American Journal of Epidemiology Vol. 154, No. 11 : 1020-1028
Copyright © 2001 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
Salmonella Typhimurium Infections Transmitted by Chlorine-pretreated Clover Sprout Seeds
1 Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA.
2 Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
3 Disease Control and Environmental Epidemiology Division, Colorado Department of Public Health and Environment, Denver, CO.
4 Laboratory and Radiation Sciences Division, Colorado Department of Public Health and Environment, Denver, CO.
5 Biostatistics and Information Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
Raw seed sprouts have caused numerous outbreaks of enteric infections. Presoaking seeds in a 20,000 mg/liter (ppm) calcium hypochlorite solution before sprouting is recommended to reduce bacterial contamination and infection risk. In 1999, the authors investigated an outbreak of Salmonella serotype Typhimurium infections in Colorado. In a case-control study, they matched 20 cases with 58 controls by age, sex, and telephone prefix; 10 (52%) of 19 cases and no controls recalled eating raw alfalfa-style sprouts in the 5 days before the patient's illness (p < 0.00001). Traceback implicated clover sprouts grown from seeds shared by two sprouters. The time period and region over which these sprouts were sold matched the occurrences of 112 culture-confirmed illnesses. Only one of the sprouters presoaked seeds as recommended, and fewer infections were attributable to this sprouter (0.29 vs. 1.13 culture-confirmed infections/50-pound (110.1-kg) bag of seed). After recall of the implicated sprouts and seed, S. Typhimurium illnesses declined. Contaminated raw clover sprouts can cause outbreaks of enteric illness. Presoaking contaminated seeds in a 20,000 mg/liter calcium hypochlorite solution reduces, but does not eliminate, the risk of infection. Until safer production methods are developed, persons eating raw sprouts continue to risk developing potentially serious gastrointestinal illness.
chlorine; disease outbreaks; gastroenteritis; Salmonella typhimurium; seeds; vegetables
Abbreviations: CDC, Centers for Disease Control and Prevention; CDPHE, Colorado Department of Public Health and Environment; CI, confidence interval; FDA, Food and Drug Administration; OR, odds ratio; PFGE, pulsed-field gel electrophoresis.
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