Salmonellosis Associated with a Thanksgiving Dinner

Many will enjoy eating turkey on Christmas. (Perhaps some on Hanukah – is turkey Kosher?) Some tips from the CDC on cooking can be found in this chilling report on a family that had a bacterial infection from Thanksgiving dinner.

The turkey can kill you.

The following is from the CDC’s MMWR publication. The MMWR can be downloaded from ftp://ftp.cdc.gov/pub/Publications/mmwr/wk/

Salmonellosis Associated with a Thanksgiving Dinner 

MMWR Morb Mortal Wkly Rep. 1996 Nov 22;45(46):1016-7.

On November 28, 1995, the county coroner’s office notified the ClarkCounty Health District in Las Vegas, Nevada, about a death suspected tohave resulted from a food-borne disease. This report summarizes the investigationof the outbreak of gastroen-teritis among persons who attended a Thanksgivingdinner. The investigation documented Salmonella serotype Enteritidis (SE)infection associated with eating improperly prepared turkey and stuffingcontaining eggs and emphasizes the need to use a meat thermometer to ensurecomplete cooking of turkey and stuffing. 

During November 25­-28, 1995, all six persons who attended a Thanksgivingdinner at a private home on November 23 and a seventh person who on November25 ate food remaining from the dinner had onset of abdominal cramps, vomiting,and diar-rhea. Two persons were hospitalized because of dehydration; athird person was found comatose at home and died from severe dehydrationand sepsis. Stool cultures obtained from three persons, including the decedent,yielded SE phage type 13a. Turkey and stuffing were the only foods eatenby all seven ill persons. No leftover food was available for culture. 

The Clark County Health District interviewed the ill persons (includingthe cook) to obtain details about the preparation and cooking of the turkeyand stuffing. On No-vember 22, a 13-pound frozen turkey was thawed for6 hours in a sink filled with cold water. After thawing, the packet ofgiblets (heart, liver, and gizzard) was removed, and the turkey was storedin a refrigerator overnight. However, on November 23, parts of the turkeywere noted to be frozen. The turkey was filled with a stuffing made frombread, the giblets, and three raw eggs, and then placed for 1 hour in anoven set at 350 F (177 C). The setting was lowered to 300 F (149 C) whilethe turkey cooked for an estimated additional 4 hours. The turkey was removedfrom the oven when the exte-rior had browned. A meat thermometer was notused. The stuffing was removed im-mediately and was served with the turkey.After the outbreak, health officials tested the oven set at 300 F (149C) and found the temperature to be 350 F (176 C). 

Reported by: O Ravenholt, MD, CA Schmutz, LC Empey, DJ Maxson, PL Klouse,AJ Bryant, Clark County Health District, Las Vegas; R Todd, DrPH, StateEpidemiologist, Nevada State Health Div. Foodborne and Diarrheal DiseasesBr, Div of Bacterial and Mycotic Diseases, National Center for InfectiousDiseases, CDC. 

Editorial Note: An estimated 2­4 million cases of salmonellosisoccur each year in the United States, resulting in at least 500 deaths( 1 ). Approximately 40,000 of these in-fections are culture-confirmed,serotyped, and reported to CDC through the National Salmonella SurveillanceSystem. In 1995, SE was the most common serotype reported, accounting for25% of the 40,720 serotyped culture-confirmed cases. Salmonellosis is frequentlyassociated with eating undercooked eggs and poultry. Undercooked eggs area particularly common source of SE infections. 

During 1988­ 1992, among foodborne disease outbreaks of salmonellosisreported to CDC in which a single food item was implicated, consumptionof turkey and eggs accounted for 4% and 14% of cases, respectively. Inaddition, eggs or foods containing eggs as a princi-pal ingredient caused64% of the SE outbreaks ( 2 ). Factors probably associated with the outbreakdescribed in this report included inadequate thawing, use of raw eggs inthe stuffing, and undercooking; in addition, the browned color of the turkeymay have caused the cook to believe that the turkey andstuffing were thoroughlycooked. Although the original source of the Salmonella is unknown, theraw eggs used in the stuffing probably contained SE, and these eggs probablywere incompletely cooked; undercooking may occur more commonly in tur-keysthat contain stuffing (J. Carpenter, Ph.D., University of Georgia, personalcommu-nication, 1996). 

Each year, an estimated 45 million turkeys are eaten in the United Statesat Thanks-giving (J. DeYoung, National Turkey Federation, personnel communication,1996). Salmonella infection may result from eating improperly cooked turkeyand stuffing ( 3,4). This risk for infection can be reduced by cookingstuffing outside the turkey. Guidelines prepared by the U.S. Departmentof Agriculture (USDA) for persons who choose to cook stuffing inside theturkey recommend preparing the stuffing immediately before it is placedinside the turkey, stuffing the turkey loosely, inserting a meat thermometerinto the center of the stuffing, and ensuring that the thermometer attainsa temperature of at least 165 F (74 C). Additional recommendations forsafely preparing and cooking a turkey include thawing the turkey completelybefore cooking, cooking in an oven set no lower than 325 F (163 C), andusing a meat 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 is completelycooked, inaccuracies in the actual temperature and incomplete thawing beforecooking can lead to undercooking. Use of a meat thermometer provides amore accurate determination of thorough cooking. Further advice on cookingturkeys and stuffing is available from USDAÕs 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;234:964­9. 

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

3. CDC. Foodborne nosocomial outbreak of Salmonella readingÑConnecticut.MMWR 1991;40: 804­6. 

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

Stephen Holland, M.D.
Section of Clinical Pharmacology
University of Illinois College of Medicine at Peoria

Author: Stephen Holland (Admin)

Stephen Holland, M.D. went to medical school at Northwestern University in Chicago, then did his medical residency at Loyola in Maywood (just West of Chicago). He then did research at the University of Alabama at Birmingham, did his GI fellowship there, and went to the University of Illinois at Peoria to teach and do research. He ran a successful private practice for over 12 years in Naperville, Illinois. Most recently he was chief of GI at Mt. Sinai Hospital in Chicago for 5 years.

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