Red Book Online Outbreaks: Salmonella Outbreak Linked to Backyard Poultry 2023

Overview

As of October 19, 2023, this outbreak is over.

As of July 20, 2023, a total of 690 people infected with one of the Salmonella outbreak strains have been reported from 47 states and Puerto Rico. Illnesses started on dates ranging from January 1, 2023, to May 25, 2023. (Multistate Salmonella Outbreak Linked to Backyard Poultry| CDC)

Backyard poultry, like chickens and ducks, can carry Salmonella even if they look healthy and clean. These germs can easily spread to anything in the areas where the poultry live and roam. People can get sick from touching backyard poultry or anything in their environment.

Clinical Guidance

• Presentation: Most people infected with Salmonella experience diarrhea, fever, and stomach cramps. Symptoms typically start 6 hours to 6 days after swallowing the bacteria. 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 present with the following symptoms of 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: Isolation of Salmonella organisms from cultures of stool, blood, urine, bile (including duodenal fluid containing bile), and material from foci of infection is diagnostic. 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. See Red Book Salmonella diagnostic tests.
• Risk Mitigation:

• • Adults and children should always wash their hands with soap and water immediately after touching backyard poultry, their eggs, or anything in the area where they live and roam.  Hand sanitizer should be used if soap and water are not readily available.
  • People should not kiss or snuggle backyard poultry, and should not eat or drink around them.
  • People should keep backyard flocks and supplies to care for them (like feed containers and shoes worn in the coop) outside of the house. Supplies should be cleaned outside the house.
  • Adults should always supervise children around backyard poultry and make sure they wash their hands properly afterward.
  • Children younger than 5 years should not touch chicks, ducklings, or other backyard poultry. Young children are more likely to get sick from germs like Salmonella.
  • Backyard poultry should not be kept in schools, childcare centers, and other facilities with children younger than 5 years old.
  • Eggs should be collected frequently. Eggs that sit in the nest can become dirty or break.
  • Cracked eggs should be discarded. Bacteria on the shell can more easily enter the egg through a cracked shell.
  • Dirt on eggs can be rubbed off with fine sandpaper, a brush, or a cloth. Eggs should not be washed because colder water can pull germs into the egg.
  • Refrigerate eggs to keep them fresh and slow the growth of bacteria.
  • Eggs should be cooked until both the yolk and white are firm, and egg dishes should be cooked to an internal temperature of at least 160°F.

• 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 the local department of public health.

Resources

• For more information see the Red Book chapter: Salmonella Infections