Outbreak of Salmonella Wandsworth and Typhimurium infections in infants and toddlers traced to a commercial vegetable-coated snack food.

OBJECTIVE: Human outbreaks of Salmonella infection have been attributed to a variety of food vehicles. Processed snack foods are increasingly consumed by children. In May 2007, state and local health departments and the Centers for Disease Control and Prevention investigated human infections from Salmonella Wandsworth, an extremely rare serotype. MATERIALS AND METHODS: Serotyping and pulsed-field gel electrophoresis were used to identify outbreak-associated illnesses. Food history questionnaires and open-ended interviews were used to generate exposure hypotheses. A nationwide case-control study was conducted to epidemiologically implicate a source. Public health laboratories cultured implicated product from patient homes and retail stores. RESULTS: Sixty-nine patients from 23 states were identified; 93% were aged 10 months to 3 years. Eighty-one percent of child patients had bloody diarrhea; 6 were hospitalized. No deaths were reported. The case-control study strongly associated illness with a commercial puffed vegetable-coated ready-to-eat snack food (mOR = 23.3, P = 0.0001), leading to a nationwide recall. Parents of 92% of interviewed case-children reported that children consumed the food during the week before their illness began; 43% reported daily consumption. Salmonella Wandsworth, 3 additional Salmonella serotypes and Chronobacter (formerly Enterobacter) sakazaki were all cultured from this product, leading to the identification of 18 human outbreak-related Salmonella Typhimurium illnesses. CONCLUSIONS: This report documents a nationwide outbreak associated with a commercial processed ready-to-eat snack food. Cases occurred primarily in infants and toddlers, many of whom frequently consumed the food. Measures are needed to ensure that ingredients added to ready-to-eat foods after the final lethal processing step are free of pathogens.

The effectiveness of vaccine day and educational interventions on influenza vaccine coverage among health care workers at long-term care facilities.

OBJECTIVES: We examined barriers to influenza vaccination among long-term care facility (LTCF) health care workers in Southern California and developed simple, effective interventions to improve influenza vaccine coverage of these workers. METHODS: In 2002, health care workers at LTCFs were surveyed regarding their knowledge and attitudes about influenza and the influenza vaccine. Results were used to develop 2 interventions, an educational campaign and Vaccine Day (a well-publicized day for free influenza vaccination of all employees at the worksite). Seventy facilities were recruited to participate in an intervention trial and randomly assigned to 4 study groups. RESULTS: The combination of Vaccine Day and an educational campaign was most effective in increasing vaccine coverage (53% coverage; prevalence ratio [PR]=1.45; 95% confidence interval [CI]=1.24, 1.71, compared with 27% coverage in the control group). Vaccine Day alone was also effective (46% coverage; PR= 1.41; 95% CI=1.17, 1.71). The educational campaign alone was not effective in improving coverage levels (34% coverage; PR=1.18; 95% CI=0.93, 1.50). CONCLUSION: Influenza vaccine coverage of LTCF health care workers can be improved by providing free vaccinations at the worksite with a well-publicized Vaccine Day.

Outbreak of Ralstonia pickettii bacteremia in a neonatal intensive care unit.

BACKGROUND: Ralstonia pickettii is a Gram-negative bacillus commonly found in soil and moist environments; however, R. pickettii is rarely isolated from clinical specimens. In August 2001, a cluster of R. pickettii bacteremia occurred among neonatal intensive care unit (NICU) infants at a California hospital. METHODS: A case-control study was conducted to determine risk factors for infection. A case was a NICU patient with R. pickettii bacteremia. Controls were NICU infants with negative blood cultures drawn during the same time period. A detailed environmental investigation was also conducted. RESULTS: We identified 18 patients with 19 distinct episodes of R. pickettii bacteremia from July 30 through August 30, 2001. All cases had intravascular access at the time of bacteremia. Although the case-control study did not implicate any statistically significant risk factors, the most likely source of the outbreak was the heparin flush prepared in the hospital pharmacy. This is supported by the following: (1) the heparin flush was the only substance introduced directly into the bloodstream of all case infants; (2) the heparin flush was used exclusively by the NICU; and (3) no further cases were identified after the heparin flush was discontinued. Cultures of remaining heparin flush and environmental cultures from the NICU were negative for R. pickettii. CONCLUSIONS: This unusual outbreak of R. pickettii bacteremia was most likely caused by contaminated heparin flush and ended after the heparin flush was discontinued.

Outbreak of necrotizing fasciitis due to Clostridium sordellii among black-tar heroin users.

In California, black tar heroin (BTH) use among injection drug users (IDUs) has resulted in an increased number of cases of wound botulism due to Clostridium botulinum, tetanus due to Clostridium tetani, and necrotizing soft-tissue infections due to a variety of clostridia. From December 1999 to April 2000, nine IDUs in Ventura County, California, developed necrotizing fasciitis; 4 died. Cultures of wound specimens from 6 case patients yielded Clostridium sordellii. Some of the patients appeared to have the toxic shock syndrome previously reported to be characteristic of toxin-mediated C. sordellii infection, which is characterized by hypotension, marked leukocytosis, and hemoconcentration. The suspected source of this outbreak was contaminated BTH that was injected subcutaneously or intramuscularly ("skin popped"). This outbreak of C. sordellii infection serves as another example of how BTH can potentially serve as a vehicle for transmitting severe and often deadly clostridial infections, and reinforces the need to educate IDUs and clinicians about the risks associated with skin popping of BTH.