Jain Seema, Bidol Sally A, Austin Jana L, Berl Erica, Elson Franny, Lemaile-Williams Mysheika, Deasy Marshall, Moll Mària E, Rea Vickie, Vojdani Jazmin D, Yu Patricia A, Hoekstra Robert M, Braden Christopher R, Lynch Michael F
Enteric Diseases Epidemiology Branch, Division of Foodborne, Bacterial, and Mycotic Diseases, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Clin Infect Dis. 2009 Apr 15;48(8):1065-71. doi: 10.1086/597397.
Infection due to Salmonella species causes an estimated 1.4 million illnesses and 400 deaths annually in the United States. Orange juice is a known vehicle of salmonellosis, for which regulatory controls have recently been implemented. We investigated a nationwide outbreak of Salmonella infection to determine the magnitude of the outbreak and to identify risk factors for infection.
We identified cases through national laboratory-based surveillance. In a case-control study, we defined a case as infection with Salmonella serotype Typhimurium that demonstrated the outbreak pulsed-field gel electrophoresis pattern in a person with illness onset from 1 May through 31 July 2005; control subjects were identified through random digit dialing.
We identified 152 cases in 23 states. Detailed information was available for 95 cases. The median age of patients was 23 years; 46 (48%) of the 95 patients were female. For 38 patients and 53 age-group matched control subjects in 5 states, illness was associated with consuming orange juice (90% vs. 43%; odds ratio, 22.2; 95% confidence interval, 3.5-927.5). In a conditional logistic regression model, illness was associated with consuming unpasteurized orange juice from company X (53% vs. 0%; odds ratio, 38.0; 95% confidence interval, 6.5-infinity). The US Food and Drug Administration found that company X was noncompliant with the juice Hazard Analysis and Critical Control Point regulation and isolated Salmonella serotype Saintpaul from company X's orange juice.
Unpasteurized orange juice from company X was the vehicle of a widespread outbreak of salmonellosis. Although the route of contamination is unknown, noncompliance with the juice Hazard Analysis and Critical Control Point regulation likely contributed to this outbreak. Pasteurization or other reliable treatment of orange juice could prevent similar outbreaks.
在美国，沙门氏菌感染每年估计导致140万例疾病和400人死亡。橙汁是已知的沙门氏菌病传播媒介，最近已实施监管控制措施。我们调查了一次全国性的沙门氏菌感染疫情，以确定疫情的规模并识别感染的风险因素。
我们通过基于全国实验室的监测来识别病例。在一项病例对照研究中，我们将病例定义为感染鼠伤寒沙门氏菌血清型且在2005年5月1日至7月31日发病的人，其具有疫情脉冲场凝胶电泳图谱；对照对象通过随机数字拨号确定。
我们在23个州识别出152例病例。95例病例有详细信息。患者的中位年龄为23岁；95例患者中有46例（48%）为女性。在5个州的38例患者和53名年龄组匹配的对照对象中，疾病与饮用橙汁有关（90%对43%；优势比，22.2；95%置信区间，3.5 - 927.5）。在条件逻辑回归模型中，疾病与饮用来自X公司的未巴氏杀菌橙汁有关（53%对0%；优势比，38.0；95%置信区间，6.5 - 无穷大）。美国食品药品监督管理局发现X公司不符合果汁危害分析与关键控制点规定，并从X公司的橙汁中分离出圣保罗沙门氏菌血清型。
来自X公司的未巴氏杀菌橙汁是沙门氏菌病广泛爆发的传播媒介。尽管污染途径未知，但不符合果汁危害分析与关键控制点规定可能导致了此次疫情爆发。对橙汁进行巴氏杀菌或其他可靠处理可预防类似疫情爆发。
