title: An outbreak of ammonia poisoning from chicken tenders served in a school lunch.
abstract: Although foodborne outbreaks of illness are relatively common, they are rarely caused by chemical agents. An outbreak of gastrointestinal illness occurred among students at two schools shortly after lunch was served. A cohort study, an environmental investigation, and microbiological and toxicological laboratory testing of food samples were performed. A case was defined as a student or teacher who ate food prepared in the kitchen at school A on 25 November 2002 (and served at schools A and B) and who later developed headache or symptoms of gastrointestinal tract irritation, with onset within 180 min of eating lunch. Among 312 persons interviewed, 157 persons became ill (attack rate = 49%; attack rate 41% for school A, 11% for school B). Onset of illness occurred within 60 min for 81% of cases; 91% of students reported that their chicken tenders smelled unusual. Eating chicken tenders that smelled unusual was associated with being a case (relative risk 9.2, 95% confidence interval 1.4 to 62.6, P < 0.05). Ammonia was detected in uncooked chicken tenders at levels as high as 2,468 ppm. The chicken had been contaminated during a warehouse leak of ammonia refrigerant. This outbreak of ammonia poisoning is only the second reported in food, and the first in a solid food. Heated chicken tenders contaminated with ammonia can cause acute illness within a short period of time.
authors.affiliation: Illinois Department of Public Health, Division of Infectious Diseases, 106 North LaSalle Street, 7th Floor South, Chicago, Illinois 60601, USA. mdworkin@idph.state.il.us
authors.forename: Mark S
authors.initials: MS
authors.lastname: Dworkin
authors.forename: Alpesh
authors.initials: A
authors.lastname: Patel
authors.forename: Michelle
authors.initials: M
authors.lastname: Fennell
authors.forename: Michael
authors.initials: M
authors.lastname: Vollmer
authors.forename: Stacey
authors.initials: S
authors.lastname: Bailey
authors.forename: James
authors.initials: J
authors.lastname: Bloom
authors.forename: Karnail
authors.initials: K
authors.lastname: Mudahar
authors.forename: Roland
authors.initials: R
authors.lastname: Lucht
mesh_terms: D000293:Adolescent; D000328:Adult; D000641:Ammonia / Q000506:poisoning*; D000818:Animals; D002645:Chickens; D002648:Child; D004196:Disease Outbreaks; D005260:Female; D005506:Food Contamination / Q000032:analysis; D005516:Food Microbiology; D005522:Food Services; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D008461:Meat Products / Q000032:analysis*; D012574:Schools
chemical_list: D000641:Ammonia