COMMENTARY

Savvy About Salmonella?

William Schaffner, MD

Disclosures

July 25, 2011

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Foodborne illness is a common, costly -- yet preventable -- public health problem. The Center for Disease Control's (CDC's) 2011 estimates of foodborne illness reveal that each year, roughly 1 in 6 Americans (48 million people) gets sick, 128,000 are hospitalized, and 3000 die of foodborne diseases.

Hello, I'm Dr. William Schaffner, Chair of the Department of Preventive Medicine at Vanderbilt University Medical Center. I am pleased to speak with you as part of the CDC Expert Video Commentary Series on Medscape to address 3 key questions about foodborne illness caused by Salmonella.

1. Of all foodborne illnesses, why focus on those caused by Salmonella?

We do this for several reasons:

  • Compared with other foodborne pathogens, Salmonella is the most serious -- it causes the most annual hospitalizations and deaths and more than 1 million cases of illness each year;

  • Trends show that illnesses caused by other foodborne pathogens, such as Escherichia coli O157, have significantly declined in the past 15 years, but Salmonella infections have shown no net improvement;

  • Salmonella can contaminate a wide range of foods -- poultry, ground beef, pork, eggs, cantaloupes, tomatoes, sprouts, and even processed foods, such as peanut butter; and

  • Different Salmonella serotypes tend to have different animal reservoirs and food sources, so this makes control challenging.

2. What are today's best practices in diagnosing and treating salmonellosis?

  • Most cases of salmonellosis are diagnosed with stool cultures from a patient with diarrhea. However, stool cultures are obtained on only a small fraction of patients with diarrhea who come to medical attention. So, if your patient has diarrhea and fever, please order a stool culture.

  • As to treatment, Salmonella infections usually resolve in 5-7 days and often do not require treatment other than oral fluids. Persons with severe diarrhea may require rehydration with intravenous fluids. Uncomplicated Salmonella diarrhea does not require antibiotic therapy.

  • People with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal. A small number of people with Salmonella experience joint pain, eye irritation, and painful urination. This is called Reiter syndrome. It can last for months or even years, and can lead to chronic arthritis that is difficult to treat. Antibiotic treatment does not make a difference in whether arthritis develops.

  • The elderly, infants, and those with impaired immune systems may have a more severe illness. In these patients, the infection may spread from the intestines to the bloodstream, and then to other body sites. These complicated infections require prompt antibiotic treatment.

3. Are there prevention messages targeted to Salmonella to share with patients?

No vaccine can prevent salmonellosis, so share these tips with all of your patients:

  • Cook poultry, ground beef, and eggs thoroughly. Use a food thermometer. Do not eat or drink foods containing raw eggs or raw (unpasteurized) milk.

  • Ground beef (hamburger) and eggs must be cooked thoroughly. I'm sorry, but the era of rare or medium-rare hamburger or runny scrambled eggs is over. The time-temperature relationships will not kill Salmonella unless food is cooked thoroughly.

  • Wash hands, kitchen work surfaces, and utensils with soap and water immediately after they have been in contact with raw meat or poultry.

  • Tell your immunocompromised patients, senior citizens, and their caregivers to cook food thoroughly. The immunocompromised and seniors are at increased risk for more serious Salmonella infections.

  • Don't work with raw poultry or meat, and care for an infant (eg, feed, change diaper) at the same time. Your contaminated hands can easily transmit infection to an infant's mouth or pacifier.

  • Mother's milk is the safest food for young infants. Breastfeeding prevents salmonellosis and many other health problems.

Web Resource

Food Safety at CDC

William Schaffner, MD, is Chairman of the Department of Preventive Medicine as well as Professor of Infectious Diseases in the Department of Medicine at the Vanderbilt University School of Medicine, Nashville, Tennessee. Dr. Schaffner is one of the country's leading authorities on infectious diseases with more than 30 years of public health experience. He is a strong proponent of collaboration between academic medical centers and public health authorities.

After graduating from Yale in 1957, Schaffner attended the University of Freiburg, Germany as a Fulbright Scholar. In 1962, he graduated from Cornell University Medical College and then did an internship, residency training, and a Fellowship in Infectious Diseases at the Vanderbilt University Medical Center. Schaffner was commissioned in the US Public Health Service as an Epidemic Intelligence Service Officer with the Centers for Disease Control in Atlanta for 2 years (1966-1968). He returned to Vanderbilt after that tour of duty.

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