1. National outbreak of Salmonella serotype saintpaul infections: importance of Texas restaurant investigations in implicating jalapeño peppers
- Author
-
Adrianne Sever, Lou Franklin, Gerhard Falkenhorst, Val Jefferson, Jana L. Austin, Ingrid Zambrana, Angie Gass, Ian T. Williams, Robert M. Hoekstra, Kathleen Wannemuehler, Patricia M. Griffin, Kristin Delea, Brian P. Emanuel, Laura B. Cantwell, Karen M Herman, David L. Swerdlow, René Wood, Sharon A Greene, Amy Cone, Sarah Pichette, Samir V. Sodha, Rajal K. Mody, Sufian F. Al-Khaldi, Thi Dang, Isaac McCullum, Casey Barton Behravesh, Linda Gaul, and J. Christopher Yee
- Subjects
Serotype ,Bacterial Diseases ,Male ,Research Report ,Salmonella ,Veterinary medicine ,Salmonellosis ,Restaurants ,Epidemiology ,lcsh:Medicine ,medicine.disease_cause ,Disease Outbreaks ,Gastrointestinal Infections ,Child ,lcsh:Science ,Epidemiological Methods ,Molecular Epidemiology ,Multidisciplinary ,Salmonella enterica ,Middle Aged ,Texas ,Infectious Diseases ,Child, Preschool ,Salmonella Infections ,Medicine ,Female ,Salmonella Food Poisoning ,Public Health ,Bacterial and Foodborne Illness ,Capsicum ,Research Article ,Disease Ecology ,Adult ,medicine.medical_specialty ,Infectious Disease Control ,Adolescent ,Gastroenterology and Hepatology ,Infectious Disease Epidemiology ,Young Adult ,Environmental health ,medicine ,Humans ,Serotyping ,Aged ,business.industry ,lcsh:R ,Case-control study ,Pulsenet ,Outbreak ,Odds ratio ,Case-Control Studies ,lcsh:Q ,business - 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.
- Published
- 2011