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Outbreaks of Salmonella Livingstone are rare. From December 1, 2023, to January 9, 2024, routine surveillance by the Utah Department of Health and Human Services found genetically similar S. Livingstone in five people in two neighboring counties. None had traveled out of state and no related cases were reported elsewhere, pointing to a local source — but routine interviews, which asked about restaurants among other things, turned up no common exposure.
Asking differently
From January 16, 2024, investigators went back with open-ended, repeated interviews and collected patients' restaurant purchase histories for the week before they fell ill.
Cases by date of illness onset, with the response timeline, October 13, 2023–January 22, 2024. CDC
| Date (2024) | |
|---|---|
| January 17 | four patients have reported eating at restaurant A |
| January 19 | eight confirmed or probable cases, all of whom ate there (no common meal) — the restaurant is closed |
| January 22 | 71 environmental and food samples collected, and all nine employees interviewed and tested |
| January 29 | the restaurant reopens |
That's three days from the first new interviews to closure.
What was found
The outbreak strain was in seven composite environmental swabs — cleaning equipment; the three-compartment sink and washing machine; a drying rack, wooden stools and trash can; a utensil shelf; stove handles; sauce bottles; and the outdoor dumpster — and in two food samples: sauces from the grill station and vegetables and ingredients from the prep area. The contamination was widespread, and the findings guided cleaning and sanitation. Interviews with staff didn't reveal how it got in. One employee, who started work on January 16 and ate several meals there, fell ill on January 20 and carried the strain.
The patients
11 people fell ill from October 13, 2023, to January 20, 2024, all after eating at restaurant A in the week before.
| Median age | 45 (range 25–68) |
| Male | 55% |
| Symptoms | diarrhea (10), abdominal pain (7), vomiting (5), nausea (4), bloody diarrhea (2) |
| Emergency department visits | 6 — 2 hospitalized; no deaths |
| Antibiotics | 7 |
| Median incubation (5 patients with exact meal times) | 52 hours (range 7–76) |
Unusually, the strain was found outside the gut in four patients: three had urinary tract infections (UTIs) — one man and two women, one of whom had no stomach symptoms at all — and one had a bloodstream infection, with diarrhea, fever and a stiff neck. UTIs from non-typhoidal Salmonella are rare; a previous S. Livingstone outbreak also included them.
As of June 10, 2024, no more cases had been reported.
Lesson
When routine interviews come up empty, open-ended interviews and purchase histories can find the source of a foodborne outbreak — and stop it — much faster.
Sources
Based on Keisling C, Hatfield J, Moore D, et al., "Notes from the Field: Rapid Linkage of a Salmonella Livingstone Outbreak to a Restaurant, Using Open-Ended Interviews and Patient Purchase Histories — Utah, 2023–2024," MMWR volume 73, number 23, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Лицензия: CC0 1.0 (общественное достояние) · По материалам www.cdc.gov
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