I'm almost getting too paranoid to travel. In August I blogged about the Cyclospora outbreak that was affecting 16 states and linked back to lettuce used by several restaurant chains including one that I had eaten at while on a trip to Michigan and Massachusetts. I just got back from San Fran on Sunday and wouldn't you know it, by Monday I was reading about a Salmonella outbreak that is currently circulating around 17 states across the US with California being the hardest hit. I was under the weather for a few days while on this trip. I did eat some chicken while there, but can't say that food was the true cause.
As of October 7, 2013, a total of 278 persons infected with seven outbreak strains of Salmonella Heidelberg have been reported from 17 states. Of these cases, 42% of ill persons have been hospitalized, but no deaths have been reported. Illness onset dates range from March 1 to September 24, 2013 with a range in age from <1 year to 93 years. The median is age of 20 years and 51% percent of ill persons are male (can we say beer, chicken wings and Monday Night Football?).
The on-going outbreak investigations conducted by local, state, and federal officials indicate that consumption of Foster Farms brand chicken is the likely source of this outbreak of Salmonella Heidelberg infections. The outbreak strains associated with the outbreak are resistant to several commonly prescribed antibiotics which may be associated with an increased numbers of hospitalizations seen thus far. While it is not unusual for raw poultry from any producer to have Salmonella bacteria, it is uncommon to have multidrug-resistant Salmonella bacteria.
Salmonella is a rod-shaped, gram-negative, non-spore-forming bacteria. In the US, there approximately 42,000 cases of salmonellosis reported each year, but because many milder cases are not diagnosed or reported, the actual number of infections may be twenty-nine or more times greater. 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. Salmonella bacteria can survive for weeks outside a living body, and they are not destroyed by freezing.
Salmonella can be transmitted both by direct and indirect contact through a number of ways as listed below, but basically, you're eating poop:
• Infected or contaminated food;
• Poor kitchen hygiene, especially problematic in institutional kitchens and restaurants because this can lead to a significant outbreak;
• Excretions from either sick or infected but apparently clinically healthy people and animals;
• Polluted surface water and standing water (such as in shower hoses or unused water dispensers);
• Unhygienically thawed fowl;
• An association with reptiles (pet tortoises, snakes, iguanas, aquatic turtles, and also amphibians (frogs)
In healthcare facilities, high touch surfaces are often contaminated with nosocomial pathogens, and may serve as vectors for cross-transmission. While Salmonella is typically associated with eating of contaminated food a study that investigated the degree of pathogen transfer from contaminated surfaces to hands showed that transmission to hands occurred 100% of the time with Salmonella spp., Escherichia coli, and Staphylococcus aureus. As hand hygiene compliance rates for healthcare workers is around 50 % at best, the risk of transmission from contaminated surfaces cannot be overlooked.
The best way to avoid any type of direct contact with Salmonella is to immediately wash your hands and all contaminated surfaces after every use. Surfaces that are reused in the kitchen such as countertops and food prep areas should be cleaned and sanitized in order to kill off bacteria. Surfaces within a patient's room infected with Salmonella should be cleaned and disinfected daily and healthcare workers and visitors should be vigilant with hand hygiene.
Let's hope that thawing a turkey in a cooler is considered hygienic! I'd hate to be the cause of a Salmonella outbreak at the Canadian Thanksgiving Dinner I'm hosting on Saturday....