IAFP 2009 Program Book and Abstract Book - AB164

P3-43 Recurrent Salmonella Anatum Outbreaks Linked to Pulled Pork Barbecue—TN, 2006 to 2008 Mary Lancaster, L. Rand Carpenter, Erin Holt and JOHN R. DUNN Tennessee Dept. of Health, Communicable and Environmental Disease Service, Nashville, TN, USA Introduction: Salmonella spp. are frequently associated with foodborne illness. The Centers for Disease Control and Prevention (CDC) estimates 1.4 million cases of salmonellosis occur in the US each year. Purpose: The investigation objectives were to describe the outbreak, implement control measures, and prevent additional illnesses. We used CDC’s Outbreak Management System (OMS) Version 1.2 in the investigation of a multijurisdictional Salmonella Anatum outbreak in Tennessee. This was the first documented use of OMS in a foodborne disease outbreak. Methods: Ill persons were initially identified by area physicians and by routine laboratory reporting. Additional cases were identified via active surveillance. All patients were interviewed using standardized FoodNet and Salmonella questionnaires. Stool and food specimens were tested for enteric pathogens. OMS and NetDraw were used for data management and visualization. Results: In the 2006 outbreak, fifty-five ill persons were identified, including 11 laboratory-confirmed cases and 44 probable cases which were epidemiologically linked to confirmed cases. In 2008, fifty (96%) of 52 persons interviewed were ill, including 13 laboratory-confirmed cases and 37 probable cases which were epidemiologically linked. All laboratoryconfirmed cases were positive for Salmonella Anatum, XbaI pattern JAGX01.0001, as were pulled pork barbeque specimens collected from ill persons in 2008. In 2008, fifty (96%) out of 52 persons who consumed pulled pork barbecue meat became ill. Significance: In two separate outbreaks, a total of 105 confirmed and probable cases of salmonellosis were linked to contaminated pulled pork barbeque from a single restaurant/catering establishment. Salmonella is not considered an adulterant of meats. Risks with pulled pork barbeque were reviewed with the restaurant including appropriate cooking temperatures, handling, and ways to mitigate cross contamination during preparation. OMS was a valuable asset for tracking specimens, identifying relationships between cases, and identifying relationships between cases and exposure events. Social network analysis provided a visual depiction of epidemiological links between cases, potential exposure events and laboratory specimens. Use of OMS and social network analysis should be considered in future investigations. P3-44 Enteric Disease Outbreaks Associated with Consumption of Fresh Melons — United States, 1998 to 2007 CARY C. CHEN, Tracy Ayers and Ian Williams CDC, Atlanta, GA, USA Introduction: Fresh produce is an important part of a healthy diet and consumption has increased in recent years. In particular, melons that are consumed raw have been associated with several large outbreaks of enteric infections in the US. Purpose: A better understanding of the epidemiology of melon-associated outbreaks is necessary to guide public health and regulatory interventions. Methods: We reviewed 1998 to 2007 data from the Foodborne-Disease Outbreak (FBDO) surveillance system in which food items implicated in outbreak investigations were classified into 17 food commodities: fish, crustaceans, mollusks, dairy, eggs, beef, game, pork, poultry, grains-beans, oils-sugars, fruits-nuts, fungi, leafy vegetables, root vegetables, sprouts, and vegetables from a vine or stalk. A melon-associated FBDO is defined as two or more illnesses due to the consumption of a single food vehicle identified as a melon (cantaloupe, honeydew, or watermelon) or consumption of at least one fruit item identified as a melon in a multiple ingredient food vehicle in which all the ingredients belonged to the fruits-nuts commodity (fruit salad). Results: Of the 11,976 single etiology FBDOs reported during 1998–2007, 6,989 (58%) implicated a food item, 2,993 (25%) implicated food items that could be classified to a single commodity, 162 were attributed to the fruits-nuts commodity; of these, 61 (38%) outbreaks classified as melon-associated caused 2,640 illnesses, 127 hospitalizations, and 6 deaths; the median size of melon-associated outbreaks (26.5 illnesses) was more than three times the median size of non-melon associated outbreaks (7). Among melon-associated FBDOs with a confirmed etiology, norovirus was responsible for 19 (46%) outbreaks and 725 (34%) illnesses, followed by Salmonella with 15 (37%) outbreaks and 515 (24%) illnesses. Six (40%) Salmonella outbreaks were due to cantaloupe (3 outbreaks), honeydew melon (1), both cantaloupe and honeydew (1), and fruit salad (1) and all had multistate exposures indicating that contamination likely occurred before preparation, whereas the largest melon-associated outbreak reported was due to watermelon cross-contaminated with Escherichia coli serotype O157:H7 at a restaurant. Significance: Understanding the epidemiology of melon-associated outbreaks is critical in guiding control efforts. Contaminated melons cause both multistate and individual restaurant-associated outbreaks; efforts by local, state, and federal agencies to control melon-associated outbreaks should span from the point of harvest to the point of preparation; attention should be placed on decreasing contamination of cantaloupes and honeydew melons with Salmonella. P3-45 Epidemiology of Multistate Foodborne Outbreaks, United States: 1998 to 2007 STEPHANI GRAY, Tracy Ayers, Julian Grass and Ian Williams CDC, Enteric Diseases Epidemiology Branch, and US Food and Drug Administration Atlanta, GA, USA Introduction: Contaminated products that are distributed on a large scale can cause foodborne disease outbreaks (FBDOs) involving multiple states. Due to geographic dispersion, these outbreaks can appear to be unassociated clusters of sporadic cases; however, due to improvements in surveillance, more multistate outbreaks are being detected. Purpose: The purpose of this study is to describe the epidemiology of multistate foodborne outbreaks. Methods: We reviewed data from CDC’s electronic Foodborne Outbreak Reporting System (eFORS) for 1998 to 2007. Foods implicated in outbreak investigations were classified into 17 food commodities: fish, crustaceans, mollusks, dairy, 164 — Abstract Book Poster

IAFP 2009 Program Book and Abstract Book

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