Outbreak of salmonellosis linked to live poultry from a mail-order hatchery.
BACKGROUND
Outbreaks of human salmonella infections are increasingly associated with contact with live poultry, but effective control measures are elusive. In 2005, a cluster of human salmonella Montevideo infections with a rare pattern on pulsed-field gel electrophoresis (the outbreak strain) was identified by PulseNet, a national subtyping network.


METHODS
In cooperation with public health and animal health agencies, we conducted multistate investigations involving patient interviews, trace-back investigations, and environmental testing at a mail-order hatchery linked to the outbreak in order to identify the source of infections and prevent additional illnesses. A case was defined as an infection with the outbreak strain between 2004 and 2011.


RESULTS
From 2004 through 2011, we identified 316 cases in 43 states. The median age of the patient was 4 years. Interviews were completed with 156 patients (or their caretakers) (49%), and 36 of these patients (23%) were hospitalized. Among the 145 patients for whom information was available, 80 (55%) had bloody diarrhea. Information on contact with live young poultry was available for 159 patients, and 122 of these patients (77%) reported having such contact. A mail-order hatchery in the western United States was identified in 81% of the trace-back investigations, and the outbreak strain was isolated from samples collected at the hatchery. After interventions at the hatchery, the number of human infections declined, but transmission continued.


CONCLUSIONS
We identified a prolonged multistate outbreak of salmonellosis, predominantly affecting young children and associated with contact with live young poultry from a mail-order hatchery. Interventions performed at the hatchery reduced, but did not eliminate, associated human infections, demonstrating the difficulty of eliminating salmonella transmission from live poultry.
Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. ngaffga@cdc.gov
Nicholas H
NH
Gaffga
Casey
C
Barton Behravesh
Paul J
PJ
Ettestad
Chad B
CB
Smelser
Andrew R
AR
Rhorer
Alicia B
AB
Cronquist
Nicole A
NA
Comstock
Sally A
SA
Bidol
Nehal J
NJ
Patel
Peter
P
Gerner-Smidt
William E
WE
Keene
Thomas M
TM
Gomez
Brett A
BA
Hopkins
Mark J
MJ
Sotir
Frederick J
FJ
Angulo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000822:Animal Husbandry; D000818:Animals; D002645:Chickens / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004372:Ducks / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011177:Postal Service; D011201:Poultry Diseases / Q000635:transmission*; D012480:Salmonella Infections / Q000453:epidemiology* / Q000635:transmission; D014481:United States / Q000453:epidemiology; D055815:Young Adult