By: Heather Williams

What started as a possible outbreak investigation of camplylobacteriosis at a private party involving 2 confirmed cases in June has lead to additional cases of campylobacter, a bacteria associated with poultry products.  Shortly thereafter another case linked to foie gras (a poultry product) at the Kirkland restaurant Café Juanita.  This is limited to two people who shared food in the same party.  At this time, the cases are unrelated.  But it is leading some to wonder what is going on with Campylobacter in King County of Seattle Washington.

On the surface, these two cases seem to be unrelated and seem to involve two different meat products.  Is it possible they are related?  How exactly is an outbreak defined?

Outbreak Defined

According to the CDC, an outbreak is defined as “an incident in which two or more persons experience a similar illness after ingestion of a common food, and epidemiologic analysis implicates the food as the source of the illness.”  This generally involves diagnostic confirmation based on criteria for the specific agent of interest.

The key in determining if the two situations are linked involves whether or not a common food was consumed in the two different locations at two different times.  This can happen when something in the supply chain is contaminated.  In this case, poultry is implicated for each.  To determine if the cases were linked and a larger outbreak is possible, the original source of the poultry would need to be traced.

Private Party

The initial investigation for Campylobacter in Washington came from a private party in June 2017.  For this event the county reported that pre-cooked chicken was served at the party.  The chicken was cooked a second time and combined in another dish before it was served, so investigators were unable to determine an exact source for the outbreak.

King County Health Department was only able to confirm two cases of campylobacter associated with the Seattle party, however many others at the party report falling ill.

Café Juanita

At least two people have been confirmed for campylobacter after eating at Café Juanita at the end of June 2017, according to a county report.  Foie gras was implicated as the source in these cases.  An interview revealed that both ill people shared multiple food items during a single party meal in late June 2017. During an inspection in August, investigators discovered that while the foie gras was being cooked thoroughly, the kitchen staff were not taking appropriate steps to ensure sufficient internal temperature by measuring the food with a food thermometer.

Campylobacter

Campylobacter is a bacteria associated with the infectious disease campylobacterosis.  Symptoms include diarrhea (sometimes bloody and experienced alongside nausea and vomiting), cramping, abdominal pain, and fever.  Symptoms often onset within two to five days of exposure, so you won’t know right away if you have been infected.  But it will certainly get you thinking about what you ate over the past few days.  Illness generally lasts about a week but can persist for up to 10 days.  While some people who have been infected may not experience symptoms at all, those with compromised immune systems may experience serious and life-threatening infections when the bacteria spread to the bloodstream.  These long-term consequences include arthritis or the rare disease Guillain-Barré syndrome.  This condition affects the nerves and onset is often several weeks after diarrheal illness subsides.  It is a result of the infected person’s immune system that is “triggered” to attack the body’s own nerves.  This could lead to paralysis that can last several weeks and requires intensive medical care for recovery.  Approximately 1 in every 1,000 reported Campylobacter results in Guillain-Barré syndrome.  While Guillain-Barré syndrome can be contracted in other ways, 40% of the cases in the United States link back to Campylobacter.

While Campylobacter is one of the most common causes of diarrheal illness in the United States, it is rarely a source of outbreaks.  Generally, cases are isolated and not parts of larger events.  Many cases of campylobacterosis, like other foodborne illness, go unreported.  This leaves gaps in statistics.  FoodNet, the Foodborne Diseases Active Surveillance Network, tracks foodborne data provided by local health departments.  It is estimated that over 1.3 million people are infected each year resulting in approximately 56 deaths attributed to the bacterial disease.  Trends in illness are interesting, with summer months being more active than winter months and infants to young adults being afflicted more than those in other age groups.  Statistically males are infected more frequently than females.

Most cases of campylobacteriosis originate from eating raw or undercooked poultry or when raw or undercooked poultry cross contaminates other food products.  Human-to-human transmission is extremely rare.  Outbreaks are rare for this bacteria, but have been known to come from unpasteurized dairy products such as milk, cheese, and yogurt, or from contaminated water or produce.  A very small amount of Campylobacter bacteria can make someone sick, with as little as 500 cells being infectious.  To put that into prospective, one drop of juice from raw chicken meat has enough of the pathogen in it to infect a healthy person.

Campylobacter is diagnosed with a stool specimen tested by a diagnostic laboratory.  A sample is grown to identify the bacterium in a culture.

Prevention

When eating at a restaurant, there is not really much you can do.  The best choice is to plan meals outside of the home at restaurants with a good reputation and always eat from places you trust.  Health departments have local regulations and food establishments generally follow them.  If you are curious how your favorite places are doing, many cities publish inspection citations online.  Take a look and see how they did on their last checkup.

At home you have quite a bit more control over your food.  From the food supplies you buy, where you store things, how you handle them during cooking, as well as how you serve and store cooked food.  Following basic food safety guidelines are a good way to ensure your food is safe and free of foodborne illness.  Wash hands thoroughly prior to preparing food and anytime you touch raw meat.  Use separate utensils and cutting boards for raw meat and other foods.  Cook meat to an appropriate internal temperature to safely kill any pathogens living on the meat.  Do not just use a judgement based on to color of the meat.  Store cooked foods and foods meant to be eaten raw away from raw meats in the refrigerator.  Also, refrigerate cooked foods within 2 hours of preparing to reduce the production of pathogenic bacteria.

 

 

Sources:

https://patch.com/washington/seattle/2-new-campylobacter-cases-emerge-seattle

http://www.kingcounty.gov/depts/health/communicable-diseases/disease-control/outbreak/private-event-august-2017.aspx

http://www.kingcounty.gov/depts/health/communicable-diseases/disease-control/outbreak/cafe-juanita.aspx