The investigation of a multistate outbreak of Salmonella Enteritidis infections found an association with eating food from a Mexican-style fast food restaurant chain (referred to as “Restaurant Chain A” by the CDC). Investigators were not able to identify a food source of the outbreak, but some evidence indicates that contamination likely occurred before the product reached Restaurant Chain A locations.
To date, 68 individuals infected with the outbreak strain of Salmonella Enteritidis have been reported from 10 states: Texas (43), Oklahoma (16), Kansas (2), Iowa (1), Michigan (1), Missouri (1), Nebraska (1), New Mexico (1), Ohio (1), and Tennessee (1).
The illnesses began on or after October 13, 2011. Thirty-one percent of patients were hospitalized.
Evidence Implicating Restaurant in Outbreak
Investigators conducted interviews with ill persons to ask questions about exposures during the days before becoming ill. Over 30 of the Salmonella victims reported eating at Restaurant Chain A in the week before illness onset. Ill persons reported eating at 18 different Restaurant Chain A locations. A total of 3 locations were identified where more than one ill person reported eating in the week before becoming ill. Because the outbreak involved multiple Restaurant A locations, the contamination of the food product that caused the outbreak likely occurred before the product reached Restaurant Chain A locations.
An epidemiologic study compared foods eaten by 48 ill and 103 well persons. Analysis of this study indicates that eating at Mexican-style fast food Restaurant Chain A was associated with illness. Ill persons (62%) were significantly more likely than well persons (17%) to report eating at Restaurant Chain A in the week before illness (this is based on 52 Salmonella victims for whom information is available).
Investigators were not able to find the specific food item or ingredient that caused the outbreak primarily because the suspected ingredients (ground beef, lettuce, cheese and tomatoes) were used together in many menu items. However, among ill persons eating at Restaurant Chain A, 90% reported eating lettuce, 94% reported eating ground beef, 77% reported eating cheese, and 35% reported eating tomatoes. According to the CDC, ground beef was an unlikely source due to the handling and cooking processes used by Restaurant Chain A.
The FDA used information on supply truck delivery routes and schedules to try to identify potential foods associated with reports of illness. The FDA collected and analyzed paper and electronic shipping records of suspected foods and various other food products shipped by a food distribution center to Restaurant Chain A locations. Despite these additional efforts, no further information was available to assist in identifying a single food item.
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