title: Alfalfa sprouts and Salmonella Kottbus infection: a multistate outbreak following inadequate seed disinfection with heat and chlorine.
abstract: Raw sprouts have been implicated in a number of foodborne disease outbreaks. Because contaminated seeds are usually responsible, many sprout producers attempt to disinfect seeds before germination and detect sprout contamination during production. In March 2001, we detected an increased number of Salmonella serotype Kottbus isolates in California. Overall, we identified 31 cases from three western states. To identify the cause, we conducted a case-control study with the first 10 identified case-patients matched to 20 controls by age, sex, and residential area. Our case-control study found illness to be statistically associated with alfalfa sprout consumption. The traceback investigation implicated a single sprouter, where environmental studies yielded Salmonella Kottbus from ungerminated seeds and floor drains within the production facility. Pulsed-field gel electrophoresis patterns of all patient, seed, and floor drain Salmonella Kottbus isolates were indistinguishable. Most implicated sprouts were from seeds that underwent heat treatment and soaking with a 2,000-ppm sodium hypochlorite solution rather than the Food and Drug Administration (FDA)-recommended 20,000-ppm calcium hypochlorite soak. Other implicated seeds had been soaked in a calcium hypochlorite solution that, when tested, measured only 11,000 ppm. The outbreak might have been averted when screening tests of sprout irrigation water detected Salmonella in January; however, confirmatory testing of these samples was negative (but testing improperly utilized refrigerated irrigation water). Producers should use the enrichment broth of positive screening samples, not refrigerated irrigation water, for confirmatory testing. Until other effective disinfection technologies are developed, producers should adhere to FDA recommendations for sprout seed disinfection.
authors.affiliation: California Department of Health Services, Division of Communicable Disease Control, 2151 Berkeley Way, Berkeley, California 94704, USA. kwinthro@dhs.ca.gov
authors.forename: K L
authors.initials: KL
authors.lastname: Winthrop
authors.forename: M S
authors.initials: MS
authors.lastname: Palumbo
authors.forename: J A
authors.initials: JA
authors.lastname: Farrar
authors.forename: J C
authors.initials: JC
authors.lastname: Mohle-Boetani
authors.forename: S
authors.initials: S
authors.lastname: Abbott
authors.forename: M E
authors.initials: ME
authors.lastname: Beatty
authors.forename: G
authors.initials: G
authors.lastname: Inami
authors.forename: S B
authors.initials: SB
authors.lastname: Werner
mesh_terms: D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D004196:Disease Outbreaks; D004202:Disinfectants / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D016521:Electrophoresis, Gel, Pulsed-Field / Q000379:methods; D005260:Female; D005506:Food Contamination; D005516:Food Microbiology; D006801:Humans; D008297:Male; D000455:Medicago sativa / Q000382:microbiology*; D008875:Middle Aged; D012475:Salmonella / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D012478:Salmonella Food Poisoning / Q000453:epidemiology; D012639:Seeds / Q000382:microbiology; D012973:Sodium Hypochlorite / Q000494:pharmacology*
chemical_list: D004202:Disinfectants; D012973:Sodium Hypochlorite