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Salmonella typhimurium Casey County, KY

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Galilean Home for Children Angel House. Infant 4 months old (Baby 1) ... All workers and infants in 'Angel House' cultured ... – PowerPoint PPT presentation

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Title: Salmonella typhimurium Casey County, KY


1
Salmonella typhimuriumCasey County, KY
  • Jasie L. Jackson, MPH
  • Regional Epidemiologist
  • Epidemiology Rapid Response Team Fall Conference
  • Sept. 15-16 2004

2
Clinical Description
  • Infection of variable severity commonly
    manifested by diarrhea, abdominal pain, nausea,
    fever, and sometimes vomiting. Asymptomatic
    infections may occur and the organism may cause
    extraintestinal infections.
  • Kentucky Reportable Disease Desk Reference

3
Salmonellosis
  • gt 2000 known serotypes
  • ? 200 serotypes are detected each year in the
    United States
  • Two most common (in most countries)
  • Salmonella Typhimurium
  • Salmonella Enteritidis

4
Casey County Statistics
5
Positive Case
  • March 4, 2004
  • Case reported
  • Galilean Home for Children Angel House
  • Infant 4 months old (Baby 1)
  • Sx diarrhea and vomiting
  • 3 more cases developed subsequently

6
Galilean Childrens Home
  • A home for children that are either castaways or
    come from homes whose parents are unable to care
    for them. Also a few are placed by loving
    families who need assistance in caring for their
    severely disabled children.

7
The Angel House
  • Home to infants from birth
  • Separate structure from home where other children
    reside.
  • Most of the babies mothers are in prison
  • 15 workers
  • 9 babies
  • 3 babies per room
  • Each has own bed
  • Common room for play-time

8
Investigation Initiated
  • Objectives
  • Confirm other cases
  • Determine mode of transmission
  • Determine source
  • Culture all workers/childcare personnel
  • Culture all infants
  • Education on proper hygiene
  • Institute prevention/protection measures

9
Site Visit
  • Site visit conducted by
  • Nursing Supervisor
  • Environmentalist
  • Regional Epidemiologist
  • Interviews conducted with
  • Director of Angel House
  • Employees

10
Investigation
  • Standard Case definition used
  • All workers and infants in Angel House cultured
  • Stool specimens collected and sent to State Lab
  • All workers negative
  • 5 of 9 infants negative
  • 4 infants with symptoms
  • 3 initially cultured positive for S. typhimurium
  • Baby 4 cultured positive one week later after
    re-culture due to prolonged illness

11
Cases
12
Epidemic Curve
13
Investigation Findings
  • All infants use same formula
  • All positive cultures were S. typhimurium
  • Common Source??
  • Couldnt be identified
  • Infants do not have assigned caretaker
  • Kitchen and sleeping areas inspected
  • Sanitary practices discussed
  • Use bleach as sanitizing solution

14
Investigation Findings (continued)
  • 3 of 4 infants slept in same bedroom
  • 2 caretakers sick prior to infant illness
  • Continued to work
  • Baby 1 visited mother in prison week prior to
    onset

15
Recommendations
  • Caution on handling and contact with reptiles,
    chicks, ducklings, amphibians, etc
  • Clean and disinfect bathrooms
  • Clean and disinfect toys at least daily and when
    soiled
  • Thoroughly cook all foods
  • Store uncooked meats on a shelf lower than other
    foods
  • Good hygiene
  • Stress handwashing
  • Stress sanitization of changing areas
  • Exclude sick caretakers
  • Exclude sick infants
  • Only one caretaker per infant
  • Do not wash hands in the same sink as dishes are
    washed
  • DO NOT drink unpasteurized milk or juices

16
Further Developments
  • Initially the outbreak was contained to 4 infants
    in the Angel House
  • 2 months later another infant (Baby 5) associated
    with the Angel House develops symptoms and
    cultures positive for S. typhimurium

17
More Cultures
  • Mother of Baby 5 works at Galilean Home for
    Children
  • Baby 5 stays at Angel House while mother works
  • Baby 5 re-cultured
  • Family of Baby 5 cultured
  • Original 4 infants repeat cultures
  • Mother and sister of Baby 5 negative
  • Father positive
  • Baby 1 still positive
  • Returned home with mother week prior to culture
    results

18
Culture, Culture, Culture
  • Father cultured 6 times
  • S. typhimurium
  • Father works in restaurant operated by Galilean
    Home
  • Advised cant work till 2 negative cultures
  • 2 negative cultures
  • 7-20-04
  • 7-27-04

19
Conclusions
  • Common Source of infection
  • Source could not be identified
  • 2 possible scenarios
  • Father of Baby 5 is carrier and passed via Baby 5
    to other infants
  • Baby 1 is carrier and passed to all other
    infants. Baby 5 passed infection to Father
    during day-to-day care.

20
References
  • Chin, James, MD ed. Control of Communicable
    Diseases Manual. 17th ed. Baltimore United,
    2000.
  • Hooker, Carol, Mary Beth Grimm, and Claudia
    Miller, eds. Infectious Diseases in Childcare
    Settings and Schools Information for Directors,
    Caregivers, Parents or Guardians and School
    Health Staff. 5th ed. Hopkins, MN Hennipen
    County Community Health Department, 2003.
  • Kentucky Reportable Disease Desk Reference. Div.
    Of Epidemiology and Health Planning. 2003.
  • Reportable Diseases in Kentucky 2002 Summary.
    Division of Epidemiology and Health Planning.
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