title: A national outbreak of Salmonella enteritidis infections from ice cream. The Investigation Team.
abstract: BACKGROUND
  In September 1994, the Minnesota Department of Health detected an increase in the number of reports of Salmonella enteritidis infections. After a case-control study implicated a nationally distributed brand of ice cream (Schwan's) in the outbreak, the product was recalled and further epidemiologic and microbiologic investigations were conducted.
  
  
  METHODS
  We defined an outbreak-associated case of S. enteritidis infection as one in which S. enteritidis was cultured from a person who became ill in September or October 1994. We established national surveillance and surveyed customers of the implicated manufacturer. The steps involved in the manufacture of ice cream associated with cases of S. enteritidis infection were compared with those of products not known to be associated with infection matched for the date of manufacture. Cultures for bacteria were obtained from ice cream samples, the ice cream plant, and tanker trailers that had transported the ice cream base (premix) to the plant.
  
  
  RESULTS
  We estimate that S. enteritidis gastroenteritis developed in 224,000 persons in the United States after they ate Schwan's ice cream. The attack rate for consumers was 6.6 percent. Ice cream associated with infection contained a higher percentage of premix that had been transported by tanker that had carried nonpasteurized eggs immediately before (P = 0.02). S. enteritidis was isolated from 8 of 226 ice cream products (3 percent), but not from environmental samples obtained from the ice cream plant (n = 157) or tanker trailers (n = 204).
  
  
  CONCLUSIONS
  This nationwide outbreak of salmonellosis was most likely the result of contamination of pasteurized ice cream premix during transport in tanker trailers that had previously carried nonpasteurized liquid eggs containing S. enteritidis. To prevent further outbreaks, food products not destined for repasteurization should be transported in dedicated containers.
authors.affiliation: Acute Disease Epidemiology Section, Minnesota Department of Health, Minneapolis 55440-9441, USA.
authors.forename: T W
authors.initials: TW
authors.lastname: Hennessy
authors.forename: C W
authors.initials: CW
authors.lastname: Hedberg
authors.forename: L
authors.initials: L
authors.lastname: Slutsker
authors.forename: K E
authors.initials: KE
authors.lastname: White
authors.forename: J M
authors.initials: JM
authors.lastname: Besser-Wiek
authors.forename: M E
authors.initials: ME
authors.lastname: Moen
authors.forename: J
authors.initials: J
authors.lastname: Feldman
authors.forename: W W
authors.initials: WW
authors.lastname: Coleman
authors.forename: L M
authors.initials: LM
authors.lastname: Edmonson
authors.forename: K L
authors.initials: KL
authors.lastname: MacDonald
authors.forename: M T
authors.initials: MT
authors.lastname: Osterholm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D004531:Eggs / Q000382:microbiology; D005260:Female; D005511:Food Handling; D006801:Humans; D007054:Ice Cream / Q000382:microbiology / Q000506:poisoning*; D007223:Infant; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D012478:Salmonella Food Poisoning / Q000453:epidemiology* / Q000382:microbiology; D012477:Salmonella enteritidis / Q000302:isolation & purification*; D014481:United States / Q000453:epidemiology