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
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;
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.
References
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.
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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