METHODS: A case was defined as any individual associated with the school that developed GI symptoms with illness onset November 11, 2015 or later. Confirmed cases had a positive stool culture for Campylobacter species. All interviews were conducted using the school menu as an interview tool. Responses were analyzed to identify common exposures and establish a case definition. A review of food products and suppliers along with food storage practices were evaluated. An environmental assessment of the school cafeteria was conducted to identify food handling and cooking practices.
RESULTS: Twenty food histories were collected out of possible 42 symptomatic individuals. The most frequent food (50%) consumed was chicken marsala, followed by grilled chicken tenders at 44%. Nine stool specimens were collected for testing of which six were positive for campylobacter species. Symptoms included diarrhea (95%), nausea (87%) abd pain and fatigue at (79%) each. The food at the school was provided by a catering company that was contracted to prepare and serve food onsite .The food supplied included uncooked frozen meat and poultry products. No unpasteurized milk was supplied. At the time of the investigation, the school was closed for thanksgiving recess and food handling and cooking practices were not assessed. The kitchen and cafeteria were however assessed after thanksgiving break and no violations were found.
CONCLUSIONS: While Campylobacter jejuni is often found in poultry products, most Campylobacter cases are sporadic, and are never traced back to a specific food or beverage; however, raw, or unpasteurized, milk has emerged as a common vehicle for Campylobacter outbreaks in recent years. While there was no raw milk served at this facility, poultry was frequently on the menu and was the most frequently consumed food product among cases. We were however unable to test food samples because the school closure due to thanksgiving recess. As a result of this investigation, the school changed their ordering practices to pre-cooked poultry products.