title: Salmonella enteritidis outbreak in a restaurant chain: the continuing challenges of prevention.
abstract: In 1990, a Salmonella enteritidis (SE) outbreak occurred in a restaurant chain in Pennsylvania. To determine its cause(s), we conducted a case-control study and a cohort study at one restaurant, and a survey of restaurants. Egg dishes were associated with illness (P = 0.03). Guests from one hotel eating at the restaurant had a diarrhoeal attack rate of 14%, 4.7-fold higher than among those not eating there (P = 0.04). There were no differences in egg handling between affected and unaffected restaurants. Eggs supplied to affected restaurants were medium grade AA eggs from a single farm, and were reportedly refrigerated during distribution. Human and hen SE isolates were phage type 8 and had similar plasmid profiles and antibiograms. We estimate the prevalence of infected eggs during the outbreak to be as high as 1 in 12. Typical restaurant egg-handling practices and refrigeration during distribution appear to be insufficient by themselves to prevent similar outbreaks.
authors.affiliation: Division of Bacterial and Mycotic Diseases, Centers for Disease Control, Atlanta, GA 30333.
authors.forename: D J
authors.initials: DJ
authors.lastname: Vugia
authors.forename: B
authors.initials: B
authors.lastname: Mishu
authors.forename: M
authors.initials: M
authors.lastname: Smith
authors.forename: D R
authors.initials: DR
authors.lastname: Tavris
authors.forename: F W
authors.initials: FW
authors.lastname: Hickman-Brenner
authors.forename: R V
authors.initials: RV
authors.lastname: Tauxe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003967:Diarrhea / Q000382:microbiology; D004196:Disease Outbreaks / Q000517:prevention & control*; D004531:Eggs / Q000382:microbiology*; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D012147:Restaurants; D012478:Salmonella Food Poisoning / Q000453:epidemiology* / Q000517:prevention & control; D012477:Salmonella enteritidis