Salmonella Outbreak during an Event Exempt from Environmental Health Inspection Regulations

BACKGROUND:  Inspection of food-serving establishments is an important public health practice that protects patrons from foodborne illnesses by ensuring that facilities are in compliance with federal and state food safety requirements.  Various entities have jurisdiction for food safety inspections depending on the type of food and/or beverage sold, but there are some organizations that are exempt from any type of inspection during food service.  During September 2013, the North Carolina Division of Public Health was notified of illness among attendees of a church barbeque.  The annual event served approximately 5,000 barbeque plates over an eight hour period.  Initial cases were hospitalized with gastrointestinal illness, including bloody diarrhea. 

METHODS: A case-control study comparing food items consumed among ill and well patrons was conducted and available stool specimens were submitted to the state public health laboratory for testing.  The local health department (LHD) did not conduct a food establishment inspection because the non-profit was exempt from inspection according to North Carolina General Statute (130A-250(7)).  Additionally, the church declined offers for voluntary inspection from LHD environmental health staff during previous years.  An assessment of food handling practices could not be completed during the event since notification of illness occurred after the event had been completed.   

RESULTS:   No particular food item was implicated; this was likely because only one main dish and a few sides were offered.  Of the 104 cases associated with this outbreak, 38 tested positive for Salmonella Infantis or Adelaide with pulsed field gel electrophoresis (PFGE) patterns that had never been observed in North Carolina.  Photographs of some food handling practices during this event revealed multiple opportunities for contamination, including bare-hand contact with ready to eat foods, undocumented holding temperatures, lack of a hand washing sink in food preparation and consumption areas, as well as consumption of food in the same areas of food service. 

CONCLUSIONS:  Positive partnerships between environmental health and exempt facilities can assist in providing education regarding proper food handling procedures during times where there is no regulatory jurisdiction.  Outbreaks associated with exempt facilities such as churches are not uncommon begging the question of whether exemption criteria for inspection of these events where food and beverages are sold should be reassessed.