Four Multistate Outbreaks of Human Salmonella Infections Associated with Live Poultry Contact, United States, 2009

Investigation of awareness, sanitation, and customer education practices among employees of pet and animal feed stores that sell live animals in the United States

BACKGROUND

Numerous zoonotic disease outbreaks have been associated with companion animals and poultry purchased at pet and animal feed stores. Employees are often the initial source of information for customers purchasing a new pet. Therefore, the objectives of this study were to: (1) investigate awareness, sanitation, and customer education practices related to zoonotic disease risk, and (2) identify predictors of providing customer education among employees of pet and animal feed stores that sell live animals.

METHODS

A survey of pet and animal feed store employees was conducted to evaluate sanitation practices, training, and awareness of zoonotic disease risk. Differences in proportions of categorical variables were assessed using Chi-square tests. Wilcoxon rank-sum and Kruskal-Wallis tests were used to assess for differences in the values of ordinal variables based on the values of categorical variables. A partial proportional odds model was used to identify predictors of providing customer education.

RESULTS

Surveys were completed by 206 respondents from the Southeast, Midwest, Southwest, and Western US, 146 of whom reported that their workplace sold live animals. Handwashing was more frequent among employees whose workplace had handwashing policies related to handling animals and their habitats (p < 0.001). Perceived zoonotic disease risk was higher among those who had received workplace training (p = 0.007). Higher odds of providing customer education related to zoonotic disease risk were associated with serving in a supervisory role (p = 0.005), higher perceived zoonotic disease risk (p = 0.001), and more frequent sanitation practices (handwashing, p = 0.031; surface disinfection, p < 0.001; and glove use, p < 0.001).

CONCLUSIONS

Pet and animal feed stores play an important role in minimizing occupational health hazards for employees and providing education for customers. These retailers should implement clear biosecurity protocols and provide training about zoonotic disease risk associated with handling live animals.

Beta-lactamase genes in bacteria from food animals, retail meat, and human surveillance programs in the United States from 2002 to 2021

The spread of beta-lactamase-producing bacteria is a global public-health concern. This study aimed to explore the distribution of beta-lactamases reported in three sampling sources (cecal, retail meat, and human) collected as part of integrated surveillance in the United States. We retrieved and analyzed data from the United States National Antimicrobial Resistance Monitoring Systems (NARMS) from 2002 to 2021. A total of 115 beta-lactamase genes were detected in E. coli, Salmonella enterica, Campylobacter, Shigella and Vibrio: including 35 genes from cecal isolates, 32 genes from the retail meat isolates, and 104 genes from the human isolates. Three genes in E. coli (blaCMY-2,blaTEM-1A, and blaTEM-1B), 6 genes in Salmonella enterica (blaCARB-2, blaCMY-2, blaCTXM-65, blaTEM-1A, blaTEM-1B, and blaHERA-3), and 2 genes in Campylobacter spp. (blaOXA-61 and blaOXA-449) have been detected across food animals (cattle, chicken, swine, and turkey) and humans over the study period. blaCTXM-55 has been detected in E. coli isolates from the four food animal sources while blaCTXM-15 and blaCTXM-27 were found only in cattle and swine. In Salmonella enterica, blaCTXM-2, blaCTXM-9, blaCTXM-14, blaCTXM-15, blaCTXM-27, blaCTXM-55, and blaNDM-1 were only detected among human isolates. blaOXAs and blaCARB were bacteria-specific and the only beta-lactamase genes detected in Campylobacter spp. and Vibrio spp respectively. The proportions of beta-lactamase genes detected varies from bacteria to bacteria. This study provided insights on the beta-lactamase genes detected in bacteria in food animals and humans in the United States. This is necessary for better understanding the molecular epidemiology of clinically important beta-lactamases in one health interface.

Risk factors for hospitalization among adults aged ≥65 years with non-typhoidal Salmonella infection linked to backyard poultry contact

OBJECTIVE

We describe the epidemiology of live poultry-associated salmonellosis (LPAS) and investigate potential risk factors associated with hospitalization among adults aged ≥65 years in the United States during 2008-2017. LPAS is a public health concern in the United States, especially among people with increased risk for hospitalization, such as older adults.

SAMPLE

We analysed data from people aged ≥65 years with non-typhoidal salmonellosis who reported live poultry contact within seven days prior to illness onset.

PROCEDURE

We used logistic regression to estimate the odds of hospitalization associated with several risk factors including types of live poultry contact exposures.

RESULTS

LPAS among older adults in this analysis resulted in high hospitalization rates. Salmonella Hadar infection was associated with increased hospitalization. Among older adults with LPAS, 109 individuals of 127 (86%) reported contact with live poultry at their or someone else's residence, and 85 of 105 with available information (81%) reported owning poultry.

CONCLUSIONS AND CLINICAL RELEVANCE

Additional infection prevention information and education targeted at poultry-owning older adults are needed to prevent illness and hospitalization.

Research Note: Fate and dissemination of Salmonella enterica serovar reading in turkeys at processing using an oral gavage challenge model

This study aimed to evaluate the fate and dissemination of Salmonella Reading (SR) in turkeys using an oral gavage challenge model. One hundred twenty-eight-week-old commercial turkey hens were moved from commercial production to research facilities. Upon arrival, a combination of enrofloxacin, 10 mg/kg, and florfenicol, 20 mg/kg, were orally administered sequentially before comingled placement on fresh pine shavings. Turkeys were challenged with 10⁸ cfu SR by oral gavage on d 4 and 7 postplacement. Subsets were subjected to simulated commercial processing on d 14 (n = 40), 21 (n = 40) and 28 (n = 32) postplacement (corresponding to 10, 11, and 12 wk of age). Stifle joint, skin, trachea, crop, lung, liver + spleen (LS), and ceca were aseptically sampled and cultured for Salmonella recovery and serotyping. SR could not be recovered from stifle joint 14 d post inoculation (PI). However, at 14 d PI, recovery of SR were: Skin 80%; crop 75%; LS 67.5%; lungs 60%; and ceca 57.5%. (P < 0.01). Interestingly, the lowest recovery of SR was observed from trachea (40%). At 21 d PI, the highest rate of positive samples to SR were observed in ceca (87.5%) and crop (67.5%). By 28 d PI, SR was only recovered from ceca (75%); crop (43.8%); lung (34.4%); and LS (21.9%). The results of this study confirms that SR is an emerging problem for the turkey industry and immediate measurements to reduce foodborne pathogens such as Salmonella should target all parts of the supply chain and consumer education about food safety.

Assessment of Fermented Soybean Meal on Salmonella typhimurium Infection in Neonatal Turkey Poults

Simple Summary

Fermented soybean meal (FSBM) improved the performance of neonatal turkey poults, and these changes were associated with morphometric changes in the intestinal mucosa, as well as reduction of leaky gut, within turkeys challenged with Salmonella typhimurium (ST) in two experimental infective models. Although the two strains used for the fermentation process showed in vitro activity against ST, no significant effect was observed in vivo. Nevertheless, FSBM reduced the severity of the ST infection in the therapeutic model. The fermentation with different beneficial bacteria and different inclusion rates of FSBM requires further investigation.

Abstract

This study’s objective was to evaluate the effect of the fermented soybean meal (FSBM) on Salmonella typhimurium (ST) to turkey poults using two models of infection. In the prophylactic model, one-day-old turkeys were randomly allocated to one of four different groups (n = 30 turkeys/group): (1) Control group, (2) FSBM group, (3) Control group challenged with ST (Control + ST), and (4) FSBM group challenged with ST (FSBM + ST). On day 9 of age, all poults were orally challenged with 10⁶ colony forming units (CFU) ST and 24 h post-inoculation, intestinal samples were collected to determine ST recovery and morphometric analysis. Blood samples were collected to evaluate serum fluorescein isothiocyanate-dextran (FITC-d). In the therapeutic model, a similar experimental design was used, but turkeys were orally gavaged 10⁴ CFU ST on day 1, and samples were collected at day 7. FSBM improved performance and reduced leaky gut in both experimental infective models. In the prophylactic model, FSBB induced morphology changes in the mucosa. Although the strains (Lactobacillus salivarius and Bacillus licheniformis) used for the fermentation process showed in vitro activity against ST, no significant effect was observed in vivo. The fermentation with different beneficial bacteria and different inclusion rates of FSBM requires further investigation.

Embracing Diversity: Differences in Virulence Mechanisms, Disease Severity, and Host Adaptations Contribute to the Success of Nontyphoidal Salmonella as a Foodborne Pathogen

Not all Salmonella enterica serovars cause the same disease. S. enterica represents an incredibly diverse species comprising >2,600 unique serovars. While some S. enterica serovars are host-restricted, others infect a wide range of hosts. The diseases that nontyphoidal Salmonella (NTS) serovars cause vary considerably, with some serovars being significantly more likely to cause invasive disease in humans than others. Furthermore, while genomic analyses have advanced our understanding of the genetic diversity of these serovars, they have not been able to fully account for the observed clinical differences. One overarching challenge is that much of what is known about Salmonella's general biology and virulence strategies is concluded from studies examining a select few serovars, especially serovar Typhimurium. As targeted control strategies have been implemented to control select serovars, an increasing number of foodborne outbreaks involving serovars that are less frequently associated with human clinical illness are being detected. Harnessing what is known about the diversity of NTS serovars represents an important factor in achieving the ultimate goal of reducing salmonellosis-associated morbidity and mortality worldwide. In this review we summarize the current understanding of the differences and similarities among NTS serovars, highlighting the virulence mechanisms, genetic differences, and sources that characterize S. enterica diversity and contribute to its success as a foodborne pathogen.

Outbreaks of Salmonella enterica infections linked to animal contact: Demographic and outbreak characteristics and comparison to foodborne outbreaks-United States, 2009-2014

In the United States, multistate Salmonella outbreaks are most commonly linked to a food source; however, contact with live animals can also result in outbreaks of human illness. To characterize Salmonella outbreaks linked to animal contact and examine differences compared to foodborne outbreaks, we analysed data reported to the Centers for Disease Control and Prevention through the National Outbreak Reporting System (NORS) from 2009 to 2014 with a primary mode of transmission listed as "animal contact" or "food." Four hundred and eighty-four outbreaks with animal contact or foodborne transmission were reported through NORS; of these outbreaks, 99 (20.5%) resulted from Salmonella transmission through animal contact and 385 (79.5%) resulted from foodborne transmission, which resulted in 3,604 (19.8%) and 13,568 (80.2%) illnesses, respectively. A higher proportion of illnesses among children aged <1 year and children aged 1-4 years were linked to animal contact outbreaks compared to foodborne outbreaks (15.2% vs. 1.4%, p < 0.01 and 24.5% vs. 5.6%, p < 0.01, respectively). Illnesses resulting in hospitalizations (OR: 1.81, 95% CI: 1.62, 2.02) were more likely to be associated with animal contact compared to food. Animal contact outbreaks reported to NORS were more likely to be multistate compared to foodborne outbreaks (OR: 5.43, 95% CI: 3.37, 8.76) and had a longer median duration (99.0 days vs. 9.0 days, p < 0.01). Characterizing the differences between outbreaks of illness linked to animal contact and outbreaks linked to food provides useful information to investigators to improve public health response.

Lead exposure to children from consumption of backyard chicken eggs

Backyard chicken ownership is rapidly increasing in urban areas in the United States, largely as a way to provide eggs for household consumption. Despite elevated levels of environmental lead contamination in many US cities, the role of backyard chicken eggs as a pathway for lead exposure, particularly for children, has received limited scrutiny. To characterize lead exposure from consumption of backyard chicken eggs for children and predict related effects on blood lead level (BLL), we conducted a cross-sectional study of backyard chicken owners in the Greater Boston area (n = 51). We interviewed participants regarding egg consumption by household members and collected backyard eggs (n = 201) and coop soil samples (n = 48) for analysis. Inductively coupled plasma mass spectrometry (ICP-MS) was used to evaluate lead concentration in homogenized eggs and an X-ray fluorescence (XRF) portable device was used to assess soil lead levels in the laboratory. We used the USEPA's Integrated Exposure Uptake Biokinetic Model for Lead in Children (IEUBK) to assess the relative contribution of backyard egg consumption to aggregate BLL in children. Four scenarios were developed in the IEUBK model to address variability in egg consumption rates and egg lead contamination. Lead was detected in egg samples from 98% of the households that provided egg samples. Mean household lead concentration was 0.10 μg/g (SD: 0.18). Egg lead concentrations ranged from below the limit of detection (0.0014 μg/g) to 1.798 μg/g (<1.4-1198 ppb). Egg lead levels were strongly positively correlated with lead concentration in coop soil (r = 0.64; p < 0.001). In modeled scenarios where a child < 7 years frequently ate eggs highly contaminated with lead, BLLs are predicted to increase by 0.9-1.5 μg/dL. In three other scenarios reflecting more moderate egg lead contamination and consumption rates, BLLs were predicted to increase from 0.1 to 0.8 μg/dL. Consumption of backyard chicken eggs can contribute to lead exposure in children. Soil lead remediation prior to chicken ownership may reduce lead exposure from backyard eggs.

Microbial pollution and food safety

Microbial pollution is a serious food safety issue because it can lead to a wide range of foodborne diseases. A great number of foodborne diseases and outbreaks are reported in which contamination of fresh produce and animal products occurs from polluted sources with pathogenic bacteria, viruses and protozoa and such outbreaks are reviewed and the sources are revealed. Investigations of foodborne outbreaks involved meat production and fresh produce, namely, that occurred at the early stages of the food chain have shown certain sources of contamination. Domesticated food animals, as well as wild animals, flies and rodents can serve as a source of contamination of nearby produce-growing fields and can lead to human infection through direct contact at farms and, mostly, mail order hatcheries. The most of the fresh produce associated outbreaks have followed wildlife intrusion into growing fields or fecal contamination from nearly animal production facilities that likely led to produce contamination, polluted water used for irrigation and improper manure. Preventive measures, as part of implemented good agricultural practice systems are described. Controlling and minimizing pre-harvest contamination may be one of the key aspects of food safety.

Outbreaks of Human Salmonella Infections Associated with Live Poultry, United States, 1990-2014

These outbreaks underscore the need for a comprehensive One Health approach that integrates human, animal, and environmental health.

Backyard poultry flocks have increased in popularity concurrent with an increase in live poultry–associated salmonellosis (LPAS) outbreaks. Better understanding of practices that contribute to this emerging public health issue is needed. We reviewed outbreak reports to describe the epidemiology of LPAS outbreaks in the United States, examine changes in trends, and inform prevention campaigns. LPAS outbreaks were defined as ≥2 culture-confirmed human Salmonella infections linked to live poultry contact. Outbreak data were obtained through multiple databases and a literature review. During 1990–2014, a total of 53 LPAS outbreaks were documented, involving 2,630 illnesses, 387 hospitalizations, and 5 deaths. Median patient age was 9 years (range <1 to 92 years). Chick and duckling exposure were reported by 85% and 38% of case-patients, respectively. High-risk practices included keeping poultry inside households (46% of case-patients) and kissing birds (13%). Comprehensive One Health strategies are needed to prevent illnesses associated with live poultry.

Multistate outbreak of human Salmonella Typhimurium infections linked to live poultry from agricultural feed stores and mail-order hatcheries, United States 2013

Live poultry-associated salmonellosis is an emerging public health issue in the United States. Public and animal health officials collaborated to investigate one of the largest (356 cases, 39 states) of these outbreaks reported to date. A case was defined as illness in a person infected with the outbreak strain of Salmonella Typhimurium with illness onset between 1 March and 22 October 2013. The median patient age was seven years (range: < 1–87 years); 58% of ill persons were children ≤ 10 years, 51% were female, 25% were hospitalized; 189 (76%) of 250 patients reported live poultry exposure in the week before illness; and 149 (95%) of 157 reported purchasing live poultry from agricultural feed stores. Traceback investigations identified 18 live poultry sources, including 16 mail-order hatcheries. Environmental sampling was conducted at two mail-order hatcheries. One (2.5%) of 40 duplicate samples collected at one hatchery yielded the outbreak strain. Live poultry are an important source of human salmonellosis, particularly among children, highlighting the need for educational campaigns and comprehensive interventions at the mail-order hatchery and agricultural feed store levels. Prevention and control efforts depend on a One Health approach, involving cooperation between public and animal health officials, industry, health professionals, and consumers.

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Live poultry-associated salmonellosis is an emerging public health issue.

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We summarize one of the largest of these outbreaks reported to date (356 cases).

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Prevention and control efforts depend on a One Health approach.

Salmonella Knowledge, Attitudes and Practices: A Survey of Backyard Poultry Owners Residing in Seattle, Washington and the Surrounding Metropolitan Area

Raising poultry flocks in urban backyard settings is becoming increasingly popular across the United States, but carries a risk of zoonotic infection. In the United States from 1990 to 2014, 53 outbreaks of human salmonellosis linked to live poultry have been documented resulting in 2611 known illnesses, 387 known hospitalizations and five known deaths (Centers for Disease Control and Prevention 2015a, http://www.cdc.gov/healthypets/resources/dont-play-chicken-with-your-health-poster-24x36_508.pdf). A cross-sectional descriptive study was developed to better understand knowledge, attitudes and practices of urban backyard poultry owners regarding Salmonella risk and prevention. The study included a survey of bird health, animal husbandry and hygiene practices, and knowledge, attitudes and practices relating to Salmonella risk. Participants were videotaped while caring for their birds, and the recordings were transcribed using notational analysis to determine whether reported practices differed from observed practices. The results indicated that while a large proportion of participants knew that exposure to Salmonella is an inherent risk associated with raising poultry and harvesting eggs, their reported and observed practices would not consistently reduce risk of transmission of Salmonella and other zoonotic diseases. Approximately one in four participants reported performing practices that increase risk of inoculation, such as snuggling and kissing birds or eating/drinking near them. None of the participants were observed kissing their birds on video; however, snuggling (holding birds to clothes) or touching their face during routine care was observed in approximately two-thirds of the video recordings. The video data provided a unique opportunity to compare reported practices with actions recorded during site visits. While the differences were not statistically significant, findings from our study suggest that flock owners may not accurately report the frequency with which risky practices are performed during routine animal care. Education and outreach targeting backyard flock owners should aim to improve husbandry and hygiene practices and reduce risk of zoonotic diseases associated with raising poultry in the backyard setting.

A Multistate Investigation of Antibiotic-Resistant Salmonella enterica Serotype I 4,[5],12:i:- Infections as Part of an International Outbreak Associated with Frozen Feeder Rodents

While most human Salmonella infections result from exposure to contaminated foods, an estimated 11% of all Salmonella infections are attributed to animal exposures, including both direct animal handling and indirect exposures such as cleaning cages and handling contaminated pet food. This report describes the epidemiologic, environmental and laboratory investigations conducted in the United States as part of the response to an international outbreak of tetracycline-resistant Salmonella enterica serotype I 4,[5],12:i:- infections with over 500 illnesses occurring from 2008 to 2010. This investigation found that illness due to the outbreak strain was significantly associated with exposure to pet reptiles and frozen feeder rodents used as food for pet reptiles. Salmonella isolates indistinguishable from the outbreak strain were isolated from a frozen feeder mice-fed reptile owned by a case patient, as well as from frozen feeder mice and environmental samples collected from a rodent producing facility (Company A). An international voluntary recall of all Company A produced frozen feeder animals sold between May 2009 and July 2010 occurred. Only 13% of cases in our investigation were aware of the association between Salmonella infection and mice or rats. Consumers, the pet industry, healthcare providers and veterinarians need to be aware of the potential health risk posed by feeder rodents, whether live or frozen. Frozen feeder rodent producers, suppliers and distributors should follow the animal food labelling requirements as described in 21 CFR §501.5, and all packages of frozen feeder rodents should include safe handling instructions. Persons should wash their hands thoroughly with soap and water after handling live or frozen feeder rodents, as well as reptiles or anything in the area where the animals live. Continued opportunities exist for public health officials, the pet industry, veterinarians and consumers to work together to prevent salmonellosis associated with pet food, pets and other animals.

A Framework to Reduce Infectious Disease Risk from Urban Poultry in the United States

OBJECTIVES

Backyard poultry ownership is increasingly common in U.S. cities and is regulated at the local level. Human contact with live poultry is a well-known risk for infection with zoonotic pathogens, notably Salmonella, yet the ability of local jurisdictions to reduce the risk of infectious disease transmission from poultry to humans is unstudied. We reviewed urban poultry ordinances in the United States and reported Salmonella outbreaks from backyard poultry to identify regulatory gaps in preventing zoonotic pathogen transmission. Based on this analysis, we propose regulatory guidelines for U.S. cities to reduce infectious disease risk from backyard poultry ownership.

METHODS

We assessed local ordinances in the 150 most populous U.S. jurisdictions for content related to noncommercial poultry ownership using online resources and communications with government officials. We also performed a literature review using publicly available data sources to identify human infectious disease outbreaks caused by contact with backyard poultry.

RESULTS

Of the cities reviewed, 93% (n=139) permit poultry in some capacity. Most urban poultry ordinances share common characteristics focused on reducing nuisance to neighbors. Ordinances do not address many pathways of transmission relevant to poultry-to-human transmission of pathogens, such as manure management.

CONCLUSIONS

To reduce the risk of pathogen exposure from backyard poultry, urban ordinances should incorporate the following seven components: limited flock size, composting of manure in sealed containers, prohibition of slaughter, required veterinary care to sick birds, appropriate disposal of dead birds, annual permits linked to consumer education, and a registry of poultry owners.

'One Health' investigation: outbreak of human Salmonella Braenderup infections traced to a mail-order hatchery - United States, 2012-2013

Human salmonellosis linked to contact with live poultry is an increasing public health concern. In 2012, eight unrelated outbreaks of human salmonellosis linked to live poultry contact resulted in 517 illnesses. In July 2012, PulseNet, a national molecular surveillance network, reported a multistate cluster of a rare strain of Salmonella Braenderup infections which we investigated. We defined a case as infection with the outbreak strain, determined by pulsed-field gel electrophoresis, with illness onset from 25 July 2012-27 February 2013. Ill persons and mail-order hatchery (MOH) owners were interviewed using standardized questionnaires. Traceback and environmental investigations were conducted. We identified 48 cases in 24 states. Twenty-six (81%) of 32 ill persons reported live poultry contact in the week before illness; case-patients named 12 different MOHs from eight states. The investigation identified hatchery D as the ultimate poultry source. Sampling at hatchery D yielded the outbreak strain. Hatchery D improved sanitation procedures and pest control; subsequent sampling failed to yield Salmonella. This outbreak highlights the interconnectedness of humans, animals, and the environment and the importance of industry knowledge and involvement in solving complex outbreaks. Preventing these infections requires a 'One Health' approach that leverages expertise in human, animal, and environmental health.

Questionnaire study and postmortem findings in backyard chicken flocks in Finland

Background

Although modern commercial poultry production today is based on large farms and intensive husbandry, keeping backyard poultry has regained popularity in industrialized countries. However, the health status of backyard flocks is still relatively poorly documented. A questionnaire was sent to the owners of 376 backyard poultry flocks (<500 birds) in order to study health management procedures and characterize backyard poultry populations in Finland. Information was also collected on the postmortem findings from non-commercial flocks using necropsy data from the Finnish Food Safety Authority (Evira).

Results

Backyard flocks in Finland are small in size (<50 birds), comprising mainly chickens. Based on the results of the questionnaire, the health of such flocks is good, mortality low and vaccinations are not commonly used. Most of the flocks were registered in the national poultry register. The standard biosecurity practices are not generally applied and contact with wild birds, pets and farm animals is frequent, which can make the flocks more prone to infectious diseases. We conducted an 11-year retrospective study of the postmortem necropsy findings of the Evira in order to document the diseases, which caused mortality in backyard chickens in Finland. Necropsy was performed on a total of 132 non-commercial laying hens during 2000 – 2011. The most common postmortem findings were Marek’s disease (27%) and colibacillosis (17%).

Conclusions

This study is the first to report data on characteristics of and management practices for backyard chicken flocks in Finland. Close connections with commercial flocks are rare and farms are usually distantly located suggesting that the risk that these backyard flocks pose to commercial poultry is low.

Multistate outbreak of Salmonella enterica serotype enteritidis infection associated with pet guinea pigs

Salmonella causes about one million illnesses annually in the United States. Although most infections result from foodborne exposures, animal contact is an important mode of transmission. We investigated a case of Salmonella enterica serotype Enteritidis (SE) sternal osteomyelitis in a previously healthy child who cared for two recently deceased guinea pigs (GPs). A case was defined as SE pulsed-field gel electrophoresis (PFGE) XbaI pattern JEGX01.0021, BlnI pattern JEGA26.0002 (outbreak strain) infection occurring during 2010 in a patient who reported GP exposure. To locate outbreak strain isolates, PulseNet and the US Department of Agriculture National Veterinary Service Laboratories (NVSL) databases were queried. Outbreak strain isolates underwent multilocus variable-number tandem repeat analysis (MLVA). Traceback and environmental investigations were conducted at homes, stores, and breeder or broker facilities. We detected 10 cases among residents of eight states and four NVSL GP outbreak strain isolates. One patient was hospitalized; none died. The median patient age was 9.5 (range, 1-61) years. Among 10 patients, two purchased GPs at independent stores, and three purchased GPs at different national retail chain (chain A) store locations; three were chain A employees and two reported GP exposures of unknown characterization. MLVA revealed four related patterns. Tracebacks identified four distributors and 92 sources supplying GPs to chain A, including one breeder potentially supplying GPs to all case-associated chain A stores. All environmental samples were Salmonella culture-negative. A definitive SE-contaminated environmental source was not identified. Because GPs can harbor Salmonella, consumers and pet industry personnel should be educated regarding risks.

Backyard poultry flocks and salmonellosis: a recurring, yet preventable public health challenge

Poultry are well recognized as possible carriers of Salmonella species. As part of the local foods movement, backyard poultry flocks have increased in popularity in recent years. Between 1996 and 2012, 45 outbreaks of human Salmonella infections linked to live poultry from mail-order hatcheries were documented. This review examines the history of live poultry-associated salmonellosis in humans in the United States, the current status of the issue, and what can be done to help prevent these illnesses. An integrated One Health approach involving the mail-order hatchery industry, feed stores, healthcare providers, veterinarians, and backyard flock owners is needed to help prevent live poultry-associated salmonellosis.

Molecular methods for serovar determination of Salmonella

Salmonella is a diverse foodborne pathogen, which has more than 2600 recognized serovars. Classification of Salmonella isolates into serovars is essential for surveillance and epidemiological investigations; however, determination of Salmonella serovars, by traditional serotyping, has some important limitations (e.g. labor intensive, time consuming). To overcome these limitations, multiple methods have been investigated to develop molecular serotyping schemes. Currently, molecular methods to predict Salmonella serovars include (i) molecular subtyping methods (e.g. PFGE, MLST), (ii) classification using serovar-specific genomic markers and (iii) direct methods, which identify genes encoding antigens or biosynthesis of antigens used for serotyping. Here, we reviewed reported methodologies for Salmonella molecular serotyping and determined the "serovar-prediction accuracy", as the percentage of isolates for which the serovar was correctly classified by a given method. Serovar-prediction accuracy ranged from 0 to 100%, 51 to 100% and 33 to 100% for molecular subtyping, serovar-specific genomic markers and direct methods, respectively. Major limitations of available schemes are errors in predicting closely related serovars (e.g. Typhimurium and 4,5,12:i:-), and polyphyletic serovars (e.g. Newport, Saintpaul). The high diversity of Salmonella serovars represents a considerable challenge for molecular serotyping approaches. With the recent improvement in sequencing technologies, full genome sequencing could be developed into a promising molecular approach to serotype Salmonella.

Outbreak of human Salmonella Typhimurium infections linked to contact with baby poultry from a single agricultural feed store chain and mail-order hatchery, 2009

BACKGROUND

Over 30 outbreaks of human salmonellosis linked to contact with live poultry from mail-order hatcheries were reported to Centers for Disease Control and Prevention between 1990 and 2010. In May 2009, we investigated an outbreak of human Salmonella Typhimurium infections, primarily affecting children.

METHODS

A case was defined as a person with the outbreak strain of Salmonella Typhimurium, as determined by pulsed-field gel electrophoresis and multiple-locus variable-number tandem repeat analysis, in a Pennsylvania or New York resident with illness onset between May 1 and September 1, 2009. We conducted a case-control study to examine the relationship between illness and live poultry contact. Controls were age-matched and geographically-matched. Traceback and environmental investigations were conducted.

RESULTS

We identified 36 case-patients in Pennsylvania and New York; 36% were children aged ≤5 years. Case-patients were more likely than controls to report live baby poultry contact (matched odds ratio [mOR]: 17.0; 95% confidence interval [CI]: 2.7-710.5), contact with chicks (mOR: 14.0; 95% CI: 2.1-592.0), ducklings (mOR: 8.0; 95% CI: 1.1-355.0) and visiting agricultural feed stores (mOR: 6.0; 95% CI: 1.3-55.2). Most (83%) visited agricultural Feed Store Chain Y, a national agricultural feed store chain, which received poultry from Hatchery C, which is supplied by multiple egg sources. Salmonella Typhimurium was isolated from a source duck flock, but had a different pulsed-field gel electrophoresis pattern than the outbreak strain.

CONCLUSIONS

Live baby poultry remain an important source of human salmonellosis, particularly among children. Preventing these infections requires comprehensive interventions at hatcheries and agricultural feed stores; pediatricians should inform patients of risks associated with live poultry contact.