Campylobacter is one of the most common bacterial causes of gastrointestinal infection in the United States, with an estimated 2.4 million cases of Campylobacter infection per year. These bacteria live in the gastrointestinal tracts of poultry, and humans are typically infected through eating undercooked poultry or handling the raw meat. As little as one drop of raw chicken juice is enough to cause Campylobacter infection. Symptoms of the illness typically begin between two and five days after exposure and usually include diarrhea (which may be bloody), cramping, abdominal pain, fever, nausea and vomiting. The Food Safety and Inspection Service (FSIS) of the U.S. Department of Agriculture (USDA) has compliance guidelines for comprehensive control of Campylobacter in poultry-processing plants, but because these recommendations are focused on consumer food safety rather than worker protection, additional measures are necessary to protect the health of employees. In 2011, management representatives of a poultry-processing plant in Virginia contacted the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC), to perform a health-hazard evaluation at the plant. A number of employees had been diagnosed with Campylobacter infections. Because the plant had experienced a similar outbreak previously, the Virginia Department of Health suggested the plant request an evaluation into the causes of and possible solutions to the problem. The plant employed approximately 1,000 employees, 24 to 35 of whom at any one time were residents of two diversion centers, residential work assignment programs run by the Virginia Department of Corrections. The plant processed about 300,000 to 350,000 birds per day. In order to assess exposures, infections and controls, we observed work practices and processes, and workplace conditions at the plant. We interviewed employees, reviewed medical and employment records, and reviewed health and safety-related policies and training manuals. We identified 29 cases of laboratory-diagnosed Campylobacter infection among plant employees through records from the health and corrections departments between January 2008 and May 2011. We also learned about the plant's ventilation system and environmental sampling programs for chlorine and Campylobacter. Details of the evaluation can be found in the Health Hazard Evaluation (HHE) report at http://www.cdc.gov/niosh/hhe/reports/pdfs/2011-0058-3157.pdf.
Based on our observations, examination of medical records and employee interviews, we determined a health hazard from Campylobacter existed in this plant. We found that approximately 15 percent of more than 3,000 encounters at the plant's medical office from January 2010 through September 2011 were related to gastrointestinal symptoms. Almost one-third of the interviewed employees reported they had been ill with gastrointestinal symptoms in the five-month period prior to the interview, and fewer than half of these employees had reported their illness to the plant.