title: Multistate outbreak of Salmonella Typhimurium and Saintpaul infections associated with unpasteurized orange juice--United States, 2005.
abstract: BACKGROUND
  Infection due to Salmonella species causes an estimated 1.4 million illnesses and 400 deaths annually in the United States. Orange juice is a known vehicle of salmonellosis, for which regulatory controls have recently been implemented. We investigated a nationwide outbreak of Salmonella infection to determine the magnitude of the outbreak and to identify risk factors for infection.
  
  
  METHODS
  We identified cases through national laboratory-based surveillance. In a case-control study, we defined a case as infection with Salmonella serotype Typhimurium that demonstrated the outbreak pulsed-field gel electrophoresis pattern in a person with illness onset from 1 May through 31 July 2005; control subjects were identified through random digit dialing.
  
  
  RESULTS
  We identified 152 cases in 23 states. Detailed information was available for 95 cases. The median age of patients was 23 years; 46 (48%) of the 95 patients were female. For 38 patients and 53 age-group matched control subjects in 5 states, illness was associated with consuming orange juice (90% vs. 43%; odds ratio, 22.2; 95% confidence interval, 3.5-927.5). In a conditional logistic regression model, illness was associated with consuming unpasteurized orange juice from company X (53% vs. 0%; odds ratio, 38.0; 95% confidence interval, 6.5-infinity). The US Food and Drug Administration found that company X was noncompliant with the juice Hazard Analysis and Critical Control Point regulation and isolated Salmonella serotype Saintpaul from company X's orange juice.
  
  
  CONCLUSIONS
  Unpasteurized orange juice from company X was the vehicle of a widespread outbreak of salmonellosis. Although the route of contamination is unknown, noncompliance with the juice Hazard Analysis and Critical Control Point regulation likely contributed to this outbreak. Pasteurization or other reliable treatment of orange juice could prevent similar outbreaks.
authors.affiliation: Enteric Diseases Epidemiology Branch, Division of Foodborne, Bacterial, and Mycotic Diseases, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. bwc8@cdc.gov
authors.forename: Seema
authors.initials: S
authors.lastname: Jain
authors.forename: Sally A
authors.initials: SA
authors.lastname: Bidol
authors.forename: Jana L
authors.initials: JL
authors.lastname: Austin
authors.forename: Erica
authors.initials: E
authors.lastname: Berl
authors.forename: Franny
authors.initials: F
authors.lastname: Elson
authors.forename: Mysheika
authors.initials: M
authors.lastname: Lemaile-Williams
authors.forename: Marshall
authors.initials: M
authors.lastname: Deasy
authors.forename: Mària E
authors.initials: ME
authors.lastname: Moll
authors.forename: Vickie
authors.initials: V
authors.lastname: Rea
authors.forename: Jazmin D
authors.initials: JD
authors.lastname: Vojdani
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Yu
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hoekstra
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Braden
authors.forename: Michael F
authors.initials: MF
authors.lastname: Lynch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001628:Beverages / Q000382:microbiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D032084:Citrus sinensis / Q000382:microbiology*; D004196:Disease Outbreaks; D005260:Female; D005511:Food Handling / Q000379:methods; D005516:Food Microbiology; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012478:Salmonella Food Poisoning / Q000453:epidemiology* / Q000382:microbiology; D019779:Salmonella enterica / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D012486:Salmonella typhimurium / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D013242:Sterilization; D014481:United States; D055815:Young Adult