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BACKGROUND: School-related foodborne disease outbreaks accounted for 17,266 illnesses in 286 outbreaks, the third most illnesses reported among all U.S. settings during 1998–2008. We investigated gastrointestinal illness among persons dining in a university cafeteria during August–September 2013 to determine the etiology and vehicle.
METHODS: We defined a case as diarrhea (≥3 stools in 24 hours) in a student or staff member after eating at the cafeteria August 17–August 24. We conducted hypothesis-generating interviews and reviewed meal-plan data to identify exposures and performed a case-control study. Control subjects were selected from nonill diners at an implicated meal. We performed an environmental assessment of the cafeteria. Isolates from case-patients and food were subtyped by using pulsed-field gel electrophoresis (PFGE) and tested for antimicrobial susceptibility.
RESULTS: We identified 23 cases (median age: 18 years; range: 18–44); 18 (78%) were male. Dinner in the university cafeteria on August 20 was the common exposure. The case-control study included 19 cases and 91 control subjects. Italian-stuffed peppers containing ground chicken were associated with illness (odds ratio: 7.0; 95% confidence interval: 2.1–23.5). Of 10 stool specimens tested, 2 were positive for Campylobacter jejuni only, 3 for Salmonella Enteritidis only, and 4 for both. All 4 lots of raw ground chicken tested yielded both pathogens, with PFGE patterns indistinguishable from those of case-patients. C. jejuni isolates were fluoroquinolone resistant. The environmental assessment identified unsafe food handling practices, including inadequate cooking and lack of temperature monitoring of ground chicken.
CONCLUSIONS: Contaminated raw chicken and multiple unsafe food handling practices contributed to this dual-pathogen outbreak. Education of food handlers can minimize illnesses associated with such high-risk foods as ground chicken.