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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.


  1. CDC. Unpublished data.

  2. 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.

  3. Barnham M, Kerby J. A profile of skin sepsis in meat handlers. J Infect 1984;9:43-50.

  4. 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.

  5. Prevention of streptococcal sepsis in meat handlers. Communicable Disease Reports (London) 1983;34:1-4.

  6. Streptococcal infection in meat workers. Communicable Disease Reports (London) 1981;16:3-4.

  7. 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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