RECURRENT OUTBREAKS OF SALMONELLA-ENTERITIDIS INFECTIONS IN A TEXAS RESTAURANT - PHAGE TYPE-4 ARRIVES IN THE UNITED-STATES

In recent years infection caused by Salmonella serotype Enteritidis (S E) phage type 4 has spread through Europe but has been uncommon in the USA. The first recognized outbreak of this strain in the USA occurred in a Chinese restaurant in El Paso, Texas, in April 1993; no source w as identified. In September 1993, a second outbreak caused by SE phage type 4 was associated with the same restaurant. To determine the caus e of the second outbreak, we compared food exposures of the 19 patient s with that of two control groups. Egg rolls were the only item signif icantly associated with illness in both analyses (first control group: odds ratio [OR] 8.2, 95% confidence interval [CI] 2.3-31.6; second co ntrol group: OR 13.1, 95% CI 2.1-97.0). Retrospective analysis of the April outbreak also implicated egg rolls (OR 32.4, 95% CI 9.1-126.6). Egg roll batter was made from pooled shell eggs and was left at room t emperature throughout the day. These two outbreaks of SE phage type 4 likely could have been prevented by using pasteurized eggs and safe fo od preparation practices.