title: A statewide outbreak of Salmonella bovismorbificans phage type 32 infection in Queensland.
abstract: Between 30 May and 1 June 2001, 10 cases of Salmonella Bovismorbificans infection were reported to Public Health Services, Queensland Health. Investigations included enhanced surveillance, case interviews, a matched case control study, environmental audit and microbiological testing of faecal isolates (phage typing) and implicated food products. Forty-one cases of S. Bovismorbificans infection were detected, 36 cases were phage type 32. A matched case control study identified that illness was associated with consumption of food from 15 outlets of a fast food chain, Company A (matched odds ratio [MOR] 17.5, 95% CI 2.0-657.3, p = 0.004) and consumption of a particular product, Product X (MOR undefined, p < 0.001) in the week before onset of illness. Manufacturers of Product X ingredients were audited. Deficiencies were identified in equipment cleansing at the salad mixture processing plant (Manufacturer M). A swab of food residue behind the cutting wheel rim of the lettuce shredder was positive for S. Bovismorbificans phage type 32. This appears to be the first reported Australian outbreak of salmonellosis associated with a lettuce product. The investigations suggest that inadequate maintenance of cutting equipment to prepare lettuce ingredients for Product X by Manufacturer M was a key factor in this statewide outbreak. The statewide nature of this outbreak demonstrates the role of timely serovar identification of Salmonella isolates by a reference laboratory as an aid to outbreak identification, and the importance of adherence to appropriate food safety procedures in the manufacture and preparation of mass produced food items for the public.
authors.affiliation: OzFoodNet and Communicable Diseases Unit, Queensland Health, Brisbane, Queensland.
authors.forename: Russell J
authors.initials: RJ
authors.lastname: Stafford
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: McCall
authors.forename: Annette S
authors.initials: AS
authors.lastname: Neill
authors.forename: Dallas S
authors.initials: DS
authors.lastname: Leon
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Dorricott
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Towner
authors.forename: Gino R
authors.initials: GR
authors.lastname: Micalizzi
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000818:Animals; D001434:Bacteriophage Typing; D016022:Case-Control Studies; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004196:Disease Outbreaks; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D011336:Probability; D011793:Queensland / Q000453:epidemiology; D012016:Reference Values; D012307:Risk Factors; D012478:Salmonella Food Poisoning / Q000453:epidemiology* / Q000209:etiology*; D012483:Salmonella Phages / Q000145:classification* / Q000302:isolation & purification; D019779:Salmonella enterica / Q000302:isolation & purification; D017678:Sex Distribution