Multistate Outbreak of Human Salmonella Heidelberg Infections Linked to "Kosher Broiled Chicken Livers" from Schreiber Processing Corporation
November 21, 2011
CDC is collaborating with public health and agriculture officials in New York, New Jersey, other states, the U.S. Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the U.S. Food and Drug Administration to investigate a multistate outbreak of Salmonella Heidelberg infections linked to a kosher chicken liver product labeled as “kosher broiled chicken livers,” which is not ready-to-eat and requires further cooking before eating. Public health investigators are using DNA “fingerprints” of Salmonella bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis (PFGE) to identify cases of illness that may be part of this outbreak. They are using data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections. Because the Salmonella Heidelberg PFGE pattern associated with this outbreak commonly occurs in the United States, some of the cases with this pattern may not be related to this outbreak. Based on ongoing case finding and the dates cases were reported, the number of persons associated with this outbreak may increase or decrease. Based on the previous 5 years of reports to PulseNet, approximately 30-40 cases with the outbreak strain would be expected to be reported per month in the United States. The outbreak strain is different from another strain of Salmonella Heidelberg associated with ground turkey recalled earlier this year.
In August 2011, CDC identified a sustained increase in the number of Salmonella Heidelberg isolates with the outbreak strain reported to PulseNet from New York and New Jersey. Based on the previous 5 years of reports to PulseNet, New York and New Jersey would expect approximately 5 cases per month, but in June through August 2011, these states experienced approximately 30-40 cases a month. No sustained increase in the number of illnesses above baseline has been identified in other states. USDA-FSIS’s ongoing investigation determined that the “kosher broiled chicken livers” were distributed to the following states: New York, New Jersey, Pennsylvania, Maryland, Minnesota, Ohio, Rhode Island, and Florida. As the investigation progresses, additional states may be identified.
From April 1 to November 16, 2011, a total of 179 illnesses due to Salmonella Heidelberg with this PFGE pattern were reported in states where the “kosher broiled chicken livers” were distributed. The number of ill persons identified in each state the product is distributed to is as follows: New York (99), New Jersey (61), Pennsylvania (10), Maryland (6), Ohio (2), and Minnesota (1). Rhode Island and Florida have not identified any cases linked to this outbreak during this period.
Among persons for whom information is available in in these states, ill persons range in age from <1 to 97 years with a median age of 13 years. Forty-nine percent are female. Among the 126 ill persons with available information, 25 (20%) have been hospitalized. No deaths have been reported.
The outbreak can be visually described with a chart showing the number of people who became ill each day or week. This chart is called an epi curve. Illnesses that occurred after October 5, 2011 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 3 weeks. Please see the Timeline for Reporting of Salmonella Cases for more details.
Investigation of the Outbreak
Epidemiologic and laboratory investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies linked this outbreak to eating “kosher broiled chicken livers” from Schreiber Processing Corporation (doing business as Alle Processing Corporation/MealMart Company), and chopped chicken liver prepared from this product. These “kosher broiled chicken livers” are sold at retail stores and may be used as an ingredient in other prepared foods. These products appear to be ready-to-eat, but are in fact partially cooked, and therefore need to be fully cooked before eating. Consumers may have incorrectly thought the use of the word “broiled” in the label meant the chicken liver was ready-to-eat; however, these chicken livers must be fully cooked before eating. Alle Processing Corporation/MealMart Company is cooperating in the on-going investigation.
Among 37 ill persons for whom information is available, 25 (68%) reported consuming chicken liver products in the week before their illness began. Laboratory testing conducted by the New York State Department of Agriculture and Markets Laboratory Division identified the outbreak strain of Salmonella Heidelberg in samples of “kosher broiled chicken livers” and chopped liver products obtained from retail stores.
New York City receives funding under the CDC FoodCORE (Foodborne Diseases Centers for Outbreak Response Enhancement) program. FoodCORE sites are supported in part by USDA-FSIS and the Association of Public Health Laboratories. These sites work together to develop new and better methods to detect, investigate, respond to, and control multistate outbreaks of foodborne diseases. New York City conducted an enhanced epidemiologic investigation, which resulted in the identification of suspect food items that might have been a source of this outbreak. These suspect food items were collected for testing and the outbreak strain was found in “kosher broiled chicken liver” products.
CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify and interview additional ill persons and to interview ill persons about foods eaten before becoming ill. FSIS is working closely with CDC and state officials to determine where this product may have been distributed.
On November 8, 2011, Schreiber Processing Corporation, of Maspeth, New York, announced a voluntary recall of an undetermined amount of “kosher broiled chicken liver” products.
Clinical Features/Signs and Symptoms
Most persons infected with Salmonella bacteria develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts 4 to 7 days, and most persons recover without treatment. However, in some persons, the diarrhea may be so severe that the patient needs to be hospitalized. Salmonella infection may spread from the intestines to the bloodstream and then to other body sites and can cause death unless the person is treated promptly with antibiotics. Older adults, infants, and those with impaired immune systems are more likely to have a severe illness from Salmonella infection. More information about Salmonella, and steps people can take to reduce their risk of infection with Salmonella in general, can be found on the CDC Salmonella Web Page and the CDC Vital Signs Web Page.
Advice to Consumers, Retailers, and Others
Cook chicken liver to the proper temperature:
- Consumers should not eat chicken liver or any foods prepared with chicken liver that have not been fully cooked to an internal temperature of 165°F.
- Restaurants and food service operators should fully cook chicken liver to an internal temperature of 165°F.
- If served undercooked chicken liver in a restaurant, send it back to the kitchen for further cooking.
- If repackaging partially cooked chicken livers for sale, retailers should clearly label them as not ready-to-eat, and therefore, require further cooking before eating.
Be careful in preparing foods:
- Separate raw livers and other uncooked meats from produce, cooked foods, and ready-to-eat foods to avoid cross contamination.
- Wash hands, kitchen work surfaces, cutting boards, knives and other utensils with soap and water immediately after they have been in contact with livers or other raw meat or poultry.
- Disinfect the food contact surfaces using a freshly prepared solution of 1 tablespoon unscented liquid chlorine bleach to 1 gallon of water.
Consult your health care provider:
- Persons who think they might have become ill from eating undercooked chicken liver or any food prepared with chicken liver should consult their health care providers.
- Infants, older adults, and persons with impaired immune systems are more likely than others to develop severe illness.
CDC's Role in Food Safety
CDC leads federal efforts to gather data on foodborne illnesses, investigate foodborne illnesses and outbreaks, and monitor the effectiveness of prevention and control efforts. CDC is not a food safety regulatory agency but works closely with the food safety regulatory agencies, in particular, with the U.S. Food and Drug Administration and USDA-FSIS. CDC also plays a key role in building state and local health department epidemiology, laboratory, and environmental health capacity to support foodborne disease surveillance and outbreak response. Notably, CDC data can be used to help document the effectiveness of regulatory interventions.
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