Salmonella Blog - Surveillance & analysis on salmonella news & outbreaks

April 16, 2006

What are Salmonella and salmonellosis?
Salmonella bacteria are found naturally in the intestines of animals, especially poultry and swine. The bacteria can also be found in the environment. People who eat food contaminated by Salmonella can become ill with salmonellosis.

What are the symptoms of salmonellosis infection?
Like other foodborne illnesses, the symptoms of salmonellosis can feel like the flu. Symptoms usually appear 12 to 72 hours after eating contaminated food and usually lasts up to seven days. Or, you may experience chronic symptoms, such as reactive arthritis three to four weeks later. Others infected with the bacteria may not get sick or show symptoms, but they can carry the bacteria, and spread the infection to others.

Oregon State Public Health Laboratory identified a cluster of five patients infected with Salmonella Enteritidis. The five patients were from four Oregon counties and had onsets of illness ranging from February to April, 2004. Further investigation would lead to documentation of at least 29 patients in 12 states and Canada with matching SE isolates, since at least as far back as September, 2003.

After a thorough investigation by local, state, and federal officials, the illnesses were definitively linked to raw almonds distributed by Paramount Farms. The investigation led to the recall of roughly 18 million pounds of Paramount Farms raw almonds. The five Oregon patients were interviewed. All reported consuming Kirkland Signature brand raw almonds, purchased at Costco stores, and produced and distributed by Paramount Farms.

Interviews with the subsequently identified persons with matching SE isolates further confirmed the link to Paramount Farms. In addition, an environmental investigation revealed Salmonella to be present at Paramount from three samples from two-huller-shellers that supplied Paramount during the period of interest.

Two patients had contacted the Lake County Health Department independently regarding becoming ill after eating at a Chili's Grill & Bar in Vernon Hills, Illinois. This prompted the LCHD to send investigators to the restaurant to inspect it.

What they found was disturbing. The restaurant's dishwashing machine was broken and corroded; the tube that fed chlorine into the machine was plugged, preventing proper sanitization of dishes. Employees told the investigators that the machine had not worked properly for at least a week. In fact, according to the LCHD Final Report, "[e]mployees had wrapped plastic bags around the line to stop the chlorine from spraying into the air." Despite the obvious broken condition of the dishwasher, the restaurant management still had done nothing to get the machine repaired.

During their inspection, the investigators also found food not stored at proper temperatures in the cooler. And following questioning of the on-duty manager, investigators learned that three employees, plus another manager, had called in sick that day with flu symptoms.
The next day, LCHD received two new reports of individuals with Salmonella infections who had eaten at Chili's on June 26, while Chili's management reported six more ill employees.

With evidence of the outbreak-source growing increasingly clear, investigators returned to the restaurant to instruct employees on hand-washing procedures, require the use of nailbrushes, and to issue a glove-use order. This meant that no further bare-hand contact of food was to be allowed at the restaurant.

Due to the large number of ill employees, and the high potential for spread of this illness, Chili's was required to cease all operation or face suspension or revocation of its food service permit, at which time Chili's management made the decision to voluntarily close the establishment. Despite the initially voluntary closure of the restaurant, Chili's management pushed to re-open almost immediately, arguing that workers from other restaurants could safely run the operation. LCHD refused because the source of Salmonella was still not known, and it could have been in a food item still on the premises, or some other contamination at the restaurant itself.

On May 9, 2005, the Macomb County Health Department received reports of five recently diagnosed cases of Salmonella species in Macomb County residents. All five had sought care at area hospitals and three had been admitted for in-patient care.

Isolates obtained from culture of stool specimens obtained from case patients were sent to the Michigan Department of Community Health Public Health Laboratory where they were serotyped as Salmonella enteritidis.

The only common exposure among the five individuals was attendance at an after-concert reception held at the Macomb County Community College Performing Arts Center in Clinton Township. After-concert events had been held on two consecutive nights, April 28 and April 29, at the Arts Center. Twenty dessert items plus coffee, wine and champagne were served. The dessert items were provided by Fern Hill Golf and Country Club, Geloso's Bakery and an independent Chocolate Fountaineer. MCHD obtained a list of menu items and interviewed employees and reception attendees.

Two critical violations were noted during the May 10th investigation. The bakery dishwasher did not have a detectable level of chlorine sanitizer and raw eggs were stored above milk and ready to eat foods in the bakery walk-in refrigerator.

Although the Macomb County Health Department was unable to identify how food items served and prepared at Fern Hill had become contaminated with Salmonella, the likely vehicle for the bacteria was identified as being eclairs on the outbreak report submitted to the Centers for Disease Control and Prevention.

According to records disclosed by Tulare County Health and Human Services, Nielsen's catering business, "Costa's Catering," which operates from Nielsen's restaurant, was the source of at least two Salmonella Typhimurium outbreaks in late July, and meals served at the restaurant itself may have caused several more illnesses.

The other known outbreak occurred at a summer science program that Costa's catered from July 25-29, 2005. On learning of illness associated with attendance at this program, health officials immediately recognized the apparent link between this outbreak and the recently discovered outbreak at the Lourenco's family reunion.

A multi-agency investigation commenced immediately after officials noticed the increased incidence of Salmonella cases with an exposure to Nielsen's or Costa's food. An inspection occurred at Nielsen's Restaurant on August 16. The conditions found were less than immaculate. Lupe Tapia, an environmental health specialist, found many code violations, both "major" and "minor." Among the violations were:

• instances of bare-handed contact
• lack of soap at handwashing sinks
• accumulation of food debris, grease from inside and outside surfaces of equipment . . . throughout the facility, especially at food prep area
• accumulation of different types of meat debris on the meat slicer
• lack of thermometer at food prep areas
• used linens stored at food prep area

Further investigation revealed other deficient practices.

A November 2005 investigation uncovered 15 cases of food poisioning linked to a meal served at a Saginaw county church. Earlier this year, health officials reminded Saginaw County churches of regulations surrounding serving food to the public.

The County Department of Public Health conducts food safety reminder campaigns during the winter holidays when many groups serve food at holiday bazaars and other public events that require a temporary food service license.

While food licenses are not required for potlucks, funeral dinners, church suppers or similar functions where participants bring a favorite dish or serve a meal to members only, a red flag goes up when the welcome mat goes out to the public.

Those traditional events are coming under scrutiny, say health officials, following confirmation of several cases of food poisoning in 2005.

Outbreaks of foodborne illness may occur in any food setting, but communal meals are especially susceptible to harboring sickening bacteria. Plus, when multiple cooks are involved it's more difficult to pinpoint the origins of the illness.

Historically, a potluck gathers people for a meal where the participants bring a favorite homemade dish to share. They are a mainstay for meeting and recruitment for a variety of groups. Serving a meal potluck-style simplifies the preparations and distributes the cost of the meal among the participants.

The Health Department insists that it isn't out to put a lid on potlucks. But once the welcome mat is extended to the general public, Richards said event sponsors must obtain a temporary food license. Food vendors serving the public at festivals, bazaars and other events where the general public is invited are required to obtain a temporary food service license good for one to two weeks. That's also the case for churches and other groups hosting suppers, pancake breakfast, fish fry or similar events where the food is prepared on site and sold to the public.