title: Emergence of Salmonella serotype Enteritidis phage type 4 in Hawaii traced to locally-produced eggs.
abstract: OBJECTIVE
  In August 1998, the Hawaii Department of Health observed a nine-fold increase in human Salmonella Enteritidis (SE) infections. Isolates were phage type 4 (PT4). An investigation was initiated to determine the source of the outbreak.
  
  
  METHODS
  A matched case-control study enrolled 38 cases. Cases were Hawaii residents with diarrhea and a stool culture yielding SE.
  
  
  RESULTS
  Eating eggs was associated with SE illness; 28 cases (74%) ate eggs in the three days before illness compared to 34 (45%) of 76 controls (MOR=3.0, 95% CI=1.4-7.4). Eighteen (47%) of 38 case patients ate eggs from Farm A compared to 11 (14%) of 76 controls (MOR=12.0, 95% CI=3.1-78.0); the eggs were not properly handled or refrigerated. Cultures from Farm A yielded SE. Human illness subsided following selective flock depopulation.
  
  
  CONCLUSIONS
  This outbreak highlights the importance of proper handling and refrigeration of eggs. The egg industry must implement quality assurance programs to prevent the spread of SE PT4 and human SE illness.
authors.affiliation: Epidemic Intelligence Service, State Branch, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA. mailto:rkmaktub@yahoo.com
authors.forename: Roger
authors.initials: R
authors.lastname: Burr
authors.forename: Paul
authors.initials: P
authors.lastname: Effler
authors.forename: Rebecca
authors.initials: R
authors.lastname: Kanenaka
authors.forename: Michelle
authors.initials: M
authors.lastname: Nakata
authors.forename: Ben
authors.initials: B
authors.lastname: Holland
authors.forename: Fred J
authors.initials: FJ
authors.lastname: Angulo
mesh_terms: D000822:Animal Husbandry; D000818:Animals; D001434:Bacteriophage Typing; D016022:Case-Control Studies; D002645:Chickens; D004196:Disease Outbreaks; D004531:Eggs / Q000382:microbiology*; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D011201:Poultry Diseases / Q000453:epidemiology / Q000382:microbiology; D012478:Salmonella Food Poisoning / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D012481:Salmonella Infections, Animal / Q000453:epidemiology / Q000382:microbiology; D012477:Salmonella enteritidis / Q000145:classification* / Q000302:isolation & purification