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BACKGROUND: On Sunday, April 28, 2013, a hospital notified the Kansas Department of Health and Environment (KDHE) of four patients who sought care after eating food from the same restaurant that afternoon. The Kansas Department of Agriculture (KDA) inspected the restaurant 70 minutes later; a voluntary closure was implemented. The following day, a complainant reported that approximately 20 of 50 attendees of a family event became ill after eating pork carnitas purchased after the restaurant closed. On April 30, KDA issued a temporary suspension order prohibiting the restaurant from operating. An outbreak investigation was conducted to determine the cause of illness and to implement corrective measures.
METHODS: A retrospective cohort study was conducted among family event attendees. A case was defined as an individual experiencing vomiting or diarrhea within eight hours of eating food from the restaurant on April 28. Nine different food samples were tested by a private laboratory for staphylococcal enterotoxin via enzyme-linked immunosorbent assay. KDA conducted Hazard Analysis and Critical Control Points (HACCP) inspections to observe processes for preparing pork carnitas and salsa.
RESULTS: Twenty-two of 35 individuals who attended the family event reported illness; 19 met the case definition. The odds of having consumed pork carnitas were 63 times more likely among those who had become ill than those who did not (odds ratio=63, p-value<0.0001, 95% confidence interval=3.2 – 1231.3). Samples of pork carnitas and salsa tested positive for staphylococcal enterotoxin. The HACCP inspection revealed that neither item cooled to 41°F within six hours, as required by the Kansas Food Code.
CONCLUSIONS: This outbreak was associated with consuming pork carnitas; temperature abuse was observed during its preparation at the HACCP inspection. The outbreak investigation was aided by rapid notification among agencies. The hospital telephoned KDHE within an hour of identifying the second affected household, KDHE notified KDA immediately, and KDA arrived at the establishment 70 minutes later. Despite this fast response, additional patrons became ill after the establishment voluntarily closed. Because the pork carnitas were held at an appropriate temperature at the time KDA arrived, the meat was not destroyed or embargoed; it was sold after the inspector left the premises. In response to issues raised during an after-action review, KDHE defined trigger points for recommending restaurant closure, and developed a template legal order that KDHE or local health officers could use to close a restaurant, in the event KDA could not rapidly respond.