Salmonellosis Associated with a Thanksgiving Dinner -- Nevada, 1995

On November 28, 1995, the county coroner's office notified the Clark County Health District in Las Vegas, Nevada, about a death suspected to have resulted from a foodborne disease. This report summarizes the investigation of the outbreak of gastroenteritis among persons who attended a Thanksgiving dinner. The investigation documented Salmonella serotype Enteritidis (SE) infection associated with eating improperly prepared turkey and stuffing containing eggs and emphasizes the need to use a meat thermometer to ensure complete cooking of turkey and stuffing.

During November 25-28, 1995, all six persons who attended a Thanksgiving dinner at a private home on November 23 and a seventh person who on November 25 ate food remaining from the dinner had onset of abdominal cramps, vomiting, and diarrhea. Two persons were hospitalized because of dehydration; a third person was found comatose at home and died from severe dehydration and sepsis. Stool cultures obtained from three persons, including the decedent, yielded SE phage type 13a. Turkey and stuffing were the only foods eaten by all seven ill persons. No leftover food was available for culture.

The Clark County Health District interviewed the ill persons (including the cook) to obtain details about the preparation and cooking of the turkey and stuffing. On November 22, a 13-pound frozen turkey was thawed for 6 hours in a sink filled with cold water. After thawing, the packet of giblets (heart, liver, and gizzard) was removed, and the turkey was stored in a refrigerator overnight. However, on November 23, parts of the turkey were noted to be frozen. The turkey was filled with a stuffing made from bread, the giblets, and three raw eggs, and then placed for 1 hour in an oven set at 350 F (177 C). The setting was lowered to 300 F (149 C) while the turkey cooked for an estimated additional 4 hours. The turkey was removed from the oven when the exterior had browned. A meat thermometer was not used. The stuffing was removed immediately and was served with the turkey. After the outbreak, health officials tested the oven set at 300 F (149 C) and found the temperature to be 350 F (176 C).

Reported by: O Ravenholt, MD, CA Schmutz, LC Empey, DJ Maxson, PL Klouse, AJ Bryant, Clark County Health District, Las Vegas; R Todd, DrPH, State Epidemiologist, Nevada State Health Div. Foodborne and Diarrheal Diseases Br, Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: An estimated 2-4 million cases of salmonellosis occur each year in the United States, resulting in at least 500 deaths (1). Approximately 40,000 of these infections are culture-confirmed, serotyped, and reported to CDC through the National Salmonella Surveillance System. In 1995, SE was the most common serotype reported, accounting for 25% of the 40,720 serotyped culture-confirmed cases.

Salmonellosis is frequently associated with eating undercooked eggs and poultry. Undercooked eggs are a particularly common source of SE infections. During 1988-1992, among foodborne disease outbreaks of salmonellosis reported to CDC in which a single food item was implicated, consumption of turkey and eggs accounted for 4% and 14% of cases, respectively. In addition, eggs or foods containing eggs as a principal ingredient caused 64% of the SE outbreaks (2).

Factors probably associated with the outbreak described in this report included inadequate thawing, use of raw eggs in the stuffing, and undercooking; in addition, the browned color of the turkey may have caused the cook to believe that the turkey and stuffing were thoroughly cooked. Although the original source of the Salmonella is unknown, the raw eggs used in the stuffing probably contained SE, and these eggs probably were incompletely cooked; undercooking may occur more commonly in turkeys that contain stuffing (J. Carpenter, Ph.D., University of Georgia, personal communication, 1996).

Each year, an estimated 45 million turkeys are eaten in the United States at Thanksgiving (J. DeYoung, National Turkey Federation, personnel communication, 1996). Salmonella infection may result from eating improperly cooked turkey and stuffing (3,4). This risk for infection can be reduced by cooking stuffing outside the turkey. Guidelines prepared by the U.S. Department of Agriculture (USDA) for persons who choose to cook stuffing inside the turkey recommend preparing the stuffing immediately before it is placed inside the turkey, stuffing the turkey loosely, inserting a meat thermometer into the center of the stuffing, and ensuring that the thermometer attains a temperature of at least 165 F (74 C). Additional recommendations for safely preparing and cooking a turkey include thawing the turkey completely before cooking, cooking in an oven set no lower than 325 F (163 C), and using a meat thermometer to ensure that the innermost part of the thigh attains a temperature of 180 F (82 C). Although the set temperature and cooking time can be used as guides to determine whether food is completely cooked, inaccuracies in the actual temperature and incomplete thawing before cooking can lead to undercooking. Use of a meat thermometer provides a more accurate determination of thorough cooking. Further advice on cooking turkeys and stuffing is available from USDA's Meat and Poultry Hotline, telephone (800) 535-4555.

References

1. Cohen ML, Tauxe RV. Drug-resistant Salmonella in the United States: an epidemiologic perspective. Science 1986;234:964-9.

2. Bean NH, Goulding JS, Loa C, Angulo FJ. Surveillance for foodborne-disease outbreaks -- United States, 1988-1992. In: CDC surveillance summaries (October). MMWR 1996;45(no. SS-5).

3. CDC. Foodborne nosocomial outbreak of Salmonella reading -- Connecticut. MMWR 1991;40: 804-6.

4. CDC. Restaurant outbreak of salmonellosis due to undercooked turkey -- Washington. MMWR 1978;27:514,519.

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