Salmonellosis Associated with a Thanksgiving Dinner -- Nevada, 1995 (2024)

On November 28, 1995, the county coroner's office notified theClark County Health District in Las Vegas, Nevada, about a deathsuspected to have resulted from a foodborne disease. This reportsummarizes the investigation of the outbreak of gastroenteritisamong persons who attended a Thanksgiving dinner. The investigationdocumented Salmonella serotype Enteritidis (SE) infectionassociated with eating improperly prepared turkey and stuffingcontaining eggs and emphasizes the need to use a meat thermometerto ensure complete cooking of turkey and stuffing.

During November 25-28, 1995, all six persons who attended aThanksgiving dinner at a private home on November 23 and a seventhperson who on November 25 ate food remaining from the dinner hadonset of abdominal cramps, vomiting, and diarrhea. Two persons werehospitalized because of dehydration; a third person was foundcomatose at home and died from severe dehydration and sepsis. Stoolcultures obtained from three persons, including the decedent,yielded SE phage type 13a. Turkey and stuffing were the only foodseaten by all seven ill persons. No leftover food was available forculture.

The Clark County Health District interviewed the ill persons(including the cook) to obtain details about the preparation andcooking of the turkey and stuffing. On November 22, a 13-poundfrozen turkey was thawed for 6 hours in a sink filled with coldwater. After thawing, the packet of giblets (heart, liver, andgizzard) was removed, and the turkey was stored in a refrigeratorovernight. However, on November 23, parts of the turkey were notedto be frozen. The turkey was filled with a stuffing made frombread, the giblets, and three raw eggs, and then placed for 1 hourin an oven set at 350 F (177 C). The setting was lowered to 300 F(149 C) while the turkey cooked for an estimated additional 4hours. The turkey was removed from the oven when the exterior hadbrowned. A meat thermometer was not used. The stuffing was removedimmediately and was served with the turkey. After the outbreak,health officials tested the oven set at 300 F (149 C) and found thetemperature to be 350 F (176 C).

Reported by: O Ravenholt, MD, CA Schmutz, LC Empey, DJ Maxson, PLKlouse, AJ Bryant, Clark County Health District, Las Vegas; R Todd,DrPH, State Epidemiologist, Nevada State Health Div. Foodborne andDiarrheal Diseases Br, Div of Bacterial and Mycotic Diseases,National Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: An estimated 2-4 million cases of salmonellosisoccur each year in the United States, resulting in at least 500deaths (1). Approximately 40,000 of these infections areculture-confirmed, serotyped, and reported to CDC through theNational Salmonella Surveillance System. In 1995, SE was the mostcommon serotype reported, accounting for 25% of the 40,720serotyped culture-confirmed cases.

Salmonellosis is frequently associated with eating undercookedeggs and poultry. Undercooked eggs are a particularly common sourceof SE infections. During 1988-1992, among foodborne diseaseoutbreaks of salmonellosis reported to CDC in which a single fooditem was implicated, consumption of turkey and eggs accounted for4% and 14% of cases, respectively. In addition, eggs or foodscontaining eggs as a principal ingredient caused 64% of the SEoutbreaks (2).

Factors probably associated with the outbreak described inthis report included inadequate thawing, use of raw eggs in thestuffing, and undercooking; in addition, the browned color of theturkey may have caused the cook to believe that the turkey andstuffing were thoroughly cooked. Although the original source ofthe Salmonella is unknown, the raw eggs used in the stuffingprobably contained SE, and these eggs probably were incompletelycooked; undercooking may occur more commonly in turkeys thatcontain stuffing (J. Carpenter, Ph.D., University of Georgia,personal communication, 1996).

Each year, an estimated 45 million turkeys are eaten in theUnited States at Thanksgiving (J. DeYoung, National TurkeyFederation, personnel communication, 1996). Salmonella infectionmay result from eating improperly cooked turkey and stuffing (3,4).This risk for infection can be reduced by cooking stuffing outsidethe turkey. Guidelines prepared by the U.S. Department ofa*griculture (USDA) for persons who choose to cook stuffing insidethe turkey recommend preparing the stuffing immediately before itis placed inside the turkey, stuffing the turkey loosely, insertinga meat thermometer into the center of the stuffing, and ensuringthat the thermometer attains a temperature of at least 165 F (74C). Additional recommendations for safely preparing and cooking aturkey include thawing the turkey completely before cooking,cooking in an oven set no lower than 325 F (163 C), and using ameat thermometer to ensure that the innermost part of the thighattains a temperature of 180 F (82 C). Although the set temperatureand cooking time can be used as guides to determine whether food iscompletely cooked, inaccuracies in the actual temperature andincomplete thawing before cooking can lead to undercooking. Use ofa meat thermometer provides a more accurate determination ofthorough cooking. Further advice on cooking turkeys and stuffing isavailable from USDA's Meat and Poultry Hotline, telephone (800)535-4555.

References

1. Cohen ML, Tauxe RV. Drug-resistant Salmonella in the United States: an epidemiologic perspective. Science 1986;234:964-9.

2. Bean NH, Goulding JS, Loa C, Angulo FJ. Surveillance for foodborne-disease outbreaks -- United States, 1988-1992. In: CDC surveillance summaries (October). MMWR 1996;45(no. SS-5).

3. CDC. Foodborne nosocomial outbreak of Salmonella reading -- Connecticut. MMWR 1991;40: 804-6.

4. CDC. Restaurant outbreak of salmonellosis due to undercooked turkey -- Washington. MMWR 1978;27:514,519.

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