Raw eggs--lessons learned from an outbreak of Salmonella serotype enteritidis infections associated with meringue pie.

OBJECTIVES: We investigated a salmonellosis outbreak related to a cafeteria to determine its extent and to identify illness risk factors. METHODS: A case was defined as isolation of Salmonella Group D or serotype Enteritidis from the stool of a person who ate at the cafeteria during June 22-July 10, 2003, and developed diarrhea in 3 days or less. Food histories of case patients (n = 11) were compared with those of their well meal companions (n = 16). RESULTS: Consumption of coconut meringue pie was associated with illness (odds ratio = 150.0; 95% confidence interval = 6.4-6901.4). Meringue was made with raw shell eggs and was baked to an internal temperature of 83 degrees F. CONCLUSIONS: Restaurant operators and public health officials should be alert for recipes containing raw shell eggs. Food service operators should use pasteurized egg products in meringue recipes if meringue will not be cooked to the required temperature of 155 degrees F. For clarification purposes, policy makers should consider adding "meringue" to the Food Safety Rule that lists foods in which pasteurized eggs should be substituted for raw shell eggs.

Epidemiologic and environmental investigation of a recreational water outbreak caused by two genotypes of Cryptosporidium parvum in Ohio in 2000.

In August 2000, the Ohio Department of Health requested assistance to investigate a cryptosporidiosis outbreak with more than 700 clinical case-patients. An epidemiologic and environmental investigation was conducted. Stool specimens, pool water, and sand filter samples were analyzed. A community-based case-control study showed that the main risk factor was swimming in pool A (odds ratio [OR] = 42, 95% confidence interval [CI] = 12.3-144.9). This was supported by results of polymerase chain reaction (PCR) analysis, which showed the presence of both the human and bovine genotypes of Cryptosporidium parvum in case-patients and samples from the filter of pool A. A pool-based case-control study indicated that the highest risk was related to exposure to pool water via the mouth (OR = 5.1, 95% CI = 2.1-12.5) or to pool sprinklers (OR = 2.5, 95% CI = 1.3-4.7). Fecal accidents at the pool were documented. Records indicated that the pool met local health regulations. The outbreak, caused by co-infection with two C. parvum genotypes (human and bovine), underscores the need for concerted action to improve public health policies for recreational water facilities and enhanced education regarding the potential for disease transmission through pools.

Legionnaires' disease outbreak in an automobile engine manufacturing plant.

We investigated 4 cases of legionnaires' disease (LD) reported among workers at an Ohio automotive plant in March 2001. A "confirmed" case of LD was defined as x-ray-confirmed pneumonia and a confirmatory laboratory test. A "possible" case of LD was defined as elevated titers of antibody and respiratory symptoms. Legionella pneumophila serogroup 1 (LP1) was isolated from 1 case patient. Legionella was isolated from 18 (9%) of 197 environmental samples; 3 isolates were LP1 but did not match the case isolate. We conducted a case-control study; 17 case patients with confirmed or possible LD and 86 control subjects (workers with low antibody titers and without symptoms) were enrolled. Visiting a specific cleaning line (odds ratio, [OR], 7.29; 95% confidence interval [CI], 2.31-23.00) and working in the cleaning region of the plant (OR, 3.22; 95% CI, 1.11-9.38) were associated with LD. LD can be transmitted in industrial settings in which aerosols are produced. Clinicians should consider LD when treating persons from these settings for pneumonia.