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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

  1. Blaser MJ, Newman LS. A review of human salmonellosis: I. Infective dose. Rev Infect Dis 1982;4:1096-106.

  2. CDC. Foodborne surveillance reports 1972-1981.

  3. Bryan FL, McKinley TW. Turkey: the bad guy of the school lunch room. School Foodservice Journal 1971;10:83-92.

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