Outbreak of Infections Caused by Salmonella I,4,[5],12:i:-

The US Centers for Disease Control and Prevention (CDC) is collaborating with public health officials in multiple states across the US and with the US Department of Agriculture Food Safety Inspection Service to investigate an ongoing outbreak of SalmonellaI,4,[5],12:i:- (pronounced "four five twelve eye minus") infections.

Between January 1, 2007 and October 11, 2007, genetic testing showed at least 165 cases of poisoning with Salmonella I,4,[5],12:i:- from 31 states. Wisconsin has had the most cases of Salmonellosis, with 20 found as of October 11. No deaths have been reported, but at least 30 people have been hospitalized.

An investigation has traced the illness back to Banquet brand pot pies produced by the ConAgra Foods company. The CDC is recommending that until the investigation is concluded and more information is available, consumers do not eat Banquet Pot pies or any pot pies made by ConAgra Foods that have a product code beginning in "5009" and ending in "P9" or "Est 1059."

If you or a member of your household has recently eaten one of these products and has severe diarrheal illness with bloody diarrhea, fever, or symptoms lasting more than three days, you should contact your healthcare provider and call your Local Health Department as well, since they might want to investigate your case.

Human Infection with Salmonella
Salmonella bacteria - discovered by a scientist named Salmon, for whom they are named - live in the intestinal tracts of people and other animals. The bacteria spread when people eat food contaminated with animal feces or contaminated by people who don't wash their hands after handling raw meat, poultry or eggs, or after using the bathroom.

Contaminated foods are often of animal origin, such as beef, poultry, milk, or eggs, but all foods, including vegetables and flour, can become contaminated. Many raw foods of animal origin are frequently contaminated, but fortunately, thorough cooking kills Salmonella. Contaminated foods usually look and smell normal.

Salmonella may also be found in the feces of some pets, especially those with diarrhea, and people can become infected if they do not wash their hands after contact with these feces. Reptiles are particularly likely to harbor Salmonella and people should always wash their hands immediately after handling a reptile, even if the animal is healthy. Adults should make sure that children wash their hands after handling a reptile.

Most people infected with Salmonella develop fever, diarrhea, and abdominal cramps within 12 to 72 hours after exposure. Although the illness usually lasts 4 to 7 days and most people recover without treatment, some people can become severely ill, requiring medical attention and hospitalization. In these patients, the Salmonella infection can spread from the intestines to the bloodstream and then to other body sites. In this situation, the infection can cause death unless the patient is treated promptly with antibiotics. Infants, elderly people, and people with impaired immune systems are more likely than other people to become severely ill.

Diagnosis and Treatment
Many different kinds of illnesses can cause diarrhea, fever, or abdominal cramps. Determining that Salmonella is the cause of the illness depends on laboratory tests that identify Salmonella in the stools of an infected person. These tests are sometimes not performed unless the laboratory is instructed specifically to look for the organism. Once Salmonella has been identified, further testing can determine its specific type, and which antibiotics could be used to treat it.

Salmonella infections often do not require treatment unless the patient becomes severely dehydrated or the infection spreads from the intestines. Those with severe diarrhea may require rehydration, often with intravenous (IV) fluids. Antibiotics are not usually needed unless the infection spreads from the intestines. Unfortunately, some Salmonella bacteria have become resistant to antibiotics, largely as a result of the use of antibiotics to promote the growth of feed animals.

People with diarrhea caused by Salmonella usually recover completely, although it might be a few months before their bowel habits are entirely normal. A small number of those who are infected will go on to develop joint pains, eye irritation, and painful urination. This is called Reiter's syndrome. It can last for months or years, and can lead to chronic arthritis. Antibiotic treatment does not make a difference in whether or not the person later develops arthritis.

Preventing Salmonella Infection
Every year, approximately 40,000 cases of salmonellosis are reported in the United States. Because many milder cases are not diagnosed or reported, the actual number of infections may be far greater. It is estimated that approximately 600 persons die each year with acute salmonellosis.

There is no vaccine to prevent salmonellosis, but there are ways you can help avoid it:

• Do not eat or drink foods containing raw eggs, or raw unpasteurized milk. Some foods typically made with raw eggs include: Hollandaise sauce, Caesar and other homemade salad dressings, tiramisu, homemade ice cream, homemade mayonnaise, cookie dough, and frostings
• If you are served undercooked meat, poultry or eggs in a restaurant, send it back to the kitchen for further cooking.
• Wash hands, kitchen work surfaces such as cutting boards and counters, and utensils with soap and water immediately after they have been in contact with raw meat or poultry.
• Be particularly careful with foods prepared for infants, the elderly, and the immunocompromised.
• Wash hands with soap after handling reptiles or birds, or after contact with pet feces.
• Don't work with raw poultry or meat, and an infant (e.g., feed, change diaper) at the same time.
• Mother's milk is the safest food for young infants. Breast-feeding prevents salmonellosis and many other health problems.
• People who have salmonellosis should not prepare food or pour water for others until they have been shown to no longer be carrying the Salmonella bacterium.
• Avoid direct or even indirect contact between reptiles (turtles, iguanas, other lizards, snakes) and infants or immunocompromised persons.
• People should wash their hands after contact with animal feces. Since reptiles are particularly likely to have Salmonella, everyone should immediately wash their hands after handling reptiles. Reptiles (including turtles) are not appropriate pets for small children and should not be in the same house as an infant.

Some preventive steps occur everyday without the public being aware of it. Pasteurization of milk and treating municipal water supplies are highly effective prevention measures that have been in place for many years.

In the 1970s, small pet turtles were a common source of salmonellosis in the United States, and in 1975, the sale of small turtles was halted in this country. Improvements in farm animal hygiene, in slaughter plant practices, and in vegetable and fruit harvesting and packing operations may help prevent salmonellosis caused by contaminated foods.

Better education of food industry workers in basic food safety and restaurant inspection procedures help prevent cross-contamination and other food handling errors that can lead to outbreaks.

This article includes information from the US Centers for Disease Control and Prevention (CDC), the US Department of Agriculture Food Safety and Inspection Service, and the CDC's National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ZVED).