample
S. Heidelberg
Chicken Kiev
K8149
Home Sample
S. Kentucky
Chicken Kiev
K8149
Home Sample
S. Enteritidis
Two recent outbreaks of
bacterial intoxications
Taco party (September)
•
•
•
•
High school football team (Dakota Co.)
Held in private home after a game
70 attendees
Taco meat prepared the night before from 30
pounds of ground beef
• Beef divided into two containers and put in the
refrigerator
Taco party (September)
• 26 interviews
• 16 cases + 5 additional illnesses that did
not meet the case definition
• Symptoms: all cases reported diarrhea,
one reported vomiting
• Median incubation period: 8.5 hours
Taco party (September)
• Two stool samples positive for C.
perfringens enterotoxin
• C. perfringens was cultured from the
leftover taco meat at 6.6 x 107 organisms
per gram
• Levels of C. perfringens at 105 or 106
organisms per gram indicate the food is a
likely vehicle
Tacos in a bag (June)
• Prepared at a private home and sold at a
community celebration in Renville Co.
• 20 pounds of ground beef cooked around
3pm on Friday and kept in a roaster until
Saturday
Tacos in a bag (June)
• Meat brought to local park on Saturday
morning at 9:30am
• Roaster turned off completely around
11:30am because “bottom was burning”
• Customers complained about cold meat
around 12:30 or 1pm
• About 80 taco bags were sold
Tacos in a bag (June)
• Taco stand organizers received about 20
independent complaints of illness
• 8 people interviewed; all were cases
• Symptoms: all cases reported diarrhea,
no vomiting
• Median incubation period, 10 hours
Excerpts from…
You say tomato, I say jalapeño:
Investigation of the 2008
National Salmonella Saintpaul
Outbreak
Originally presented by
Erin Hedican, MPH
at the 2008 MEHA Fall conference
Number* and incidence rate† of laboratoryconfirmed cases of Salmonella Saintpaul by
state – United States, 2008§
MMWR 2008 Vol. 57 No. 34
Number of laboratory-confirmed cases of
Salmonella Saintpaul, by date of illness
onset – United States, 2008*
MN Received first case
in lab
MMWR 2008 Vol. 57 No. 34
Number of Cases
Salmonella Saintpaul Patron Cases Associated
with the Good Earth Restaurant by Date
Received in Laboratory, June 2008
Second case names
Good Earth
7
6
Visit restaurant
5
Initial case-control
study/traceback
results to CDC
4
3
2
1
22
23
24
25
26
27
28
29
30
June
Meal Date
1
2
3
4
Univariate and Multivariate Results of
Minnesota Case-Control study
Ingredient
No. cases
exposed/total
OR
p
Red salsa
13/18
14.7
<0.001
Not significant
Avocado salsa
14/19
7.5
<0.001
Not significant
Mexican
garnish
17/19
69
<0.001
Not significant
Red peppers
17/19
43
<0.001
Not significant
Cilantro
18/19
21.4
<0.001
Not significant
Fresh
tomatoes
6/19
0.5
0.2
Not significant
Jalapenos
17/19
69
<0.001
aOR
62
p
<0.001
Salmonella Saintpaul cases in
Minnesota
• 33 cases with the outbreak strain
– 2 cases that traveled out of state (NYC, TX)
– 3 cases not associated with the Good
Earth
– 28 restaurant-associated cases
• 20 patrons
• 8 foodworkers
–Onsets similar to patrons
–4 asymptomatic
Number and percentage of exposures to Salmonella
Saintpaul among case patients and controls in
seven case-control studies, by implicated food
item/exposure – United States, 2008§
MMWR 2008 Vol. 57 No. 34
Tomatoes vs. Peppers:
Attribution Difficulties
• Mexican-style ingredients often eaten
together
• Produce items like peppers are often
consumed in small quantities, difficult to
remember
Evidence for Tomatoes
• Initial epidemiologic study in New Mexico,
Texas
• Well established vehicle for salmonellosis
– Jalapeño/Serrano peppers never identified
as outbreak vehicle in US
Evidence against Tomatoes
• No single type of tomato implicated
• No traceback convergence
• No isolates of S. Saintpaul
Evidence for Chili Peppers
• Restaurant outbreaks
• Outbreak strain isolated from water, peppers
on a farm in Mexico
– This farm did not grow tomatoes
MMWR 2008 Vol. 57 No. 34
Notable quotes from recent interviews by
Team D students…
“Boy, was it messy! I had to walk through the
sewing room, living room, and dining room. I live
in an old house, and I had to scrub that carpet on
my knees!”
“I know how I got sick, it’s from my cats. I have
cougars, bobcats, and lynx. I was wrestling with
them and they splashed muck into my mouth.”
Notable quotes from recent interviews by
Team D students…
“When I farted, you could feel it vibrate up my
colon.”
Team D student: “Everything you tell me today will
be kept confidential.”
Interviewee: “You don’t have to keep it
confidential. I live my life with no secrets.”