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Salmonella typhimurium Casey County, KY

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

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  1. Salmonella typhimuriumCasey County, KY Jasie L. Jackson, MPH Regional Epidemiologist Epidemiology Rapid Response Team Fall Conference Sept. 15-16 2004

  2. 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

  3. Salmonellosis • > 2000 known serotypes •  200 serotypes are detected each year in the United States • Two most common (in most countries) • Salmonella Typhimurium • Salmonella Enteritidis

  4. Casey County Statistics

  5. 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

  6. 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.

  7. 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

  8. 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

  9. Site Visit • Site visit conducted by: • Nursing Supervisor • Environmentalist • Regional Epidemiologist • Interviews conducted with: • Director of Angel House • Employees

  10. 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

  11. 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

  12. Epidemic Curve

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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.

  20. 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.

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