Tuesday, May 7, 2013

Salmonella Typhi Infected Food Employee Potentially Exposes Restaurant Patrons

This past week, a San Francisco foodservice worker diagnosed with Salmonella Typhi, had potentially exposed restaurant patrons to infection (news report below). Salmonella Typhi is the causative agent of typhoid fever (CDC Report below).

As required by the US Food Code, (http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/ucm181242.htm#part2-2), employees must contact their manager before coming to work when they have the symptoms of diarrhea, vomiting or jaundice, or have been diagnosed with, or have been exposed to, one of following reportable agents:
    a) Norovirus,
    b) Hepatitis A virus,
    c) Shigella spp.,
    d) Enterohemorrhagic or Shiga toxin-producing Escherichia coli, or
     e) Salmonella Typhi

 A question that often arises is why Salmonella Typhi is singled out from the other strains of Salmonella for reporting, especially since other strains of Salmonella are more likely to be involved in foodborne illness cases.

Salmonella Typhi, the causative agent for typhoid fever, is a strain that is only carried by humans and is spread through direct contact or through food handled by an infected person. Basically, the organism passes through the intestinal tract and then invades the bloodstream leading to multisystem infection. If not treated, it invades the liver, spleen, bone marrow, gall bladder and lymph nodes.  

The symptoms are related to the systematic infection that results. The primary symptoms of Typhoid fever are typified by high sustained fever of 103 to 104 degree F, which is related to the intensive infection. Symptoms also include stomach pains, headache, and a rash or rose color spots. Untreated, the disease can progress to delirium, intestinal hemorrhaging, and potentially death (approximately 20% mortality rate). 

In some cases, people can become carriers and will shed the organism. This was the case of Typhoid Mary, a Salmonella typhi- infected house cook who contaminated approximately 50 of the people served with illness (in the years from 1900 to about 1915).  

Salmonella Typhi infection is seldom seen in the United States, in fact, most infections occur when people travel overseas. However, health officials must pay special attention in order to prevent large scale outbreaks.


SF Issues Warning After Mall Food Handler Diagnosed With Typhoid Fever
May 3, 2013 11:14 PM

 SAN FRANCISCO (CBS SF) – The San Francisco Department of Public Health is warning residents about potential exposure to typhoid fever.
SFDPH reports that a restaurant worker a the Nordstrom Café at Stonestown Galleria has been diagnosed with the infectious disease.

 An investigation is ongoing, but officials said the food handler likely contracted the disease overseas.

Anyone who ate at the Nordstrom Cafe within the Nordstrom store in the Stonestown Galleria in San Francisco on April 16, 17, 18, 20, or 27, 2013 may be at risk of exposure. SFDPH advises those individuals to see a healthcare provider right away if they start to experience symptoms such as fever, weakness, stomach pains, headache, nausea, vomiting, diarrhea, or loss of appetite.

Symptoms usually begin within 8 to 14 days after exposure, but could potentially appear for up to 30 days, according tho SFDPH.

Typhoid fever is an illness caused by the bacterium Salmonella enterica serotype Typhi. Although death is uncommon, typhoid fever can be severe and life-threatening. In the United States, 300-400 cases of typhoid fever occur each year, and most of those are acquired during international travel.

Nordstrom has set up two test labs for customers who ate at the cafe and are now feeling the symptoms, they are are located at the Franciscan Treatment Room on Bush Street and The Sutter Park Medical Foundation. San Franciscans with no medical insurance can visit San Francisco General Hospital’s Urgent Care Clinic.

CDC - National Center for Emerging and Zoonotic Infectious Diseases


 Typhoid Fever

 General Information

Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. In the United States, it is estimated that approximately 5,700 cases occur annually. Most cases (up to 75%) are acquired while traveling internationally. Typhoid fever is still common in the developing world, where it affects about 21.5 million persons each year.

Typhoid fever can be prevented and can usually be treated with antibiotics. If you are planning to travel outside the United States, you should know about typhoid fever and what steps you can take to protect yourself.

How is typhoid fever spread?

Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed Salmonella Typhi in their feces (stool).

You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding Salmonella Typhi or if sewage contaminated with Salmonella Typhi bacteria gets into the water you use for drinking or washing food. Therefore, typhoid fever is more common in areas of the world where handwashing is less frequent and water is likely to be contaminated with sewage.

Once Salmonella Typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream. The body reacts with fever and other signs and symptoms.

Where in the world do you get typhoid fever?

Typhoid fever is common in most parts of the world except in industrialized regions such as the United States, Canada, western Europe, Australia, and Japan. Therefore, if you are traveling to the developing world, you should consider taking precautions. Over the past 10 years, travelers from the United States to Asia, Africa, and Latin America have been especially at risk.

How can you avoid typhoid fever?

Two basic actions can protect you from typhoid fever:

1. Avoid risky foods and drinks.

2. Get vaccinated against typhoid fever.

It may surprise you, but watching what you eat and drink when you travel is as important as being vaccinated. This is because the vaccines are not completely effective. Avoiding risky foods will also help protect you from other illnesses, including travelers' diarrhea, cholera, dysentery, and hepatitis A.

"Boil it, cook it, peel it, or forget it"

· If you drink water, buy it bottled or bring it to a rolling boil for 1 minute before you drink it. Bottled carbonated water is safer than uncarbonated water.

· Ask for drinks without ice unless the ice is made from bottled or boiled water. Avoid popsicles and flavored ices that may have been made with contaminated water.

· Eat foods that have been thoroughly cooked and that are still hot and steaming.

· Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well.

· When you eat raw fruit or vegetables that can be peeled, peel them yourself. (Wash your hands with soap first.) Do not eat the peelings.

· Avoid foods and beverages from street vendors. It is difficult for food to be kept clean on the street, and many travelers get sick from food bought from street vendors.

Getting vaccinated

If you are traveling to a country where typhoid is common, you should consider being vaccinated against typhoid. Visit a doctor or travel clinic to discuss your vaccination options.

Remember that you will need to complete your vaccination at least 1-2 weeks (dependent upon vaccine type) before you travel so that the vaccine has time to take effect. Typhoid vaccines lose effectiveness after several years; if you were vaccinated in the past, check with your doctor to see if it is time for a booster vaccination. Taking antibiotics will not prevent typhoid fever; they only help treat it.

What are the signs and symptoms of typhoid fever?

Persons with typhoid fever usually have a sustained fever as high as 103° to 104° F (39° to 40° C). They may also feel weak, or have stomach pains, headache, or loss of appetite. In some cases, patients have a rash of flat, rose-colored spots. The only way to know for sure if an illness is typhoid fever is to have samples of stool or blood tested for the presence of Salmonella Typhi.

What do you do if you think you have typhoid fever?

If you suspect you have typhoid fever, see a doctor immediately. If you are traveling in a foreign country, you can usually call the U.S. consulate for a list of recommended doctors.

You will probably be given an antibiotic to treat the disease. Three commonly prescribed antibiotics are ampicillin, trimethoprim-sulfamethoxazole, and ciprofloxacin. Persons given antibiotics usually begin to feel better within 2 to 3 days, and deaths rarely occur. However, persons who do not get treatment may continue to have fever for weeks or months, and as many as 20% may die from complications of the infection.

Typhoid fever's danger doesn't end when symptoms disappear

Even if your symptoms seem to go away, you may still be carrying Salmonella Typhi. If so, the illness could return, or you could pass the disease to other people. In fact, if you work at a job where you handle food or care for small children, you may be barred legally from going back to work until a doctor has determined that you no longer carry any typhoid bacteria.

If you are being treated for typhoid fever, it is important to do the following:

Keep taking the prescribed antibiotics for as long as the doctor has asked you to take them.

Wash your hands carefully with soap and water after using the bathroom, and do not prepare or serve food for other people. This will lower the chance that you will pass the infection on to someone else.

Have your doctor perform a series of stool cultures to ensure that no Salmonella Typhi bacteria remain in your body.

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