title: Creating student sleuths: how a team of graduate students helped solve an outbreak of Salmonella Heidelberg infections associated with kosher broiled chicken livers.
abstract: Since 2009, the New York City Department of Health and Mental Hygiene (DOHMH) has received FoodCORE funding to hire graduate students to conduct in-depth food exposure interviews of salmonellosis case patients. In 2011, an increase in the number of Salmonella Heidelberg infections with pulsed-field gel electrophoresis Xba I pattern JF6X01.0022 among observant Jewish communities in New York and New Jersey was investigated. As this pattern is common nationwide, some cases identified were not associated with the outbreak. To reduce the number of background cases, DOHMH focused on the community initially identified in the outbreak and defined a case as a person infected with the outbreak strain of Salmonella Heidelberg with illness onset from 1 April to 17 November 2011 and who consumed a kosher diet, spoke Yiddish, or self-identified as Jewish. Nationally, 190 individuals were infected with the outbreak strain of Salmonella Heidelberg; 63 New York City residents met the DOHMH case definition. In October 2011, the graduate students (Team Salmonella) interviewed three case patients who reported eating broiled chicken livers. Laboratory testing of chicken liver samples revealed the outbreak strain of Salmonella Heidelberg. Although they were only partially cooked, the livers appeared fully cooked, and consumers and retail establishment food handlers did not cook them thoroughly before eating or using them in a ready-to-eat spread. This investigation highlighted the need to prevent further illnesses from partially cooked chicken products. Removing background cases helped to focus the investigation. Training graduate students to collect exposure information can be a highly effective model for conducting foodborne disease surveillance and outbreak investigations for local and state departments of public health.
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York 11101, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Hanson
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30329, USA.
authors.forename: W Thane
authors.initials: WT
authors.lastname: Hancock
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York 11101, USA.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Harrison
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York 11101, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Kornstein
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York 11101, USA. hwaechte@health.nyc.gov.
authors.forename: HaeNa
authors.initials: H
authors.lastname: Waechter
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York 11101, USA.
authors.forename: Vasudha
authors.initials: V
authors.lastname: Reddy
authors.affiliation: New York State Department of Agriculture and Markets, Albany, New York 12235, USA.
authors.forename: John
authors.initials: J
authors.lastname: Luker
authors.affiliation: New Jersey Department of Health, Trenton, New Jersey 08625, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Malavet
authors.affiliation: New York State Department of Health, Albany, New York 12237, USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Huth
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30329, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Gieraltowski
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York 11101, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Balter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002645:Chickens; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006801:Humans; D007223:Infant; D008099:Liver / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D009518:New York / Q000453:epidemiology; D012475:Salmonella / Q000235:genetics / Q000302:isolation & purification*; D012478:Salmonella Food Poisoning / Q000453:epidemiology / Q000382:microbiology*; D012480:Salmonella Infections / Q000453:epidemiology; D019779:Salmonella enterica; D013334:Students; D055815:Young Adult