Multistate Outbreak of Human Salmonella Altona and Salmonella Johannesburg Infections Linked to Chicks and Ducklings (Final Update)

Posted October 6, 2011

Outbreak Summary

CDC collaborated 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 two outbreaks linked to chicks and ducklings. The first was an outbreak of human Salmonella Altona infections, and the second was an outbreak of human Salmonella Johannesburg infections. Both of these are rare types of Salmonella, and ill persons in both outbreaks had a similar geographic distribution. Investigators used the PulseNet system to identify cases of illness that may have been a 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.

These outbreaks 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. These particular outbreaks appear to be over. However, illnesses that occurred after August 29, 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 Timeline for Reporting Cases of Salmonella Infection for more details.

Salmonella Altona Outbreak Investigation

As of October 4, 2011, a total of 68 individuals infected with the outbreak strain of Salmonella Altona were been reported from 20 states. The number of ill persons identified in each state is as follows: Georgia (1), Illinois (1), Indiana (1), Kentucky (6), Maryland (5), Michigan (1), Minnesota (1), Mississippi (1), New Hampshire (1), New York (4), North Carolina (9), Ohio (12), Pennsylvania (6), South Carolina (1), Tennessee (3), Texas (2), Virginia (7), Vermont (1), Wisconsin (1), and West Virginia (4).

Among the persons with reported dates available, illnesses began between February 25, 2011 and September 10, 2011. Infected individuals ranged in age from less than one year old to 92 years old, and 31% of ill persons were 5 years of age or younger. Fifty-one percent of patients were female. Among the 62 patients with available information, 19 (31%) were hospitalized. No deaths were reported.

In interviews, ill persons answered questions about contact with animals and foods consumed during the week before becoming ill. Forty-two (74%) of 57 ill persons interviewed reported contact with live poultry (chicks, chickens, ducklings, ducks, geese, and turkeys) before becoming ill. Of ill persons who could recall the type of live poultry with which they had contact, 40 identified chicks, ducklings, or both, and 33 (89%) of 37 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 reported purchasing live poultry for either backyard flocks to produce eggs or as pets.

In May and June 2011, laboratory testing yielded Salmonella Altona bacteria from multiple samples: three samples from a chick and its environment collected from an ill person’s household in Ohio, three samples collected from chick and duckling displays at two locations of Feed Store Chain A in North Carolina, and three samples collected from a chicken and two ducks from an ill person’s household in Vermont. Findings of multiple traceback investigations of live chicks and ducklings from homes of ill persons identified a single mail-order hatchery in Ohio as the source of these chicks and ducklings. In June 2011, the Ohio Department of Agriculture inspected the mail-order hatchery and made recommendations for improvement.

Salmonella Johannesburg Outbreak Investigation

As of October 4, 2011, a total of 28 individuals infected with the outbreak strain of Salmonella Johannesburg were reported from 15 states. The number of ill persons identified in each state is as follows: Alabama (1), Arkansas (1), Georgia (2), Indiana (1), Kansas (1), Kentucky (2), Maine (1), New York (4), North Carolina (4), Ohio (3), Pennsylvania (1), South Carolina (1), Tennessee (3), Vermont (2), and West Virginia (1).

Among the persons with reported dates available, illnesses began between March 19, 2011 and July 29, 2011. Infected individuals ranged in age from less than one year old to 60 years old, and 75 percent of ill persons were 5 years of age or younger. Fifty-seven percent of patients were female. Among the 22 patients with available information, 9 (41%) were hospitalized. No deaths have been reported.

In interviews, ill persons answered questions about contact with animals and foods consumed during the week before becoming ill. Seventeen (71%) of 24 ill persons interviewed reported contact with live poultry before becoming ill. Of ill persons who could recall the type of live poultry with which they had contact, 14 identified chicks, ducklings, or both, and 10 (71%) of 14 ill persons with available vendor information reported purchasing chicks and ducklings from multiple locations of the same nationwide agriculture feed store identified in the outbreak of Salmonella Altona infections, Feed Store Chain A.

Findings of multiple traceback investigations of live chicks and ducklings from homes of ill persons identified the same single mail-order hatchery in Ohio identified in the outbreak of Salmonella Altona infections as the source of these chicks and ducklings. In June 2011, the Ohio Department of Agriculture inspected the mail-order hatchery and made recommendations for improvement.

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.

Advice to Consumers

These particular outbreaks appear to be over. However, contact with live poultry can be a source of human Salmonella infections; therefore, you should always follow the following recommendations:

• 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.

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.
• Mail-order hatcheries and agricultural feed stores should implement interventions to prevent human Salmonella infections associated with 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 and Spanish.
• 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

Key Resources

• Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2011
  • Appendix C: Hand-Washing Recommendations to Reduce Disease Transmission from Animals in Public Settings
• Posters
  • Reducing Your Risk of a Salmonella Infection from Contact with Live Baby Poultry
  • In Spanish: Reduzca su riesgo de infección por Salmonella por el contacto con crías de aves de corral
• CDC.gov Features
  • Risk of Human Salmonella Infections from Live Baby Poultry
  • Keeping Live Poultry
  • Stay Healthy at Animal Exhibits This Summer
• CDC Kidtastics Podcast
  • Why Parents Should Think Twice Before Giving Baby Birds to Young Children for Easter

Final Case Count Map

Persons infected with the outbreak strains of Salmonella Altona (n=68) and Salmonella Johannesburg (n=28), by state, as of October 4, 2011

Salmonella Altona

As of October 4, 2011, a total of 68 individuals infected with the outbreak strain of Salmonella Altona were been reported from 20 states. The number of ill persons identified in each state is as follows: Georgia (1), Illinois (1), Indiana (1), Kentucky (6), Maryland (5), Michigan (1), Minnesota (1), Mississippi (1), New Hampshire (1), New York (4), North Carolina (9), Ohio (12), Pennsylvania (6), South Carolina (1), Tennessee (3), Texas (2), Virginia (7), Vermont (1), Wisconsin (1), and West Virginia (4).

Salmonella Johannesburg

As of October 4, 2011, a total of 28 individuals infected with the outbreak strain of Salmonella Johannesburg were reported from 15 states. The number of ill persons identified in each state is as follows: Alabama (1), Arkansas (1), Georgia (2), Indiana (1), Kansas (1), Kentucky (2), Maine (1), New York (4), North Carolina (4), Ohio (3), Pennsylvania (1), South Carolina (1), Tennessee (3), Vermont (2), and West Virginia (1).

Final Epi Curve

Persons infected with the outbreak strains of Salmonella Altona and Salmonella Johannesburg, by month of illness onset*

*n=94 for whom information was reported as of October 4, 2011. Onset data not currently available for all persons with reported illness.