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Investigation Update: Multistate Outbreak of Human Salmonella Altona Infections Linked to Chicks and Ducklings

June 9, 2011

Introduction

CDC is collaborating with public health and agriculture officials in many states and the U.S. Department of Agriculture's (USDA) National Poultry Improvement Plan (NPIP) to investigate a multistate outbreak of human Salmonella serotype Altona infections. As of June 8, 2011, a total of 39 individuals infected with the outbreak strain of Salmonella Altona have been reported from 15 states. The number of ill persons identified in each state is as follows: Georgia (1), Indiana (1), Kentucky (4), Michigan (1), Maryland (3), Minnesota (1), North Carolina (6), New York (2), Ohio (8), Pennsylvania (4), Tennessee (2), Virginia (3), Vermont (1), Wisconsin (1), and West Virginia (1).

Among the persons with reported dates available, illnesses began between February 25, 2011 and May 23, 2011. Infected individuals range in age from less than one year old to 86 years old and 44 percent of ill persons are 5 years of age or younger. Forty-five percent of patients are male. Among the 32 patients with available information, 9 (28%) were hospitalized. No deaths have been reported.

The outbreak can be visually described with a chart showing the number of persons who became ill each day. This chart is called an epidemic curve or epi curve. Illnesses that occurred after May 6, 2011 might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 3 weeks. Please see the Salmonella Outbreak Investigations: Timeline for Reporting Cases for more details.

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Investigation of the Outbreak

CDC, in collaboration with many state and local health departments, state departments of agriculture, and USDA-NPIP, is investigating an outbreak of human Salmonella Altona infections linked to contact with chicks and ducklings. Investigators are using the PulseNet system to identify cases of illness that may be part of this outbreak. In PulseNet, the national network of public health and food regulatory agency laboratories coordinated by CDC, DNA is analyzed from bacteria obtained through diagnostic testing of ill people.

In interviews, ill persons answered questions about contact with animals and foods consumed during the week before becoming ill. Twenty-five (81%) of 31 ill persons interviewed reported contact with live poultry (chicks, chickens, ducks, ducklings, geese, and turkeys) prior to becoming ill. Of ill persons who could recall the type of live poultry with which they had contact, all 25 identified chicks, ducklings, or both, and 19 out of 19 (100%) ill persons with available vendor information reported purchasing chicks and ducklings from multiple locations of a nationwide agriculture feed store, Feed Store Chain A. Ill persons report purchasing live poultry for either backyard flocks to produce eggs or as pets.

In May 2011, laboratory testing yielded Salmonella Altona bacteria from three samples from a chick and its environment collected from an ill person’s household in Ohio, and three environmental samples collected from chick and duckling displays at two locations of Feed Store Chain A in North Carolina.

Findings of multiple traceback investigations of live chicks and ducklings from homes of ill persons have identified a single mail-order hatchery as the source of these chicks and ducklings.

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Clinical Features/Signs and Symptoms

Most persons infected with Salmonella bacteria develop diarrhea, fever, and abdominal cramps 12-72 hours after infection. Infection is usually diagnosed by culture of a stool sample. The illness usually lasts from 4 to 7 days. Although most people recover without treatment, severe infections may occur. Infants, elderly persons, and those with weakened immune systems are more likely than others to develop severe illness. When severe infection occurs, Salmonella bacteria may spread from the intestines to the bloodstream and then to other body sites and can cause death unless the person is treated promptly with antibiotics.

More general information about Salmonella can be found at the CDC’s Salmonella webpage.

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Advice to Consumers

Wash your hands thoroughly with soap and water right after touching live poultry or anything in the area where they live and roam. Adults should supervise hand washing for young children.
If soap and water are not readily available, use hand sanitizer until you are able to wash your hands thoroughly with soap and water.
Clean any equipment or materials associated with raising or caring for live poultry outside the house, such as cages or feed or water containers.
Do not let children younger than 5 years of age, elderly persons, or people with weak immune systems handle or touch chicks, ducklings, or other live poultry.
Do not let live poultry inside the house, in bathrooms, or especially in areas where food or drink is prepared, served, or stored, such as kitchens, or outdoor patios.
Do not snuggle or kiss the birds, touch your mouth, or eat or drink around live poultry.

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Advice to Mail-order Hatcheries and Feed Stores Who Sell or Display Live Poultry

Mail-order hatcheries, agricultural feed stores, and others who sell or display chicks, ducklings and other live poultry should provide health-related information to owners and potential purchasers of these birds prior to the point of purchase. This should include information about the risk of acquiring a Salmonella infection from contact with live poultry.
An example flyer on the risk of human Salmonella infections from contact with live poultry and prevention recommendations is available in English [PDF - 795 KB] and Spanish [PDF - 726 KB].
More information on displaying animals in public settings can be found in the 2011 Compendium of Measures to Prevent Diseases Associated with Animals in Public Settings [PDF - 1,300 KB]

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