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Topics in Minority Health Yersinia enterocolitica Infections during the Holidays in Black Families -- Georgia

During the 1988-89 winter holidays (i.e., Thanksgiving through New Year's Day), an outbreak of gastroenteritis caused by raw chitterlings (i.e., pork intestines, a traditional winter holiday food in some black families) contaminated with Yersinia enterocolitica 0:3 occurred among 15 children in metropolitan Atlanta (1). All the children were black, and 11 were enrolled in the Women, Infants, and Children (WIC) Program. Chitterlings had been prepared in 12 of 13 case households and five of 26 control households (p less than 0.001). The infecting organism was primarily transferred from the raw chitterlings to the children through contact with the hands of the foodhandlers. Of child-caretakers enrolled in the Fulton County (the county where most of the cases occurred) WIC Program, nearly half reported household preparation of chitterlings for a Thanksgiving, Christmas, or New Year's Day meal.

To increase community awareness about the potential risk for acquiring yersiniosis from raw chitterlings, particularly among WIC Program participants, a supplementary lesson plan was developed and incorporated from October 1989 to January 1990 into an existing Fulton County WIC Program group nutrition education program. The lesson included a lecture and discussion that informed mothers, grandmothers, and other child-caretakers about

  1. the signs and symptoms of yersiniosis in children; 2) the transmission of Y. enterocolitica infections to children through direct and indirect contact with contaminated raw chitterlings;

  2. the need for special care when handling raw chitterlings because of potential contamination with bacteria; and 4) the prevention of Y. enterocolitica infections. Means of preventing illness discussed with each group included 1) careful handwashing by persons cleaning chitterlings before touching a child or anything used by a child (e.g., a toy or bottle) and 2) not allowing children to touch raw chitterlings. All WIC Program enrollees who attended classes or obtained vouchers during the winter holidays were also given an educational flyer summarizing key points of the lesson plan; enrollees were encouraged to share the flyer with other household foodhandlers (Figure 1). Reported by: MW Monroe, MS, PE McCray, MS, RJ Finton, MSPH, WR Elsea, MD, Fulton County Health Dept, Atlanta; JD Smith, Georgia Dept of Human Resources. Enteric Diseases Br, Div of Bacterial and Mycotic Diseases, Center for Infectious Diseases, CDC.

    Editorial Note

Editorial Note: Y. enterocolitica causes an enteric infection with fever, diarrhea, and abdominal pain. The recent emergence of Y. enterocolitica 0:3 infections in the United States appears to have been accompanied by the establishment of a widely distributed swine reservoir: chitterlings from many regions of the country harbor Y. enterocolitica 0:3 (1). Because chitterlings are a common traditional food in some black households, particularly during the winter holidays, they probably represent an important vehicle for transmitting infections to children.

Yersiniosis should be suspected in black infants and children with febrile diarrheal illnesses during the winter holidays. During the winter, hospitals with large black pediatric populations should consider routinely culturing all stool specimens on cefsulodin-irgasan-novobiocin (CIN) agar, a medium selective for Yersinia (2).

Cleaning raw chitterlings is a labor-intensive and time-consuming process that may expose household members to potentially infectious agents. Because the potential for transmission of the agent is strongest from foodhandlers to children, someone other than the foodhandler should care for the children while chitterlings are being prepared.

The efforts of the Fulton County Health Department indicate that educational messages can be incorporated into existing WIC educational programs; these messages can provide information to child-caretakers about transmission and prevention of Y. enterocolitica infections due to contaminated chitterlings. Information on the lesson plan and a copy of the educational flyer is available from the WIC Program Office, Fulton County Health Department; telephone (404) 730-1441.


  1. Lee LA, Gerber AR, Lonsway DR, et al. Yersinia enterocolitica 0:3 infections in infants and children, associated with the household preparation of chitterlings. N Engl J Med 1990;322:984-7.

  2. Farmer JJ III, Wells JG, Griffin PM, Wachsmuth IK. "Enterobacteriacea infections" in diagnostic procedures for bacterial infections. 7th ed. Washington, DC: American Public Health Association, 1987:285-96.

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