By: Heather Williams

Not one, but two Burger Kings in Bemidji, Minnesota have closed their doors while dealing with an outbreak investigation.  Health officials at Minnesota Department of Health have confirmed 27 cases of Salmonella with an additional two more probable cases linked to the two fast-food restaurants.  One located at 1000 Paul Bunyan Drive S.W. and the other at 2575 Hannah Avenue N.W.

Generally, Salmonella infections originate from unwashed produce and “ready-to-eat” foods that have not been properly cleaned. A burger joint is not high on the list of outbreak sources.  While it has not been 100% confirmed, this outbreak appears to be attributed to a sick employee.  No produce vendors have reported recalls, and the Salmonella does not appear to be coming from any produce in the restaurants.

Both locations have closed their doors on Thursday to begin yet another decontamination process of the restaurant.  The two restaurants are required by health officials to take appropriate measures to ensure the safety of all patrons and staff upon re-opening.  But what did it take to get these restaurants to finally take notice of their food safety issues?  It took two strings of a Salmonella outbreak for Burger King to finally make that decision.

Outbreak First String

The outbreak was identified in September, with most cases being identified during that month.  It is likely that the victims were exposed to the bacteria before then, as it can take a few days for symptoms to appear and sometimes a few more days for the sick person to seek medical treatment where the strain of Salmonella can be identified and uploaded for surveillance comparison.  It is only then, that investigators can begin connecting the dots and asking the right questions to identify a source.  “They may have been sick a couple weeks or so before then,” says Doug Schultz, a spokesman for the Minnesota State Department of Health.  “It takes a while before people get symptoms, and then they’re sick enough to go to the doctor, and then we identify.”  When diagnosed, the specific strain is isolated.  Epidemiologists pay attention when a few of the same strain begin to ping on the radar.

During the first round of the outbreak, over two dozen became ill.  Once the Minnesota Department of Health identified Burger King was related to the outbreak in September, “stringent” interventions were put into place.  Both restaurants were thoroughly cleaned and employees who had exhibited symptoms were prohibited from working until they were symptom free for a full 72 hours.  This of course was contingent upon the honor system.  “Most of the time that does the trick; 98 percent of the time we don’t see further transmission,” explains Schultz. It was not good enough.

In this case, the 2% showed itself.  Two additional cases emerged this week, indicating that whatever measures were taken were not sufficient.  Schultz indicated that Minnesota Department of Health is pointing fingers towards this outbreak being caused by an employee illness.  “We do clearly have evidence of food worker illness being part of the problem,” Schultz says.  If this is the case, cleaning is important, but employee monitoring must be top priority.  If an employee is sick, even strict hand cleaning may still transmit the bacteria, resulting in additional illness.

Safety Measures

At this time, both affected locations are closed to the public.  Not only are employees prohibited from reporting to work until after they are symptom-free, but they must now be tested.  This test must occur not once, but twice and no less than 24 hours apart, with negative results for both.  “Once that’s done, we can do additional cleaning and they can open again,” explains Schultz.  This extreme measure insures that all employees are completely cleared and will not re-infect the restaurant during the additional cleaning process.

What You Need to Know About Salmonella

Salmonella is an illness causing bacteria responsible for sickening 1.2 million people in the United States, resulting in about 450 deaths each year.  There are many strains of Salmonella, though Salmonella serotype Typhimurium and Salmonella serotype Enteritidis are the most common found in the United States.  The strain of Salmonella responsible for the Burger King outbreak has not yet been released.

Symptoms usually begin between 12 and 72 hours after exposure and may last 4 to 7 days in a normally healthy individual.  These symptoms include diarrhea, abdominal cramps, and fever.  Most otherwise healthy people can recover without treatment.  For this reason, Salmonella infection is often underreported.  In more severe cases, diarrhea may be so severe that extreme dehydration requires patient hospitalization.  When infection becomes very severe, the bacteria can spread beyond the intestines to the blood stream and then to other parts of the body.  In these extreme cases, antibiotic treatment must be given promptly or the patient may die.  The very young, the very old, and those with a compromised immune system are at higher risk for severe illness.

While most symptoms are very short-term, with the infected individual recovering completely, sometimes it can take several months for bowel habits to completely return to normal.  In rare cases, an illness called reactive arthritis may develop as a result of Salmonella infection.  This condition may last for months or even years and can lead to chronic arthritis.  There is no indication on whether or not antibiotic treatment can reduce the risk of developing reactive arthritis.  In addition to joint pain, those who suffer from reactive arthritis may also develop irritation of the eyes or painful urination.

What Should I Do if I Think I May Be Involved in the Outbreak?

As with any foodborne illness, it is very important to get the medical attention you need and report your illness to the appropriate health authority.  While you may not be very sick, there could be others who could have more severe symptoms or complications.  You may also want to seek medical attention in case the illness develops further. Furthermore, the simple activity of answering a few questions about where you have eaten and what types of foods you have eaten could present enough information to link cases together to determine a source.  Once a source has been discovered, action can be taken that will hopefully prevent others from becoming ill as well.

If you have/had symptoms of Salmonella infection, please contact your doctor and local health department.  Call 1-877-FOOD-ILL (1-877-366-3455) to be connected to the appropriate authorities.  If related to the current Burger King Salmonella outbreak, you can email [email protected].

UnsafeFoods will continue to release information concerning this outbreak as details arise.