Human Salmonella Isolates -- United States, 1983

In 1983, 38,881 Salmonella isolates (including Salmonella typhi) from humans were reported to CDC. This represents a 3.2% increase over the 37,683 isolates reported in 1982. During the past 16 years, the number of Salmonella isolates reported to CDC has continued to rise from the 19,659 isolates reported in 1968. The increase was not confined to one state or region. Notable increases over 1982 were seen in: Maryland--183% increase (442 to 1,251); Vermont--119% increase (73 to 160); Indiana--105% increase (242 to 497); New Mexico--37% increase (243 to 333); Utah--34% increase (85 to 114); Oklahoma--33% increase (272 to 361); Alabama--31% increase (561 to 743); and New York--27% increase (2,300 to 2,916). The extent to which these increases represent reporting artifacts is unknown.

The 10 most frequently reported isolates comprised 71% of all the isolates reported (Table 1). S. heidelberg increased 42% (2,641 isolates in 1982 to 3,746 isolates in 1983), and S. agona increased 24% (1,125 to 1,396).

Increases were also reported in some less frequently isolated serotypes. S. stanleyville increased from one isolate reported in 1982 to 37 in 1983; 57% of these isolates were reported by New York state. S. djuju increased from three reported isolates to 24; an outbreak at a catered party in Alabama was partially responsible for this increase. S. tennessee increased from 59 to 136 reported isolates; increases were reported by Illinois and Virginia. S. braenderup increased from 212 to 324; an outbreak of this serotype was reported in a restaurant in Illinois. Reported isolates of S. havana increased from 71 to 114; an outbreak that occurred in a North Carolina hospital was in part responsible for this increase. S. dublin increased from 126 to 182; 66% of these isolates were reported by California. S. hadar increased from 144 to 325; 40% of these isolates were reported by New Jersey, New York, North Carolina, and Virginia.

Age data were reported for 80% of the isolates. The reported rates of Salmonella isolation were highest for 2- to 4-month-old infants, decreased abruptly among early childhood age groups, and then remained relatively constant through the adult years. The reported rates were slightly higher among males in the under-20-year age groups and slightly higher among females in the 20- to 69-year age groups. This is consistent with reports from previous years. During the past 16 years, the median age of all persons from whom isolates were obtained has increased from a median of 6 years in 1968 to 14 years in 1982 and 1983.

In 1983, 525 S. typhi isolates were reported: 156 were from cases; 26 were from carriers; and the remaining were not designated as to case or carrier status. The carriers' median age was 61; the median age of cases was 25. Reported by Statistical Svcs Activity, Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: This report is based on the Salmonella surveillance activity conducted by the Association of State and Territorial Epidemiologists, the Association of State and Territorial Public Health Laboratory Directors, and CDC. It is a passive laboratory-based system that receives weekly reports from the states and the District of Columbia and regular summaries from the U.S. Department of Agriculture. The reports do not distinguish between clinical and subclinical infections or between chronic and convalescent carriers. Many factors affect whether an infection will be reported; however, these data permit comparison with past and future tabulations and have provided information for epidemiologic investigations and a crude index of the effectiveness of various public health measures.

In many of the detected outbreaks, the cause was a relatively uncommon serotype, which points to the importance of serotyping Salmonella. An increase in a common serotype is less likely to be recognized as an outbreak. Recently, however, identification of outbreaks caused by common serotypes has been facilitated by the application of molecular biologic techniques, such as plasmid profile analysis.

Information from epidemiologic investigations during 1983 has added to the understanding of salmonellosis. In early 1983, 18 persons in four midwest states developed salmonellosis. These patients, most of whom had developed severe salmonellosis after taking antimicrobials for other illnesses, were infected with multi-drug-resistant S. newport. The investigation demonstrated that this organism was transmitted by hamburger from a beef herd that had been fed subtherapeutic doses of an antimicrobial for growth promotion (1). This outbreak demonstrated that antimicrobial-resistant bacteria of animal origin can cause serious human disease, especially among persons taking antimicrobials. A second investigation of S. dublin infections in California confirmed the findings of previous studies linking S. dublin to the consumption of certified raw milk (CRM) (2). The risk of contracting S. dublin for California CRM drinkers in 1983 was calculated to be 158 times greater than the California population that did not drink CRM. A third study in Puerto Rico again associated pet turtles with human disease (3). This study of salmonellosis among children under 1 year of age showed that turtles were responsible for 12%-17% of reported infant salmonellosis in Puerto Rico. Although the U.S. Food and Drug Administration banned interstate and intrastate commercial distribution of turtles under 4 inches long in 1975, pet turtles raised in and exported from the United States continue to pose a public health problem. These animals remain inappropriate pets for children.

References

1. Holmberg SD, Osterholm MT, Senger KA, Cohen ML. Drug-resistant Salmonella from animals fed antimicrobials. N Engl J Med 1984;311:617-22.

2. CDC. Salmonella dublin and raw milk consumption--California. MMWR 1984;33:196-8.

3. CDC. Pet-turtle-associated salmonellosis--Puerto Rico. MMWR 1984;33:141-2.

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