Turkey-Associated Salmonellosis at an Elementary School -- Georgia
Between May 10, and May 16, 1985, an estimated 351 children and
staff at a Georgia elementary school developed febrile
gastroenteritis. Salmonella enteritidis, sensitive to all
antimicrobials tested, was isolated from more than 100 children; 23
were hospitalized; none died. The risk of illness was strongly
associated with eating turkey salad with the school lunch on May
10,
which was reported by 64 (91%) of 70 ill children and none of 13
well
children in a case-control study (p 10))-8))). Culture of
leftover
refrigerated turkey salad yielded S. enteritidis; quantitative
culture yielded 8.8 x 10((5)) Salmonella per gram of salad. Each
child received an estimated 56 grams of salad (5.0 x 10((7))
Salmonella).
The turkey salad had been prepared by four asymptomatic
foodhandlers. Inspection of the kitchen did not reveal
foodhandling
practices or equipment malfunctions that might have contributed to
the
outbreak, except that after being cooked and deboned May 9, the
turkey
was refrigerated overnight in an 8-inch deep pan.
Reported by M Smith, W Fancher, R Blumberg, MD, G Bohan, MD, DeKalb
County Health Dept, D Smith, T McKinley, MPH, Office of
Epidemiology,
RK Sikes, DVM, State Epidemiologist, Georgia Dept of Human
Resources;
Enteric Diseases Br, Div of Bacterial Diseases, Center for
Infectious
Diseases, CDC.
Editorial Note
Editorial Note: In studies of nontyphoidal Salmonella with human
volunteers, the lowest dose of organisms to cause illness varied
from
1.0 x 10((5)) to 4.5 x 10((7)), but the amount of Salmonella
ingested
in foodborne outbreaks is often lower (1). The observation of a
100%
attack rate among children consuming an estimated 5.0 x 10((7))
organisms suggests that the minimum dose required to cause illness
is
much lower.
Although turkey was reported as the vehicle in only 27 (7%) of
405
foodborne outbreaks of salmonellosis reported through the CDC
foodborne surveillance system during 1972-1981, it was the vehicle
in
seven (23%) of 30 of the Salmonella outbreaks occurring in schools
during that time (2). Turkey was the most common vehicle for all
bacterial foodborne outbreaks in Georgia schools in 1971, usually
after contamination during deboning followed by inadequate
refrigeration (3). When a pan more than 4 inches deep is used to
refrigerate a large hot mass, the center of the mass can remain
above
50 degrees for over 24 hours, allowing ample growth of
contaminating
bacteria. Particular attention to adequate cooking and
refrigeration
during the upcoming holiday season can prevent turkey-associated
outbreaks.
References
Blaser MJ, Newman LS. A review of human salmonellosis: I.
Infective dose. Rev Infect Dis 1982;4:1096-106.
CDC. Foodborne surveillance reports 1972-1981.
Bryan FL, McKinley TW. Turkey: the bad guy of the school lunch
room. School Foodservice Journal 1971;10:83-92.
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