Commercially produced non-RTE frozen breaded stuffed chicken products, such as chicken cordon bleu, have been a repeated source of Salmonella infection. "During 1998–2022, 11 Salmonella outbreaks linked to these products were reported; 57% of samples per outbreak from patient homes and retail stores yielded Salmonella."
Although packing has cooking instructions, people continue to prepare them, or handle them as if they are fully cooked items. The reason is that they appear to be cooked, which they are in order to set the coating, but not to the point where the chicken itself if cooked to eliminate Salmonella contamination.
https://www.cdc.gov/mmwr/volumes/72/wr/mm7218a2.htm
Salmonella Associated with Not Ready-to-Eat Breaded, Stuffed Chicken Products — United States, 1998–2022
Weekly / May 5, 2023 / 72(18);484–487
Summary
What is already known about this topic?
Not ready-to-eat breaded, stuffed chicken products have repeatedly been a source of Salmonella outbreaks. On April 28, 2023, the U.S. Department of Agriculture proposed to declare Salmonella an adulterant in these products.
What is added by this report?
During 1998–2022, 11 Salmonella outbreaks linked to these products were reported; 57% of samples per outbreak from patient homes and retail stores yielded Salmonella. Outbreaks continue to occur, although a smaller percentage of patients reported cooking the product in a microwave after labeling changes.
What are the implications for public health practice?
Outbreaks have continued despite consumer-based interventions. Additional control measures for Salmonella contamination by manufacturers could reduce Salmonella-involved illnesses associated with these products.
Discussion
Eleven Salmonella outbreaks linked to NRTE breaded, stuffed chicken products (involving 187 patients) were reported in the United States during 1998–2022. Most of the products tested contained Salmonella. Products were produced by at least three establishments. Outbreaks have continued to occur despite changes made to product labels to better inform consumers and increase the percentages of persons who understand that the product is sold raw. Thus, stronger controls are needed to prevent illnesses associated with these products.
NRTE breaded, stuffed chicken products can be made with various types of chicken, including comminuted, trimmings, or other parts. Certain chicken types are subject to FSIS performance standards, which are used to measure an establishment’s process control; the comminuted chicken used to make these products has the highest allowable percentage (13 of 52 [25%]) of Salmonella positives (6). On April 28, 2023, the U.S. Department of Agriculture proposed to declare Salmonella an adulterant in NRTE breaded, stuffed chicken products, meaning that the product will be subject to regulatory action if Salmonella is detected even at very low levels (5).
Canada enacted regulations for certain breaded chicken products after investigators identified 19 Salmonella outbreaks caused by NRTE breaded chicken products during 2015–2019 (7). These products were not stuffed; most were chicken nuggets. The government introduced four control options in nonstuffed products to reduce Salmonella to below detectable amounts in these products (7). In 2019, the incidence of illness caused by Salmonella Enteritidis, the serotype implicated in 89% of those outbreaks, was 33% lower than it was during 2015–2018 and 7% lower than during the baseline years 2010–2014 (8).
Consumer-based interventions alone, such as improved product labels, have not been an effective solution. In recent years, labels have recommended using a conventional oven rather than a microwave and using a food thermometer (3); however, a consumer research study found that even when consumers read the label, 12% did not realize the product was raw or partially cooked, and among consumers who owned a food thermometer, 52% reported that they typically did not use it while preparing this product (9). Although labeling changes can help protect consumers, the questionnaire data show that some persons who knew the product was raw and followed the cooking instructions still became ill. Moreover, label changes cannot address inequities in access to recommended cooking appliances (3).
The number of patients who became ill from these products is likely much higher than that indicated from outbreak reports. Many persons regularly eat these products: in a U.S. population survey, 7.4% reported eating these products in the previous week.§§§ Although implicated products were distributed nationally, MDH officials identified all multistate outbreaks, and almost one half of outbreaks had cases identified only in Minnesota, suggesting that some outbreaks occurred but were not identified in other states.
Illnesses even among persons who reported that they used a conventional oven and knew the product was raw indicate that consumer-based interventions have been insufficient. The high rate of contamination of products in outbreaks and the lack of first recognition of multistate outbreaks by a state other than Minnesota suggest that the prevalence of illness due to these products is higher than that indicated by outbreaks. Moreover, only a small proportion of all Salmonella illnesses are identified as such. Illness could be reduced by enhanced Salmonella control at the manufacturers that produce these products. The U.S. Department of Agriculture’s proposal to declare Salmonella an adulterant in NRTE breaded and stuffed chicken products will bring additional focus to this public health problem and encourage producers to better control Salmonella in the ingredients used to produce these products.
Eleven Salmonella outbreaks linked to NRTE breaded, stuffed chicken products (involving 187 patients) were reported in the United States during 1998–2022. Most of the products tested contained Salmonella. Products were produced by at least three establishments. Outbreaks have continued to occur despite changes made to product labels to better inform consumers and increase the percentages of persons who understand that the product is sold raw. Thus, stronger controls are needed to prevent illnesses associated with these products.
NRTE breaded, stuffed chicken products can be made with various types of chicken, including comminuted, trimmings, or other parts. Certain chicken types are subject to FSIS performance standards, which are used to measure an establishment’s process control; the comminuted chicken used to make these products has the highest allowable percentage (13 of 52 [25%]) of Salmonella positives (6). On April 28, 2023, the U.S. Department of Agriculture proposed to declare Salmonella an adulterant in NRTE breaded, stuffed chicken products, meaning that the product will be subject to regulatory action if Salmonella is detected even at very low levels (5).
Canada enacted regulations for certain breaded chicken products after investigators identified 19 Salmonella outbreaks caused by NRTE breaded chicken products during 2015–2019 (7). These products were not stuffed; most were chicken nuggets. The government introduced four control options in nonstuffed products to reduce Salmonella to below detectable amounts in these products (7). In 2019, the incidence of illness caused by Salmonella Enteritidis, the serotype implicated in 89% of those outbreaks, was 33% lower than it was during 2015–2018 and 7% lower than during the baseline years 2010–2014 (8).
Consumer-based interventions alone, such as improved product labels, have not been an effective solution. In recent years, labels have recommended using a conventional oven rather than a microwave and using a food thermometer (3); however, a consumer research study found that even when consumers read the label, 12% did not realize the product was raw or partially cooked, and among consumers who owned a food thermometer, 52% reported that they typically did not use it while preparing this product (9). Although labeling changes can help protect consumers, the questionnaire data show that some persons who knew the product was raw and followed the cooking instructions still became ill. Moreover, label changes cannot address inequities in access to recommended cooking appliances (3).
The number of patients who became ill from these products is likely much higher than that indicated from outbreak reports. Many persons regularly eat these products: in a U.S. population survey, 7.4% reported eating these products in the previous week.§§§ Although implicated products were distributed nationally, MDH officials identified all multistate outbreaks, and almost one half of outbreaks had cases identified only in Minnesota, suggesting that some outbreaks occurred but were not identified in other states.
Illnesses even among persons who reported that they used a conventional oven and knew the product was raw indicate that consumer-based interventions have been insufficient. The high rate of contamination of products in outbreaks and the lack of first recognition of multistate outbreaks by a state other than Minnesota suggest that the prevalence of illness due to these products is higher than that indicated by outbreaks. Moreover, only a small proportion of all Salmonella illnesses are identified as such. Illness could be reduced by enhanced Salmonella control at the manufacturers that produce these products. The U.S. Department of Agriculture’s proposal to declare Salmonella an adulterant in NRTE breaded and stuffed chicken products will bring additional focus to this public health problem and encourage producers to better control Salmonella in the ingredients used to produce these products.
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