Salmonella Enteritidis Outbreak: District of Columbia, 2015

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Figure 1. Onset of Illness.

Table 1. Demographic Characteristics.

Table 2. Selected Food.

Summary.

Background

Creating safe environment for population is essential;
Therefore, the representatives of the services in question must strive to identify the existing threats efficiently;
The sanitation-related concerns and the exposure of the target population to the threat of contracting diseases require proper attention;
The recent notorious case in the District of Columbia (DC) shows that preventing epidemics is a crucial goal.

Goals

The issue of epidemics prevention will be explored by summarizing the article by Kuramoto-Crawford et al. (289);
A concise summary of the case, the investigation, and the key findings will be represented;
A detailed analysis of the subject matter will help shed light on the reasons for the problem to occur;
Thus, the prerequisites for improving the quality of services and maintaining health safety will be created.

Essential Information

9/8/2015: a person developed a severe gastroenterological disorder after dining at a DC restaurant;
Salmonella group D was the reason for the disease and the pain experienced by them;
The products containing truffle oil were contaminated with the Salmonella enterica serotype Enteritidis infection;
Cooperation between healthcare providers, public officials at different levels of influence (from local to state ones), public, and media was required to address the problem.

Epidemiologic Investigation: Description

A case cohort study was designed, and people that had eaten at the restaurant in the following time slot: 7.1.2015–9.1.2015 were recruited for participation;
Two categories for cases were suggested: confirmed and probable, with control subjects being determined based on DCDOH self-reports;
9.9.2015–10.28.2015: 277 people that used the restaurant’s services were identified, of whom 159 (63%) were patients, whereas 95 (37%) were represented by control participants.
Most of the cases of Salmonella enteric contraction occurred on 8.31.2015-9.10.2015 among the DC citizens, although there were also the residents of 11 states;
There was no major difference between the control group and the patients;
The patients reported diarrhea, abdominal cramps, chills, headache, nausea, and fever after dining at restaurant A;
A detailed analysis and comparison of the food items consumed by 155 patients and 88 representatives of the control group were carried out.

Epidemiologic Investigation: Outcomes

The food poisoning at Restaurant A led to the contraction of Salmonella enteric and the symptoms such as nausea, fever, etc.;
After six dishes were isolated, truffle oil was suspected as the primary cause of the problem;
The further analysis confirmed that truffle oil must have been the food item that contained the Salmonella enteric infection.

Environmental and Laboratory Investigations: Outcomes

9.9.2015: First investigation was conducted at Restaurant A;
Both truffle fries and raw truffles that were stored at the restaurant kitchen were infected with Salmonella enteric;
Truffle fries also showed positive results during the test for Salmonella in the course of the polymerase chain reaction (PCR);
However, the following control tests did not show the presence of Salmonella enteric in the truffle oil samples.

Traceback Investigation: Retrospect

The rest of the food items returned negative test results for Salmonella enteric (PFGE XbaI pattern JEGX01.0008).
9.10.2015: DCDOH placed the issue of epidemic into the spotlight of the public attention;
Los Angeles County Department of Public Health reported to the DCDOH about similar instances in the Los Angeles restaurant A chain;
10.1.2015: FDA and the NY State Department of Agriculture and Markets stated that the suppliers could have been responsible for Salmonella enteric contraction.
The food items distributed in both restaurants were the same, i.e., mushrooms, croquette mix, and truffles;
The analysis of the truffle oil samples that were shipped 8.1.2015–9.15.2015 implied the use of the VIDAS Enzyme Linked Fluorescent Assay;
The analysis showed that the 102 environmental sponge subsamples were not contaminated with any form of Salmonella;
Similarly, the shipmen records were scrutinized closely in order to detect the possible source of Salmonella enteric.

Public Health Response

Restaurant’s A license was temporarily suspended by DCDOH;
Restaurant A was instructed to address the violations in the food safety standards that had been spotted during the security check;
Regular inspections with reports submitted to the corresponding organizations were considered a necessity for Restaurant A to restore its functions and be given its license back.

What the Investigation Showed

Instances of gastroenterological pain were reported among 159 people that had dined at Restaurant A;
Salmonella enteric is typically found in the food such as poultry, eggs, Turkish pine nuts, yet the current study showed that low-water activity food may also be the source of the infection;
The analysis based on genome sequencing showed that there were differences between the Salmonella Enteritidis and the pine-nut-related infection.

Limitations and What They Entail

It is rather difficult to identify the single food item that caused the epidemic due to the lack of precision in the analysis;
Some of the samples were collected after the patients developed the symptoms of Salmonella Enteritidis and, therefore, cannot be viewed as useful for the study;
There is a possibility of investigation biases that may have affected the accuracy of the results and, therefore, led to a mistake in analysis.

Outcomes of the Study: Addressing the Outbreak

The fact that the dishes containing truffle oil were the source of Salmonella Enteritidis can be considered proven;
Therefore, the products and dishes containing truffle oil must be viewed as the most likely source of the Salmonella Enteritidis outbreak in the target population;
Thus, apart from legal repercussions, Restaurant A’s managers will have to consider implementing the policies aimed at the promotion of essential sanitary rules.
The restaurant patrons and the emergency department recognized the problem fast and addressed it in a timely manner;
In the PulseNet database, the PFGE pattern observed in the case is among the most common ones;
Therefore, a further analysis of the problem is required;
The importance of cooperation between DCDOH epidemiologists and the DCPHL was crucial for promoting people’s safety.
Collaboration of all agencies must be promoted. Thus, further aggravation of the issue can be prevented successfully;
The case, therefore, should be viewed as a prime example of successful epidemic prevention. Moreover, it is the source of general ideas about carrying out public health campaigns;
The emphasis on promoting cooperation between healthcare services, local authorities, the administration, the citizens, etc., is required.

Conclusion

It is crucial to create the environment in which all stakeholders will be safe;
Because of the lack of the appropriate quality standards, ethics, and leadership, Restaurant A has nearly caused an outbreak of the Salmonella Enteritidis epidemic;
A set of more rigid standards for quality checks should be introduced. Thus, the foundation for improving public health and removing the threats to people’s well-being can be created.

Work Cited

Kuramoto-Crawford, Janet S., et al. “Investigation of Salmonella Enteritidis Outbreak Associated with Truffle Oil – District of Columbia, 2015.” Morbidity and Mortality Weekly Report (MMWR), vol. 66, no. 10, 2017, pp. 278-281.