Samonelosis En Aves De Corral

The

n e w e ng l a n d j o u r na l

of

m e dic i n e

original article

Outbreak of Salmonellosis Linked to Live
Poultry from a Mail-Order Hatchery
Nicholas H. Gaffga, M.D., M.P.H., Casey Barton Behravesh, D.V.M., Dr.P.H.,
Paul J. Ettestad, D.V.M., Chad B. Smelser, M.D., Andrew R. Rhorer, M.S.,
Alicia B. Cronquist, R.N., M.P.H., Nicole A. Comstock, M.S.P.H.,
Sally A. Bidol,M.P.H., Nehal J. Patel, M.P.H., Peter Gerner-Smidt, M.D., D.Med.Sci.,
William E. Keene, Ph.D., M.P.H., Thomas M. Gomez, D.V.M.,
Brett A. Hopkins, D.V.M., Ph.D., Mark J. Sotir, Ph.D., M.P.H.,
and Frederick J. Angulo, D.V.M., Ph.D.

A bs t r ac t
Background

Outbreaks of human salmonella infections are increasingly associated with contact
with live poultry, but effective control measures areelusive. In 2005, a cluster of
human salmonella Montevideo infections with a rare pattern on pulsed-field gel
electrophoresis (the outbreak strain) was identified by PulseNet, a national subtyping network.
Methods

In cooperation with public health and animal health agencies, we conducted
multistate investigations involving patient interviews, trace-back investigations,
and environmentaltesting at a mail-order hatchery linked to the outbreak in order
to identify the source of infections and prevent additional illnesses. A case was
defined as an infection with the outbreak strain between 2004 and 2011.
Results

From 2004 through 2011, we identified 316 cases in 43 states. The median age of
the patient was 4 years. Interviews were completed with 156 patients (or their caretakers)(49%), and 36 of these patients (23%) were hospitalized. Among the 145
patients for whom information was available, 80 (55%) had bloody diarrhea. Information on contact with live young poultry was available for 159 patients, and 122
of these patients (77%) reported having such contact. A mail-order hatchery in the
western United States was identified in 81% of the trace-back investigations,and
the outbreak strain was isolated from samples collected at the hatchery. After interventions at the hatchery, the number of human infections declined, but transmission continued.

From the Division of Foodborne, Waterborne, and Environmental Diseases,
National Center for Emerging and Zoonotic Infectious Diseases, Centers for
Disease Control and Prevention, Atlanta
(N.H.G., C.B.B., N.J.P.,P.G.-S., M.J.S.,
F.J.A.); the New Mexico Department of
Health, Santa Fe (P.J.E., C.B.S.); the Animal and Plant Health Inspection Service,
National Poultry Improvement Plan
(A.R.R.) and Veterinary Services (T.M.G.),
Department of Agriculture, Washington,
DC; the Colorado Department of Public
Health and Environment, Denver (A.B.C.,
N.A.C.); the Michigan Department of
Community Health,Lansing (S.A.B.); the
Oregon Public Health Division, Portland
(W.E.K.); and Pfizer Animal Health, Overland Park, KS (B.A.H.). Address reprint
requests to Dr. Gaffga at the Centers for
Disease Control and Prevention, 1600 Clifton Rd., NE MS E-02, Atlanta, GA 30333,
or at ngaffga@cdc.gov.
N Engl J Med 2012;366:2065-73.
Copyright © 2012 Massachusetts Medical Society.

Conclusions

We identifieda prolonged multistate outbreak of salmonellosis, predominantly affecting young children and associated with contact with live young poultry from a
mail-order hatchery. Interventions performed at the hatchery reduced, but did not
eliminate, associated human infections, demonstrating the difficulty of eliminating salmonella transmission from live poultry.
n engl j med 366;22

nejm.org

may31, 2012

The New England Journal of Medicine
Downloaded from nejm.org on May 31, 2012. For personal use only. No other uses without permission.
Copyright © 2012 Massachusetts Medical Society. All rights reserved.

2065

The

n e w e ng l a n d j o u r na l

N

ontyphoidal salmonella infections are associated with substantial
morbidity and mortality in the United
States, with an...