The Athen’s County Department of Health has found that of the 56 case patients entered into the Ohio Disease Reporting System (ODRS), 47 reside in Athens County, including some with temporary Athens County Residence *83.93%, N=47) , 1 resides in Fairfield County, 1 in Franklin County, 3 in Meigs County, 1 in Morgan County, 1 in Stark County and 2 in Tuscarawas County. 33 of the case patients are females and 23 are male. Ages of case patients ranged from 5 years of age to 82 years of age, with a median age of 33.5 and mean age of 37.6. At least 7 (12.5%, N= 7) of the case patients were known to have been hospitalized due to the illness. Of those hospitalized, 4 were female and 3 were male. Of the case patients hospitalized, their ages ranged from 19 to 82, with a median age of 48 and a mean age of 47.3.
Early in the investigation, a single menu item, chiles rellenos, drew attention as a source of the salmonella infections. This was based on the early case/control interviews and positive Salmonella test results from a leftover meal sample.
The ingredients of the chiles rellenos (along with the prep procedure and storage of the item) were carefully considered as possible sources of the bacterial contamination. A product in common with the Salmonella enteritidis outbreak in North Carolina, packaged pasteurized egg whites, was especially suspect due to the nature of the material (egg white) and the coincidence of the NC outbreak.
Lab test results of prepared chiles rellenos, samples of the unused pasteurized egg product from the local restaurant, the NC restaurant and the manufacturing facility did not support a hypothesis that the Salmonella originated from the pasteurized product.
Opportunities for cross contamination also were observed including improper use of single-use gloves, and the storage of raw animal products above uncovered chiles rellenos. Hot holding and cold holding conditions observed at the restaurant were conducive for the growth of bacteria. Microbiological testing supports the hypothesis of the common food source as well.
Actions taken to protect the public health included:
• Voluntary removal of the suspect menu item during investigation of the outbreak to reduce the risk of others consuming a possibly infectious ingredient;
• Provision of information to the public regarding general food safety measures to reduce the risk of acquiring salmonellosis and other food borne illnesses;
• Provision of education to the person in charge regarding the violations and measures necessary to correct them; and
• Repeat inspections to ensure that the violations were corrected and appropriate standards are being met to continue the food service operation.