title: Typhoid fever outbreak associated with frozen mamey pulp imported from Guatemala to the western United States, 2010.
abstract: BACKGROUND
  Fifty-four outbreaks of domestically acquired typhoid fever were reported between 1960 and 1999. In 2010, the Southern Nevada Health District detected an outbreak of typhoid fever among persons who had not recently travelled abroad.
  
  
  METHODS
  We conducted a case-control study to examine the relationship between illness and exposures. A case was defined as illness with the outbreak strain of Salmonella serotype Typhi, as determined by pulsed-field gel electrophoresis (PFGE), with onset during 2010. Controls were matched by neighborhood, age, and sex. Bivariate and multivariate statistical analyses were completed using logistic regression. Traceback investigation was completed.
  
  
  RESULTS
  We identified 12 cases in 3 states with onset from 15 April 2010 to 4 September 2010. The median age of case patients was 18 years (range, 4-48 years), 8 (67%) were female, and 11 (92%) were Hispanic. Nine (82%) were hospitalized; none died. Consumption of frozen mamey pulp in a fruit shake was reported by 6 of 8 case patients (75%) and none of the 33 controls (matched odds ratio, 33.9; 95% confidence interval, 4.9). Traceback investigations implicated 2 brands of frozen mamey pulp from a single manufacturer in Guatemala, which was also implicated in a 1998-1999 outbreak of typhoid fever in Florida.
  
  
  CONCLUSIONS
  Reporting of individual cases of typhoid fever and subtyping of isolates by PFGE resulted in rapid detection of an outbreak associated with a ready-to-eat frozen food imported from a typhoid-endemic region. Improvements in food manufacturing practices and monitoring will prevent additional outbreaks.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. anagha.loharikar@gmail.com
authors.forename: Anagha
authors.initials: A
authors.lastname: Loharikar
authors.forename: Anna
authors.initials: A
authors.lastname: Newton
authors.forename: Patricia
authors.initials: P
authors.lastname: Rowley
authors.forename: Charlotte
authors.initials: C
authors.lastname: Wheeler
authors.forename: Tami
authors.initials: T
authors.lastname: Bruno
authors.forename: Haroldo
authors.initials: H
authors.lastname: Barillas
authors.forename: James
authors.initials: J
authors.lastname: Pruckler
authors.forename: Lisa
authors.initials: L
authors.lastname: Theobald
authors.forename: Susan
authors.initials: S
authors.lastname: Lance
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Brown
authors.forename: Ezra J
authors.initials: EJ
authors.lastname: Barzilay
authors.forename: Wences
authors.initials: W
authors.lastname: Arvelo
authors.forename: Eric
authors.initials: E
authors.lastname: Mintz
authors.forename: Ryan
authors.initials: R
authors.lastname: Fagan
mesh_terms: D000293:Adolescent; D000328:Adult; D001628:Beverages / Q000382:microbiology; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D004196:Disease Outbreaks; D005260:Female; D005516:Food Microbiology; D005638:Fruit / Q000382:microbiology*; D006166:Guatemala; D006630:Hispanic or Latino; D006801:Humans; D016015:Logistic Models; D008297:Male; D031252:Mammea / Q000276:immunology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009505:Nevada / Q000453:epidemiology; D009922:Oregon / Q000453:epidemiology; D012307:Risk Factors; D012485:Salmonella typhi / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D011795:Surveys and Questionnaires; D014435:Typhoid Fever / Q000453:epidemiology* / Q000208:ethnology / Q000382:microbiology