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APHA Scientific Session and Event Listing

Recorded presentation

Andrea Arendt, RN, MPH, Jackie Napolitano, RS, and Chris Kippes, MS. Epidemiology & Surveillance, Cuyahoga County Board of Health, 5550 Venture Drive, Parma, OH 44130, (216)201-2001, aarendt@ccbh.net

Background In February 2006, a cluster of Salmonella Group D was recognized by the Cuyahoga County Board of Health (CCBH) during routine disease surveillance activities. Additional complaints of illness were received by CCBH following a local news story featuring the illness cluster.

Methods A case control study was performed and attack rates and odds ratios were calculated. Field investigations included a detailed review of the menu and food preparation processes. Food samples as well as stool specimens from ill patrons and employees involved in food preparation were collected and tested for Salmonella.

Results Forty-eight laboratory confirmed cases of Salmonella enteritidis, 64 probable cases, and 1 suspect case were identified. An asymptomatic food handler also tested positive for Salmonella enteritidis. The distribution of illness onset dates (January 26-February 14, 2006) is typical of a propagated epidemic curve and does not ordinarily occur with food-borne outbreaks. Samples of chopped liver, corned beef, matzo ball, and oil tested positive for Salmonella enteritidis. Consumption of chopped liver and salad/vegetables was significantly associated with illness (OR=42.5 and OR=4.5, respectively). After controlling for chopped liver and salad/vegetables, matzo ball soup was also statistically significant (OR=3.2).

Discussion The oil likely became contaminated from shell eggs used in matzo ball preparation when cooks dipped their hands in it to aid in rolling of the matzo balls. The leftover oil was then poured onto cooked chopped liver to keep it moist. Conducting a detailed review of food preparation procedures led to the identification of this unusual source of cross-contamination.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Identify food safety issues that may be overlooked during a standard inspection.
• Describe the complexities associated with investigating a large multi-causal illness outbreak.
• Understand how local health authorities can capitalize on media coverage which is usually met with trepidation and use it as an opportunity to obtain valuable information.

Keywords: Epidemiology, Food Safety

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation