An Investigation into Multiple Salmonella Enteritidis Outbreaks at Correctional Facilities from June - August, 2014 in Florida

BACKGROUND:   From June through August 2014, the Florida Department of Health’s (FDOH) Food and Waterborne Disease Program investigated four Salmonella outbreaks associated with three correctional institutions. A total of 131 inmates met the outbreaks case definitions and eight inmates were hospitalized.  Clinical specimens obtained from each outbreak were tested at the FDOH Bureau of Public Health Laboratories. All four outbreaks had specimens that were culture positive for Salmonella Enteritidis with matching pulsed-field gel electrophoresis (PFGE) patterns. As a result, FDOH aimed to determine the linkage between these four outbreaks.

METHODS:   An invoice records review/traceback was conducted by FDOH in conjunction with the Florida Department of Corrections (FDOC) to identify common food items that were distributed to the facilities. Invoices were obtained from FDOC and were analyzed for product numbers, delivery dates, and facility distribution information during each facility outbreak exposure period. Further characterization of the clinical isolates was performed using second enzyme subtyping.

RESULTS:   Six raw meat products were identified that were distributed to all three facilities. Delivery dates indicated that these products were delivered within the week prior to the outbreaks occurring. The facilities have different shipping distributors, but all products were ordered from the same vendor. The clinical isolates second enzyme PFGE analysis revealed two slightly different patterns. The two outbreaks that occurred at the same facility had matching patterns and the two outbreaks at the two other facilities also had matching patterns.

CONCLUSIONS:   Based on the clustering of the outbreaks at multiple correctional facilities and the shared confirmed pathogen, it is likely that a contaminated common food item distributed to these facilities was the source of these outbreaks. Recommendations to the facilities could include switching to using products that come pre-cooked or ensure strict handling policies for raw products used within the facility. Due to the number of people involved in these outbreaks, providing education to the facilities about safe food handling practices, proper hand hygiene, and excluding ill food handlers from work should continue to be a focus of public health messaging.