Epidemiologic Notes and Reports Group-A, -B Hemolytic
Streptococcus Skin Infections in a Meat-Packing Plant --
Oregon
In the period October 17, 1985-January 9, 1986, 44 episodes of
pyoderma occurred among 32 workers in an Oregon meat-packing plant.
Most of the 44 reports involved impetigo-like lesions on the hand,
wrist, and forearm, but six episodes of cellulitis and two of
lymphangitis were also reported. The same epidemic strain of
Group-A,
-B hemolytic Streptococcus (GAS) isolated from skin lesions was
also
isolated from meat in the plant.
In November 1985, emergency-room personnel in Pendleton,
Oregon,
reported to the Umatilla County Health Department a cluster of skin
infections affecting three employees in a meat-packing plant, all
from
the same small, family-owned facility. After the Oregon State
Health
Division was asked to investigate, all 69 persons employed in the
plant were interviewed for a history of and examined for the
presence
of pustular, draining, or inflamed skin lesions.
Seventy lesions were cultured, representing the initial 44
episodes of infection and 14 later sporadic cases. GAS, only, was
isolated from 26%; both GAS and Staphylococcus aureus from 54%; and
Staph. aureus, only, from 17%. Whereas multiple phage types of
Staph.
aureus were isolated from patients and meat, a single strain of
GAS,
MNT T14 SOR+, was identified in 24 group A streptococcal isolates
serotyped.
Between October 17, 1985, and January 9, 1986, all but four of
the
32 ill meat packers worked at least part-time on the kill floor or
on
the boning line or both. The attack rate for boners/killers was
74%,
compared with 13% for workers who were never involved in killing or
boning (relative risk (RR)=5.7, 95% confidence limits
(CL)=2.9-11.3).
The epidemic investigation suggested that meat was a vehicle of
transmission of GAS between workers. Cultures of two pork loins
revealed the same epidemic strain (MNT T14 SOR+) as did isolates
from
patients. An increased risk for acquiring infection could not be
shown for other exposures. Workers who became infected did not
share
knives or gloves more often than did uninfected workers. Meat
packers
usually own and maintain their own knives.
Recommendations to the meat-packing plant included an increased
emphasis on worker safety; an increased emphasis on worker hygiene,
e.g., covering skin lacerations; removal of workers with untreated
skin infections from the meat-processing line; and improved
surveillance of skin injuries and infections, including modifying
sick-leave benefits to encourage reporting.
Reported by K Flanagan, St. Anthony's Hospital, Pendleton, S Kline,
Umatilla County Health Dept, K Quackenbush, Public Health
Laboratory,
L Foster, State Epidemiologist, Oregon State Health Div; Div of
Field
Svcs, Epidemiology Program Office, Respiratory Diseases Br, Div of
Bacterial Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: This is the second reported outbreak of GAS skin
infections among U.S. meat packers. During a similar outbreak in a
Vermont meat-packing plant involving 18 of 59 employees, a worker
with
a chronic impetiginous lesion may have introduced GAS into the
plant,
and meat was postulated as one mode of transmission (1). Epidemic
and
sporadic cases of GAS skin infections among meat workers have been
recognized in Great Britain since the mid-1970s (2-4). In the
Oregon
outbreak, it is also likely that meat was the vehicle of
transmission
after initial contamination by an infected human. Knife use is
probably the significant risk shared by killers and boners vs.
other
meat workers. Bone has also been recognized as a source of skin
injury among meat workers (5). GAS might spread from a
meat-packing
plant outside to non-plant workers, although there is no evidence
of
such transmission in the Oregon outbreak. In Great Britain, retail
butchers and restaurant workers have been infected with epidemic
GAS
strains during outbreaks in meat-packing plants, presumably by
handling contaminated meat (6,7). Improved surveillance of skin
infections in the meat-packing industry may document more
accurately
the occurrence of such outbreaks in the United States.
References
CDC. Unpublished data.
Fraser CA, Ball LC, Morris CA, Noah ND. Serological
characterization of group-A streptococci associated with skin
sepsis in meat handlers. J Hyg Camb 1977;78:283-96.
Barnham M, Kerby J. A profile of skin sepsis in meat handlers.
J
Infect 1984;9:43-50.
Public Health Laboratory Service Working Group on Streptococcal
Infection in Meat Handlers. The epidemiology and control of
Streptococcus sepsis in meat handlers. Environ Health (Great
Britain) 1982;10:256-8.
Prevention of streptococcal sepsis in meat handlers.
Communicable
Disease Reports (London) 1983;34:1-4.
Streptococcal infection in meat workers. Communicable Disease
Reports (London) 1981;16:3-4.
Fraser CA, Ball LC, Maxted WR, Parker MT. Streptococcal skin
sepsis among meat handlers. Pathogenic streptococci.
Proceedings
of the VII International Symposium on Streptococci and
Streptococcal Disease, September 1978, 1979. Parker MT, ed.
1979:115-6.
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