Food Protection Trends - March/April 2021 - 243

TABLE 2. Additional S. I 4,[5],12:i:- isolates identified as highly related to WGS Cluster 1
using the NCBI Pathogen Detection Isolates Browser
Strain ID
PNUSAS037581
PNUSAS041017
PNUSAS041014
PNUSAS035615
PNUSAS039728
PNUSAS040730
FSIS11807011
FSIS21821073
FSIS21821453
FSIS31800041
FSIS31800132
FSIS31800355

Isolation Source

Location

Collection Date

SNP Diversity Range
when Compared with
Isolates in WGS Cluster 1

stool
stool
stool
stool
stool
stool
chicken
chicken
chicken
chicken
chicken
chicken

NY
NYC
NYC
PA
VA
MD
NJ
PA
PA
PA
USA:PA
USA:NY

3/5/2018
3/19/2018
3/7/2018
1/14/2018
4/5/2018
4/16/2018
12/21/2017
1/29/2018
4/3/2018
12/27/2017
1/29/2018
4/10/2018

0-6
0-8
0-8
0-8
0-8
0-8
0-6
0-6
0-6
0-6
0-6
0-6

Pennsylvania (one), and Virginia (one), were within 0 to
8 SNPs of the isolates belonging to WGS cluster 1. The
food isolates originated from the U.S. Department of
Agriculture's (USDA's) Food Safety and Inspection Service
(FSIS) sampling of chicken carcass rinse, chicken livers,
ground chicken, and chicken breast in New Jersey (one),
Pennsylvania (four), and New York (one) and were within
0 to 6 SNPs from the clinical isolates belonging to WGS
cluster 1.
On 15 June 2018, NYSDOH contacted epidemiology
colleagues at NYC, Maryland, Pennsylvania, and Virginia
departments of health to request exposure information on
cases whose isolates were related to WGS cluster 1. The initial
interview data gathered from these cases suggested a kosher
food or kosher diet association. Of the 11 cases now included
in the multistate WGS cluster, 10 cases had been interviewed
with a Salmonella hypothesis-generating questionnaire.
All cases (10 of 10) reported chicken consumption. Six
cases (60%) reported kosher food exposure or exposures.
Eight cases (80%) reported exposure to dairy, and six cases
(60%) reported exposure to cucumbers, zucchini, or squash.
Clinical isolates had collection dates spanning September
2017 to April 2018.
On 18 June 2018, the NYSDOH Bureau of Community
Environmental Health and Food Protection contacted FSIS
to request additional information about the six chicken
isolates related by WGS on NCBI to the clinical isolates
belonging to WGS cluster 1 (13). FSIS shared information
about the isolates, including product and brand information,
in accordance with established information-sharing processes

(11). The isolates, collected in December 2017 through April
2018, originated from samples of raw chicken collected at
multiple slaughter and processing establishments, including
samples collected as part of routine testing under the
Salmonella performance standards (9).
FSIS notified NYSDOH on 20 June 2018 that all six
chicken isolates were products of kosher or halal processing
facilities. Recognizing the strength of the combined
epidemiologic, environmental health, and laboratory
data, NYSDOH immediately contacted CDC to provide
a summary of the multistate Salmonella I 4,[5],12:i:investigation and the hypothesis that the source of illness was
a kosher-related food product, possibly chicken. In agreement
with CDC, a focused questionnaire was developed by
NYSDOH and distributed to NYC, Maryland, Pennsylvania,
and Virginia for case re-interviews. All cases were contacted
via phone and asked to participate in a second interview
focusing on special diets and exposure to kosher or halal
food items. For the 7-day food history before illness onset,
cases were questioned about 17 food items (including
chicken, fish, products containing eggs, dairy, fresh produce,
prepared salads, deli meats, and spreads and dips). One aim
of the focused questionnaire was to probe for more detailed
poultry exposures; under the poultry section, 25 brand
names were inserted as a checklist to assist cases with recall
of brand information. This information would later be used
to determine whether there was an association between
products produced at facilities where WGS-related chicken
isolates were collected and human illness.

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