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Salmonella typhimurium Casey County, KY. Jasie L. Jackson, MPH Regional Epidemiologist Epidemiology Rapid Response Team Fall Conference Sept. 15-16 2004. Clinical Description.

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salmonella typhimurium casey county ky

Salmonella typhimuriumCasey County, KY

Jasie L. Jackson, MPH

Regional Epidemiologist

Epidemiology Rapid Response Team Fall Conference

Sept. 15-16 2004

clinical description
Clinical Description
  • Infection of variable severity commonly manifested by diarrhea, abdominal pain, nausea, fever, and sometimes vomiting. Asymptomatic infections may occur and the organism may cause extraintestinal infections.

~ Kentucky Reportable Disease Desk Reference

salmonellosis
Salmonellosis
  • > 2000 known serotypes
  •  200 serotypes are detected each year in the United States
  • Two most common (in most countries)
    • Salmonella Typhimurium
    • Salmonella Enteritidis
positive case
Positive Case
  • March 4, 2004
  • Case reported
  • Galilean Home for Children – Angel House
  • Infant – 4 months old (Baby 1)
  • Sx – diarrhea and vomiting
  • 3 more cases developed subsequently
galilean children s home
Galilean Children’s Home
  • A home for children that are either castaways or come from homes whose parents are unable to care for them. Also a few are placed by loving families who need assistance in caring for their severely disabled children.
the angel house
Home to infants from birth

Separate structure from home where other children reside.

Most of the babies’ mothers are in prison

15 workers

9 babies

3 babies per room

Each has own bed

Common room for play-time

The Angel House
investigation initiated
Investigation Initiated
  • Objectives
    • Confirm other cases
    • Determine mode of transmission
    • Determine source
    • Culture all workers/childcare personnel
    • Culture all infants
    • Education on proper hygiene
    • Institute prevention/protection measures
site visit
Site Visit
  • Site visit conducted by:
    • Nursing Supervisor
    • Environmentalist
    • Regional Epidemiologist
  • Interviews conducted with:
    • Director of Angel House
    • Employees
investigation
Standard Case definition used

All workers and infants in “Angel House” cultured

Stool specimens collected and sent to State Lab

All workers negative

5 of 9 infants negative

4 infants with symptoms

3 initially cultured positive for S. typhimurium

Baby 4 cultured positive one week later after re-culture due to prolonged illness

Investigation
cases

Infant

Sex

Age

Results

1

F

4 mo.

S. Tryphimurium v. copenhagen

2

M

3 mo.

S. Tryphimurium v. copenhagen

3

F

2 mo.

S. Tryphimurium v. copenhagen

4

F

2 mo.

S. Tryphimurium v. copenhagen

Cases
investigation findings
Investigation Findings
  • All infants use same formula
  • All positive cultures were S. typhimurium
  • Common Source??
    • Couldn’t be identified
  • Infants do not have assigned caretaker
  • Kitchen and sleeping areas inspected
  • Sanitary practices discussed
    • Use bleach as sanitizing solution
investigation findings continued
Investigation Findings (continued)
  • 3 of 4 infants slept in same bedroom
  • 2 caretakers sick prior to infant illness
    • Continued to work
  • Baby 1 visited mother in prison week prior to onset
recommendations
Good hygiene

Stress handwashing

Stress sanitization of changing areas

Exclude sick caretakers

Exclude sick infants

Only one caretaker per infant

Do not wash hands in the same sink as dishes are washed

DO NOT drink unpasteurized milk or juices

Caution on handling and contact with reptiles, chicks, ducklings, amphibians, etc

Clean and disinfect bathrooms

Clean and disinfect toys at least daily and when soiled

Thoroughly cook all foods

Store uncooked meats on a shelf lower than other foods

Recommendations
further developments
Further Developments
  • Initially the outbreak was contained to 4 infants in the Angel House
  • 2 months later another infant (Baby 5) associated with the Angel House develops symptoms and cultures positive for S. typhimurium
more cultures
Mother of Baby 5 works at Galilean Home for Children

Baby 5 stays at “Angel House” while mother works

Baby 5 re-cultured

Family of Baby 5 cultured

Original 4 infants repeat cultures

Mother and sister of Baby 5 negative

Father positive

Baby 1 still positive

Returned home with mother week prior to culture results

More Cultures
culture culture culture
Culture, Culture, Culture
  • Father cultured 6 times
    • S. typhimurium
  • Father works in restaurant operated by Galilean Home
    • Advised – can’t work till 2 negative cultures
  • 2 negative cultures
    • 7-20-04
    • 7-27-04
conclusions
Conclusions
  • Common Source of infection
  • Source could not be identified
  • 2 possible scenarios
    • Father of Baby 5 is carrier and passed via Baby 5 to other infants
    • Baby 1 is carrier and passed to all other infants. Baby 5 passed infection to Father during day-to-day care.
references
References
  • Chin, James, MD ed. Control of Communicable Diseases Manual. 17th ed. Baltimore: United, 2000.
  • Hooker, Carol, Mary Beth Grimm, and Claudia Miller, eds. Infectious Diseases in Childcare Settings and Schools: Information for Directors, Caregivers, Parents or Guardians and School Health Staff. 5th ed. Hopkins, MN: Hennipen County Community Health Department, 2003.
  • Kentucky Reportable Disease Desk Reference. Div. Of Epidemiology and Health Planning. 2003.
  • Reportable Diseases in Kentucky: 2002 Summary. Division of Epidemiology and Health Planning.