Outbreak of Salmonella Serotype Hartford Infections Associated With Unpasteurized Orange Juice
- Kim A. Cook, MD, MSPH;
- Thomas E. Dobbs, MD;
- W. Gary Hlady, MD, MS;
- Joy G. Wells, MS;
- Timothy J. Barrett, PhD;
- Nancy D. Puhr;
- Gayle A. Lancette;
- Dean W. Bodager, RS, MPA;
- Bill L. Toth, MPH;
- Carol A. Genese, MBA;
- Anita K. Highsmith, MS;
- Keith E. Pilot;
- Lyn Finelli, PhD;
- David L. Swerdlow, MD
- From the Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases (Drs Cook, Dobbs, Barrett, and Swerdlow and Mss Wells, Puhr, and Highsmith), and the Epidemic Intelligence Service, Epidemiology Program Office (Dr Cook), Centers for Disease Control and Prevention, and the US Food and Drug Administration, Southeast Regional Laboratory (Ms Lancette), Atlanta, Ga; the Florida Department of Health, Tallahassee (Dr Hlady and Mr Bodager); the Orange County Public Health Unit, Orlando, Fla (Mr Toth); and the New Jersey Department of Health and Senior Services, Trenton (Ms Genese, Mr Pilot, and Dr Finelli).
Abstract
Context.— Acidic foods such as orange juice have been thought to be unlikely vehicles of foodborne illness.
Objective.— To investigate an outbreak of Salmonella enterica serotype Hartford (Salmonella Hartford) infections among persons visiting a theme park in Orlando, Fla, in 1995.
Design.— Review of surveillance data, matched case-control study, laboratory investigation, and environmental studies.
Setting.— General community.
Participants.— The surveillance case definition was Salmonella Hartford or Salmonella serogroup C1 infection in a resident of or a visitor to Orlando in May or June 1995. In the case-control study, case patients were limited to theme park hotel visitors and controls were matched to case patients by age group and hotel check-in date.
Main Outcome Measures.— Risk factors for infection and source of implicated food.
Results.— Sixty-two case patients from 21 states were identified. Both Salmonella Hartford and Salmonella enterica serotype Gaminara (Salmonella Gaminara) were isolated from stool samples of 1 ill person. Thirty-two case patients and 83 controls were enrolled in the case-control study. Ninety-seven percent of case patients had drunk orange juice in the theme park vs 54% of controls (matched odds ratio, undefined; 95% confidence interval, 5.2 to undefined). The orange juice was unpasteurized and locally produced. Salmonella Gaminara was isolated from 10 of 12 containers of orange juice produced during May and July, indicating ongoing contamination of juice probably because of inadequately sanitized processing equipment.
Conclusions.— Unpasteurized orange juice caused an outbreak of salmonellosis in a large Florida theme park. All orange juice was recalled and the processing plant closed. Pasteurization or other equally effective risk-management strategies should be used in the production of all juices.
