title: An international outbreak of salmonellosis associated with raw almonds contaminated with a rare phage type of Salmonella enteritidis.
abstract: During the winter of 2000 to 2001, an outbreak due to Salmonella Enteritidis (SE) phage type 30 (PT30), a rare strain, was detected in Canada. The ensuing investigation involved Canadian and American public health and food regulatory agencies and an academic research laboratory. Enhanced laboratory surveillance, including phage typing and pulsed-field gel electrophoresis, was used to identify cases. Case questionnaires were administered to collect information about food and environmental exposures. A case-control study with 16 matched case-control pairs was conducted to test the hypothesis of an association between raw whole almond consumption and infection. Almond samples were collected from case homes, retail outlets, and the implicated processor, and environmental samples were collected from processing equipment and associated farms for microbiological testing. One hundred sixty-eight laboratory-confirmed cases of SE PT30 infection (157 in Canada, 11 in the United States) were identified between October 2000 and July 2001. The case-control study identified raw whole almonds as the source of infection (odds ration, 21.1; 95% confidence interval, 3.6 to infinity). SE PT30 was detected in raw whole natural almonds collected from home, retail, distribution, and warehouse sources and from environmental swabs of processing equipment and associated farmers' orchards. The frequent and prolonged recovery of this specific organism from a large agricultural area was an unexpected finding and may indicate significant diffuse contamination on these farms. Identification of almonds as the source of a foodborne outbreak is a previously undocumented finding, leading to a North American recall of this product and a review of current industry practices.
authors.affiliation: Centre for Infectious Disease Prevention and Control, Health Canada, Guelph, Ontario, Canada N1G 5B2. sandy_isaacs@hc-sc.gc.ca
authors.forename: S
authors.initials: S
authors.lastname: Isaacs
authors.forename: J
authors.initials: J
authors.lastname: Aramini
authors.forename: B
authors.initials: B
authors.lastname: Ciebin
authors.forename: J A
authors.initials: JA
authors.lastname: Farrar
authors.forename: R
authors.initials: R
authors.lastname: Ahmed
authors.forename: D
authors.initials: D
authors.lastname: Middleton
authors.forename: A U
authors.initials: AU
authors.lastname: Chandran
authors.forename: L J
authors.initials: LJ
authors.lastname: Harris
authors.forename: M
authors.initials: M
authors.lastname: Howes
authors.forename: E
authors.initials: E
authors.lastname: Chan
authors.forename: A S
authors.initials: AS
authors.lastname: Pichette
authors.forename: K
authors.initials: K
authors.lastname: Campbell
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.forename: L Y
authors.initials: LY
authors.lastname: Lior
authors.forename: M
authors.initials: M
authors.lastname: Pearce
authors.forename: C
authors.initials: C
authors.lastname: Clark
authors.forename: F
authors.initials: F
authors.lastname: Rodgers
authors.forename: F
authors.initials: F
authors.lastname: Jamieson
authors.forename: I
authors.initials: I
authors.lastname: Brophy
authors.forename: A
authors.initials: A
authors.lastname: Ellis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001434:Bacteriophage Typing; D002170:Canada / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004196:Disease Outbreaks; D004866:Equipment Contamination; D005260:Female; D005506:Food Contamination; D019649:Food Industry / Q000592:standards; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D027861:Prunus / Q000382:microbiology*; D012307:Risk Factors; D012478:Salmonella Food Poisoning / Q000453:epidemiology*; D012483:Salmonella Phages / Q000145:classification* / Q000302:isolation & purification; D012477:Salmonella enteritidis / Q000302:isolation & purification