title: Outbreak of Salmonella enterica serotype I 4,5,12:i:- infections: the challenges of hypothesis generation and microwave cooking.
abstract: We investigated an outbreak of 396 Salmonella enterica serotype I 4,5,12:i:- infections to determine the source. After 7 weeks of extensive hypothesis-generation interviews, no refined hypothesis was formed. Nevertheless, a case-control study was initiated. Subsequently, an iterative hypothesis-generation approach used by a single interviewing team identified brand A not-ready-to-eat frozen pot pies as a likely vehicle. The case-control study, modified to assess this new hypothesis, along with product testing indicated that the turkey variety of pot pies was responsible. Review of product labels identified inconsistent language regarding preparation, and the cooking instructions included undefined microwave wattage categories. Surveys found that most patients did not follow the product's cooking instructions and did not know their oven's wattage. The manufacturer voluntarily recalled pot pies and improved the product's cooking instructions. This investigation highlights the value of careful hypothesis-generation and the risks posed by frozen not-ready-to-eat microwavable foods.
authors.affiliation: Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: R K
authors.initials: RK
authors.lastname: Mody
authors.affiliation: Foodborne, Vectorborne, and Zoonotic Disease Unit, Minnesota Department of Health, St Paul, MN, USA.
authors.forename: S
authors.initials: S
authors.lastname: Meyer
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Trees
authors.affiliation: Applied Epidemiology Staff, Office of Public Health Science, Food Safety and Inspection Service, United States Department of Agriculture, Omaha, NE, USA.
authors.forename: P L
authors.initials: PL
authors.lastname: White
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: T
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Nevada Division of Public and Behavioral Health, Carson City, NV, USA.
authors.forename: R
authors.initials: R
authors.lastname: Sowadsky
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: O L
authors.initials: OL
authors.lastname: Henao
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: P C
authors.initials: PC
authors.lastname: Lafon
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Austin
authors.affiliation: Nevada Division of Public and Behavioral Health, Carson City, NV, USA.
authors.forename: I
authors.initials: I
authors.lastname: Azzam
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: P M
authors.initials: PM
authors.lastname: Griffin
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: R V
authors.initials: RV
authors.lastname: Tauxe
authors.affiliation: Foodborne, Vectorborne, and Zoonotic Disease Unit, Minnesota Department of Health, St Paul, MN, USA.
authors.forename: K
authors.initials: K
authors.lastname: Smith
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: I T
authors.initials: IT
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003296:Cooking; D003625:Data Collection; D004196:Disease Outbreaks; D005260:Female; D005515:Food Labeling; D059022:Food Safety; D005628:Frozen Foods; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011634:Public Health / Q000379:methods; D012478:Salmonella Food Poisoning / Q000453:epidemiology*; D019779:Salmonella enterica; D014481:United States / Q000453:epidemiology; D055815:Young Adult
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