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Red Book Online Outbreaks: Salmonella Infections and Backyard Poultry

June 29, 2022

As of June 9, 2022, 219 people infected with one of the outbreak strains of Salmonella (serotypes Entiritidis, Hadar, Infantis, and Typhimurium) have been reported from 38 states (see map). Illnesses started on dates ranging from February 15, 2022, to May 19, 2022 (see timeline). Of the 87 people interviewed thus far, 61 (70%) reported contact with backyard poultry before getting sick; 16 reported eating eggs from backyard poultry and 2 reported eating meat from backyard poultry.

Sick people range in age from less than 1 to 89 years, with a median age of 29 years, and 56 (26%) are children under 5 years. Of 213 people with information available, 116 (54%) are female. Of 95 people with information available, 27 (28%) have been hospitalized. One death has been reported from Tennessee.

The true number of individuals affected by this outbreak may be higher because many people with diarrheal illness recover without medical care and are not tested for Salmonella. In addition, recent illnesses may not yet be reported as it usually takes 2 to 4 weeks to determine if a sick person is part of an outbreak.

 

Clinical Guidance

  • Presentation: Most people infected with Salmonella experience diarrhea, fever, and stomach cramps. Symptoms usually start 6 hours to 2 days after ingesting Salmonella, though incubation periods of a week or more have been reported. Most people recover without treatment after 4 to 7 days.
  • Who is at highest risk/complications: The incidence of non-typhoidal Salmonella (NTS) infection is highest in children younger than 4 years of age. In the United States, rates of invasive infections and mortality are higher in infants, elderly people, and people with hemoglobinopathies (including sickle cell disease) and immunocompromising conditions (eg, malignant neoplasms, HIV infection).
  • Patients should be seen by their pediatrician if they have any of these symptoms suggesting severe Salmonella infection:
    • Diarrhea and a fever higher than 102°F
    • Diarrhea for more than 3 days that is not improving
    • Bloody diarrhea
    • Not tolerating oral liquids
    • Signs of dehydration, such as decreased urine output, dry mucous membranes, orthostatic hypotension
  • Diagnosis: Salmonella gastroenteritis is diagnosed by stool culture or molecular testing (including PCR); stool testing should be obtained in all children with bloody diarrhea or unexplained persistent or severe diarrhea. 
  • Risk Mitigation: Backyard flock owners should:
    • Wash hands
    • Be safe around backyard flocks
      • Do not kiss or snuggle backyard poultry or eat or drink around them
      • Keep your backyard flock and supplies you use to care for them (like feed containers and shoes you wear in the coop) outside of the house
    • Supervise children around flocks
      • Children younger than 5 years should not touch chicks, ducklings, or other backyard poultry
    • Handle eggs safely
  • Treatment: Antimicrobial therapy usually is not indicated for patients with either asymptomatic infection or uncomplicated gastroenteritis caused by NTS, because therapy does not shorten the duration of diarrheal disease, can prolong duration of fecal shedding, and increases symptomatic relapse rate. Antimicrobial therapy is recommended for gastroenteritis caused by NTS serovars in people at increased risk for invasive disease, including infants younger than 3 months and people with chronic gastrointestinal tract disease, malignant neoplasms, hemoglobinopathies, HIV infection, or other immunosuppressive illnesses or therapies. It should also be considered for those experiencing severe symptoms such as severe diarrhea or prolonged or high fever. If antimicrobial therapy is initiated in patients in the United States with presumed or proven NTS gastroenteritis, a blood and a stool culture should be obtained prior to antibiotic administration and an initial dose of ceftriaxone should be given. The patient who does not appear ill or have evidence of disseminated infection can be discharged with oral azithromycin pending blood culture results. Once susceptibilities are available, ampicillin or trimethoprim-sulfamethoxazole may be considered for susceptible strains. A fluoroquinolone is an alternative option. For those who appear ill or have evidence of disseminated infection, hospitalization is required.
  • Reporting: Suspected cases should be reported to local department of public health.

 

Resources

 

Pediatric Practice Tools and Info

CDC: Salmonella

 

Public Health Resources

CDC case count map: Where Sick People Lived | Salmonella Outbreak Linked to Backyard Poultry

CDC: When People Got Sick | Salmonella Outbreak Linked to Backyard Poultry

CDC: Investigation Details | Salmonella Outbreak Linked to Backyard Poultry

 

Infection Prevention and Control Resources

Project Firstline (aap.org)

 

Information for Patients and Caregivers

AAP HealthyChildren.org: Salmonella Infections in Children | In Spanish: Infecciones por Salmonela

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