On May 9, 2005, the Macomb County Health Department (MCHD) received reports of five recently diagnosed cases of Salmonella species in Macomb County residents. All five had sought care at area hospitals and three had been admitted for in-patient care. Isolates obtained from culture of stool specimens obtained from case patients were sent to the Michigan Department of Community Health (MDCH) Public Health Laboratory where they were serotyped as Salmonella enteritidis (S. enteritidis).
MCHD staff conducted initial interviews with the five case patients. All had experienced symptom onset on or after April 29, 2005 and the only common exposure among the five individuals was attendance at an after-concert reception held at the Macomb County Community College Performing Arts Center in Clinton Township. Review of 2005 surveillance data prior to April 29 found no previously reported cases of S. enteriditis associated with the performance center, prompting health officials to launch an outbreak investigation. Neighboring health departments and area health care providers were alerted that a foodborne outbreak investigation was underway. Hospitals and laboratories were advised to send Salmonella isolates to the MDCH for serotyping.
After concert events had been held on two consecutive nights, April 28 and April 29, at the Arts Center. Twenty dessert items plus coffee, wine and champagne were served. The dessert items were provided by Fern Hill Golf and Country Club, Geloso’s Bakery and an independent Chocolate Fountaineer. MCHD obtained a list of menu items and interviewed employees and reception attendees. In total 91 interviews were conducted; 78 had attended one or both of the receptions. For purposes of data analysis, individuals who attended the reception on April 28 were classified as “Group One” and those who were at the April 29 event were classified as “Group Two”. Data were analyzed and reported by individual group as well as by the two groups combined.
Responses from 70 persons were included in the data analysis. Twenty three persons reported symptoms consistent with a salmonellosis infection and eight were laboratory confirmed with Salmonella. Six of the eight were serotyped as Salmonella enteriditis. Two were not serotyped. The analysis established a statistically significant association between consumption of eclairs served both days and illness. There was no statistical association between illness and consumption of either the cream puffs and parfaits which contained essentially the same filling as the eclairs, but investigators theorized this was due to sample size limitations. See Macomb County Health Department Outbreak Report..
Concomitant to the epidemiologic investigation, an environmental investigation was conducted by MCHD environmental health supervisor Ren Hewitt-Lichota. On May 10, 2005, Ms. Hewitt-Lichota conducted an on-site visit to the Fern Hill Golf and Country Club. Fern Hill prepared all dessert items for the event with the exception of the angel wings, canollis, and chocolate fountain which came from outside vendors. There was no food leftover from the event.
Two critical violations were noted during the May 10th investigation. The bakery dishwasher did not have a detectable level of chlorine sanitizer and raw eggs were stored above milk and ready to eat foods in the bakery walk-in refrigerator. The employee who had prepared the desserts was out of town and unavailable to be interviewed.
On May 13, Ms. Hewitt-Lichota made a second visit to Fern Hill for additional information about suppliers and ingredients of the chocolate mousse and cream fillings. When asked about illness before, during, or after the two receptions, Yola indicated that she had the flu (vomiting only) several weeks earlier. She could not recall the exact days but indicated it was “sometime around Easter.” See Macomb County Health Department Outbreak Report.
Fern Hill Golf and Country Club management was advised to monitor the placement of raw foods of animal origin to ensure they are not placed above ready-to-eat product, that utensils greater than six inches in dept be manually sanitized, and that sanitizer concentration of the dishwasher final rinse be monitored at least once daily to ensure that concentration of chlorine is maintained.
Although the Macomb County Health Department was unable to identify how food items served and prepared at Fern Hill had become contaminated with Salmonella, the likely vehicle for the bacteria was identified as being eclairs on the outbreak report submitted to the Centers for Disease Control and Prevention. See “Investigation of a Foodborne Outbreak.” The report lists 8 confirmed cases and 17 probable cases of S. enteriditis occurring at the Macomb County Community College “After-Concert” reception.