Salmonella Enteritidis Outbreak in Ontario 2005

1. Salmonella Enteritidis Outbreakin Ontario 2005 KFL&A Public Health Environmental Health Department Jerry Zalewski, C.P.H.I.(C)

2. Background • In just over three weeks, from November 1st to November 17th, there were 127 cases of S. enteritidis. • Normally expect approximately 20 – 25 cases per month.

4. Chronology • November 16th & 17th: • Several patients visit local emergency departments. • Many are symptomatic with marked diarrhea and some have fever.

5. Chronology • November 16th & 17th: • Syndromic surveillance system detects an increase in gastro-intestinal illness. • Similar demographics – young adults, downtown postal code were primarily affected. • Stool culture sampling instituted to assess the excess of g-i illness.

6. Saturday, November 19, 2005 • Dr. Kieran Moore informed Dr. Ian Gemmill who informed Mr. Peter Moccio of a cluster of Salmonella cases isolated by KGH Laboratory.

7. November 19 & 20, 2005 • The four people were interviewed. One was a patient at K.G.H.

8. Sunday, November 20, 2005 • Called K.G.H. Laboratory. The four Salmonella species samples appear to be similar and two appear identical. • Two people ate at a restaurant on November 12th and 13th. • One person, who was ill on November 9th, only ate at home.

9. Monday, November 21, 2005 • The third case was called again and it was confirmed he ate at the same restaurant on November 11th. • Received several calls from ill people who ate at the restaurant on November 11th, 12th, or 13th.

10. Monday, November 21, 2005 (cont.) • The suspect food was Phad Thai (shrimp, chicken, bean sprouts, roasted peanuts, and fried noodles). • The total number of suspect cases was twelve people. • The restaurant is closed on Mondays.

11. Tuesday, November 22, 2005 • Pam Landy (PHI) closed the restaurant while she conducted her investigation. The menu was reviewed and compared to what the ill people ate. Bean sprouts were part of the four different meals served to ill people. • Called the one person who did not have bean sprouts with his dinner. His girlfriend had the Phad Thai and he ate her bean sprouts. • Obtained invoice for bean sprouts.

12. Tuesday, November 22, 2005 (cont.) • Called the individual who was ill on November 9th, and she had purchased bean sprouts from grocery store prior to onset of illness. • Faxed Dr. Dean Middleton that our outbreak of twelve suspect cases all ate bean sprouts.

13. Wednesday, November 23, 2005 • Spoke to Melanie Barbacsy (PHI), Hastings & Prince Edward Counties Health Unit. She has three Salmonella cases and she suspected bean sprouts with two different suppliers. Advised her that the two suppliers have the same address and recommended she notify Dr. Dean Middleton.

14. Wednesday, November 23, 2005 (cont.) • There are three confirmed Salmonella Enteritidis cases, one Salmonella species and eleven suspect cases linked to eating bean sprouts. This information was faxed to Dr. Middleton. • Dr. Gemmill and Mr. Moccio agreed all bean sprouts should be removed until such time a source of the contamination could be determined. If the seeds were the source then other bean sprout producers may have purchased them from the same supplier. • Hospitals, Queen’s Student Health Services, and private physicians were to be notified of the outbreak.

15. November 23, 24, & 25, 2005 • Public Health Inspectors went to approximately 100 food premises in the KFL&A area suspected of serving or selling bean sprouts. Premises that had been sprouts disposed of them. • On November 23rd, Pam Landy collected bean sprouts from a restaurant that purchased them from a grocery store. On December 5th, the Ministry of Health Laboratory confirmed three of the four samples contained Salmonella Enteritidis. • Ministry of Health and Long-Term Care Telephone Conference. We spilled the beans!

16. Thursday, November 24, 2005 • The Kingston Whig-Standard – Salmonella Warning.

17. Friday, November 25, 2005 • Toronto Public Health ordered the company to stop the distribution of bean sprouts. C.F.I.A. issued a recall.

18. 16 cases SE PT 13 – bean sprout consumption within KFL&A (Outbreak 0000-2005-058) Mean age = 27 Sex = 9 female (56%), 7 male (44%) Onset dates 11/9/05 to 11/21/05 Symptoms: Diarrhea (16/16 – 100%) cramps (13/16 – 81%) chills (7/16 – 44%) fever (7/16 – 44%) headache (5/16 – 31%) vomiting (3/16 – 19%) nausea (2/16 – 13%) other: dehydration (1/16 – 6%) 10 cases SE (not PT13 confirmed) – bean sprout consumption within KFL&A (Outbreak 2241-2005-044) Mean age = 36 Sex = 7 female (70%), 3 male (30%) Onset dates 11/12/05 to 11/24/05 Symptoms: Diarrhea (10/10 – 100%) cramps (9/10 – 90%) fever (6/10 – 60%) headache (6/10 – 60%) chills (5/10 – 50%) nausea (3/10 – 30%) vomiting (1/10 – 10%) other: bloody diarrhea (1/10 – 10%) KFL&A Salmonella Enteritidis outbreak linked to bean sprout consumption November 2005

19. KFL&A Salmonella Enteritidis outbreak linked to bean sprout consumption November 2005 NOTE: 2 other Salmonella cases consumed bean sprouts outside of KFL&A Public Health jurisdiction (Guelph and Toronto). These cases were NOT included in the summary above.

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