title: Outbreak of Salmonella serotype Hartford infections associated with unpasteurized orange juice.
abstract: BACKGROUND
  Acidic foods such as orange juice have been thought to be unlikely vehicles of foodborne illness.
  
  
  OBJECTIVE
  To investigate an outbreak of Salmonella enterica serotype Hartford (Salmonella Hartford) infections among persons visiting a theme park in Orlando, Fla, in 1995.
  
  
  METHODS
  Review of surveillance data, matched case-control study, laboratory investigation, and environmental studies.
  
  
  METHODS
  General community.
  
  
  METHODS
  The surveillance case definition was Salmonella Hartford or Salmonella serogroup C1 infection in a resident of or a visitor to Orlando in May or June 1995. In the case-control study, case patients were limited to theme park hotel visitors and controls were matched to case patients by age group and hotel check-in date.
  
  
  METHODS
  Risk factors for infection and source of implicated food.
  
  
  RESULTS
  Sixty-two case patients from 21 states were identified. Both Salmonella Hartford and Salmonella enterica serotype Gaminara (Salmonella Gaminara) were isolated from stool samples of 1 ill person. Thirty-two case patients and 83 controls were enrolled in the case-control study. Ninety-seven percent of case patients had drunk orange juice in the theme park vs 54% of controls (matched odds ratio, undefined; 95% confidence interval, 5.2 to undefined). The orange juice was unpasteurized and locally produced. Salmonella Gaminara was isolated from 10 of 12 containers of orange juice produced during May and July, indicating ongoing contamination of juice probably because of inadequately sanitized processing equipment.
  
  
  CONCLUSIONS
  Unpasteurized orange juice caused an outbreak of salmonellosis in a large Florida theme park. All orange juice was recalled and the processing plant closed. Pasteurization or other equally effective risk-management strategies should be used in the production of all juices.
authors.affiliation: Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Cook
authors.forename: T E
authors.initials: TE
authors.lastname: Dobbs
authors.forename: W G
authors.initials: WG
authors.lastname: Hlady
authors.forename: J G
authors.initials: JG
authors.lastname: Wells
authors.forename: T J
authors.initials: TJ
authors.lastname: Barrett
authors.forename: N D
authors.initials: ND
authors.lastname: Puhr
authors.forename: G A
authors.initials: GA
authors.lastname: Lancette
authors.forename: D W
authors.initials: DW
authors.lastname: Bodager
authors.forename: B L
authors.initials: BL
authors.lastname: Toth
authors.forename: C A
authors.initials: CA
authors.lastname: Genese
authors.forename: A K
authors.initials: AK
authors.lastname: Highsmith
authors.forename: K E
authors.initials: KE
authors.lastname: Pilot
authors.forename: L
authors.initials: L
authors.lastname: Finelli
authors.forename: D L
authors.initials: DL
authors.lastname: Swerdlow
mesh_terms: D001628:Beverages / Q000382:microbiology*; D016022:Case-Control Studies; D002957:Citrus / Q000382:microbiology*; D004196:Disease Outbreaks; D004812:Epidemiologic Methods; D005431:Florida / Q000453:epidemiology; D005525:Food-Processing Industry; D006801:Humans; D012478:Salmonella Food Poisoning / Q000453:epidemiology* / Q000209:etiology; D019779:Salmonella enterica / Q000302:isolation & purification*; D012703:Serotyping