In November 1982 and October 1983, two unrelated outbreaks of
foodborne salmonellosis caused by improperly cooked poultry giblets
occurred in Maine. The two restaurants involved were located 50
miles apart but were part of the same restaurant chain. Reports of
the outbreaks follow.
Outbreak 1: One hundred twelve culture-confirmed cases of
Salmonella enteritidis serotype enteritidis were identified
following
exposure to this restaurant over the Thanksgiving weekend, November
25-27, 1982. A univariate analysis was unable to differentiate
five
of 42 foods associated with illness (roasted turkey, chef's
dressing,
giblet gravy, mashed potatoes, and apple cider) (p = 0.0001).
Further
analyses of food histories associated the giblet gravy most
strongly
with illness (p 0.0001). All items served with the turkey dinner
had been used by the time the investigation was initiated. Food
from
five "doggy" bags was retrieved following the outbreak, but the
contents contained a nonsegregated mixture of the turkey dinner.
Nevertheless, turkey from two bags was positive for Salmonella, as
were mashed potatoes from the third bag.
A review of the method used to prepare the giblet gravy
revealed
that, 3 days before Thanksgiving, the giblets had been removed from
forty-three 22- to 24-pound turkeys, which had been thawed at room
temperature for 36 hours before cooking. The giblets were
refrigerated, with instructions reportedly given to boil them the
day
before Thanksgiving at the time the stock was being prepared.
However, when each of the 18 foodhandlers was questioned
individually,
no one admitted to cooking the giblets or recalled seeing the
giblets
being boiled. The uncooked giblets were ground in a blender and
added
to a thickened, hot stock mixture. The gravy was not returned to a
boil after addition of the ground giblets, so the thickened mixture
would not scorch. The mixture was stored on the counter behind the
stove at room temperature throughout Thanksgiving Day. Leftover
gravy
was used for turkey luncheon specials offered November 26 and 27.
Outbreak 2: Seven persons, all of whom were culture-positive
for
Salmonella serotype heidelberg, became ill after eating at the
second
restaurant on October 17, 1983. In univariate analysis of the
latter
outbreak, eating liver pate was associated with illness (p =
0.003).
No pate remained for laboratory analysis, since the restaurant had
been alerted to the problem by a customer and had stopped making
the
pate 2 days before the investigation. The pate was prepared
October
15. Four 5-pound containers of frozen chicken livers had been
defrosted under refrigerated conditions for 4 days before use.
They
were sauteed in a 20-quart vessel and ground in a food processor.
After addition of seasoning and diced boiled eggs, the mixture was
poured into a large storage pan and refrigerated. The pate was
served
in a small crock on the salad bar, which was replenished from the
refrigerated storage container as needed from October 16 to October
19.
Reported by KF Gensheimer, MD, Maine Dept of Human Svcs; Enteric
Diseases Br, Div of Bacterial Diseases, Center for Infectious
Diseases, CDC.
Editorial Note
Editorial Note: Poultry products are a frequent source of
Salmonella
infections, and reported outbreaks from turkey increase markedly
during the Thanksgiving and Christmas holiday seasons (1). Culture
surveys of poultry flocks and market poultry have demonstrated that
salmonellae may be recovered frequently (2), a fact that is often
not
known or is overlooked during rushed holiday preparations.
The outbreaks described here were unusual in that they involved
giblets that had been stored under refrigeration for several days
and
that, because they had oxidized, appeared to have been cooked.
Domestic and commercial foodhandlers should be aware of the
misleading
appearance of giblets and other poultry organs that have been
refrigerated for prolonged periods.
References
Horwitz MA, Gangarosa EJ. Foodborne disease outbreaks traced
to
poultry, United States, 1966-1974. J Milk Food Technol
1976;39:859-63.
Zecha BC, McCapes RH, Dungan WM, Holte RJ, Worcester WW,
Williams
JE. The Dillon Beach Project--a five-year epidemiological
study
of naturally occurring salmonella infection in turkeys and
their
environment. Avian Dis 1977; 21:141-59.
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