Salmonellosis, 2012

During 2012, 780 culture-confirmed cases of Salmonella infection (14.6 per 100,000 population) were reported. This represents a 17% increase from the median annual number of cases reported from 2002 to 2011 (median, 669 cases; range, 578 to 755). Of the 82 serotypes identified in 2012, 5 serotypes, S. Enteritidis (185), S. Typhimurium (110), S. Newport (67), S. I 4,[5],12:i:- (52), and S. Infantis (28) accounted for 57% of cases. Salmonella was isolated from stool in 688 (88%) cases, urine in 45 (6%) cases, and blood in 42 (5%) cases. Other specimen sources included cerebrospinal fluid, vaginal swab, tibial lesion, and wound site.

Of the 707 cases interviewed, 106 (15%) had traveled internationally during the week prior to their illness onset. There were 4 cases of S. Typhi infection; 1 had traveled to Pakistan, 1 to Guatemala, 1 to the Philippines, and 1 to India and the United Arab Emirates. There were 2 cases of S. Paratyphi A infection; 1 had traveled to India and the other to Nepal. There were 2 cases of S. Paratyphi B infection; 1 had traveled to the Philippines, and the travel history of the other case was unknown.

Three culture-confirmed cases of Salmonella infection died in 2012: a 64 year-old case died of ischemic bowel disease and atherosclerosis secondary to type 2 diabetes mellitus 2 days after Salmonella was isolated from a stool specimen; a 63 year-old case died of a brain tumor 3 days after Salmonella was isolated from a stool specimen; and a 85 year-old case died of congestive heart failure, stage three kidney disease, and bowel obstruction 8 days after Salmonella was isolated from a stool specimen.

One hundred eight cases were part of 24 Salmonella outbreaks identified in 2012. Nine outbreaks involved cases in multiple states. Fourteen of the outbreaks involved foodborne transmission, six outbreaks were due to animal contact, and four outbreaks were due to person-to-person transmission. The 24 outbreaks resulted in a median of 3 culture-confirmed cases per outbreak (range, 1 to 26 cases).

In January, 4 cases of S. Enteritidis infection were associated with consumption of desserts containing undercooked eggs at a restaurant. As a result of the outbreak, the restaurant discontinued the use of unpasteurized shell eggs in uncooked foods.

In February, 2 cases of S. Typhimurium infection were associated with person-to-person transmission at a daycare center.

In April, 5 cases of S. Enteritidis infection were associated with consumption of Hollandaise sauce containing unpasteurized shell eggs at a restaurant.

From May through October, 6 cases of Salmonella infection were part of 4 separate multi-state outbreaks associated with contact with baby poultry. The outbreak serotypes were S. Muenchen, S. Thompson, S. Infantis, and S. Braenderup.

In May, 2 cases of S. Montevideo infection were associated with person-to-person transmission at an in-home daycare.

In May, 6 cases of S. Newport infection were associated with a graduation party held at a private home. The tightly grouped illness onsets suggested a food vehicle at the event as the most likely source of illness; however, a specific food vehicle could not be identified.

In June, 5 cases of S. Newport infection were associated with a wedding reception; the vehicle and source of contamination were not identified.

In June, 12 cases of S. Montevideo infection were associated with a restaurant. No food item was implicated as the vehicle of transmission. The initial source of contamination was not identified, but some of the cases could have resulted from transmission from infected food workers.

In July, 1 case of S. Bredeney infection was part of a multi-state outbreak involving 42 cases in 20 states. Commercially distributed peanut products from a single company were implicated as the vehicle. The outbreak led to a national consumer alert and product recall.

In July, 1 case of S. Typhimurium infection was part of a multi-state outbreak involving 20 cases in 8 states. The investigation linked the outbreak to contact with pet hedgehogs purchased from multiple hedgehog breeders in different states.

In July, 2 cases of S. Typhimurium infection were part of a multi-state outbreak associated with cantaloupe that resulted in 228 cases in 24 states. Environmental samples collected at the suspected farm matched the outbreak strain. As a result of this investigation, there was a nationwide recall of cantaloupes originating from the implicated farm.

In July, 4 cases of S. Newport infection were associated with a multi-state outbreak for which commercially distributed cantaloupe was the suspected vehicle. Traceback investigations did not reveal a common source for this outbreak and the previous cantaloupe outbreak.

In July, 10 cases of S. Enteritidis infection were associated with a restaurant. The outbreak vehicle was not determined; however, eggs and food workers were suspected sources of illness.

In August, 5 cases of S. Javiana infection in Minnesota were associated with turkey jerky from a meat market. In addition, 2 cases were identified in North Dakota and 1 case in South Dakota. The Minnesota Department of Agriculture collected samples of the implicated product and found two samples of turkey jerky that tested positive for the outbreak strain. As a result of this investigation, the meat market issued a voluntary recall of all whole-muscle turkey jerky products sold on or before August 21

. In August, 26 cases of S. Enteritidis infection were associated with beef from a single cow purchased from a farmer. Cases reported purchasing raw beef directly from the farmer and consuming raw or undercooked ground beef at multiple private homes.

In August, 2 cases of S. Newport infection were probably due to person-to- person transmission in a retirement complex.

In September, 2 cases of S. Bareilly infection were associated with consumption of sushi at a restaurant. No specific sushi ingredient was identified as the outbreak vehicle. The outbreak PFGE pattern for this outbreak did not match the 2012 multistate outbreak of S. Bareilly infections associated with tuna scrape.

In October, 4 cases of S. Javiana infection were part of a multi-state outbreak involving 37 cases in 9 states that was associated with lettuce or cucumber consumption. The Minnesota cases were associated with lettuce or cucumber consumption at a national sandwich restaurant chain.

In October, 3 cases of S. Heidelberg infection were associated with transmission at a hospital neonatal intensive care unit in South Dakota. The initial source of contamination was not determined.

In November, 2 cases of S. Saintpaul infection were associated with a family Thanksgiving party. The source of contamination and route of transmission were not definitively identified; however, smoked turkey was the suspected vehicle.

In December, 3 cases of S. Typhimurium infection were identified as part of a multi-state outbreak associated with contact with frozen feeder mice (for snakes).

• For up to date information see>> Salmonellosis (Salmonella)
• Full issue>> Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health, 2012