On Friday April 23, 2010 Durham County Health Department (DCHD) Environmental Health was notified that employees of a local business were sick with a suspected foodborne illness.  On April 20 the employees had eaten food prepared at Bullock’s Bar-B-Que (“Bullock’s”) Restaurant in Durham.  Over the weekend DCHD staff received more reports of illness in Bullock’s customers.  One patient was hospitalized and preliminary laboratory testing suggested a Salmonella infection.  On Monday, April 26, DCHD notified state agencies that a foodborne illness outbreak was underway.  An investigation involving multiple local and state agencies was initiated.

Bullock’s catered several events between April 20-25, 2010.  Event contact persons were notified to identify ill other persons.  A press release was issued on April 27 for additional case finding, and several news outlets interviewed Gayle Harris, DCHD Health Director.  A hotline was established and manned by DCHD.  Callers were interviewed using a foodborne illness questionnaire developed by DCHD staff.

In total 65 persons met the case definition of having been ill with vomiting or diarrhea within seven days of consuming food prepared at Bullock’s.  Twenty-two of the patients were laboratory confirmed with an indistinguishable genetic strain of Salmonella Enteriditis.    Forty-three persons were classified as “probable” cases based on clinical symptoms.   DCHD and North Carolina Division of Public Health investigators conducted a case-control study in an effort to identify food(s) responsible for the outbreak.  Patients classified as “confirmed” and patients classified as “probable” were combined for the persons of data analysis.  Meals dates occurred between 4/10/2010 and 4/24/2010.  Controls (n=41) were non-ill meal companions to cases.  Case patients and controls were asked about consumption of menu items served at Bullock’s.  Two dessert items, banana pudding and chocolate pie, were combined to create a variable, “dessert,” which was the only food item significantly associated with illness.  Bullock’s customers who consumed dessert were 3 times more likely to become ill than customers who did not consume dessert.  Additional analysis led investigators to conclude that the outbreak was associated with consuming meringue, which topped both the pudding and the pie.

DCHD environmental staff reviewed Bullock’s general production processes and food handling practices during sampling and investigative site visits.  Review of inspections conducted before the outbreak showed that although scores were generally high, there were certain areas of the operation needing more proactive supervision by management.  These items included proper hot and cold storage practices, proper hand washing procedures, and cleaning/sanitizing procedures.  Environmental samples were taken from the mixer used to make meringue and on surfaces at the restaurant.  All environmental samples were negative for Salmonella.

A sample of leftover chocolate pie, saved by a probable case patient, was positive Salmonella Enteriditis.  This finding led state investigators from the North Carolina Department of Agriculture and Consumer Services, the Ohio Department of Agriculture and the Minnesota Department of Agriculture and their federal partners at the USDA and FDA to investigate the manufacturing facility that produced the egg whites used in the meringue topping.  The plant had no violations and food samples were negative although it was noted that samples were taken from a different production lot from that used by Bullock’s during the time of the outbreak.  None of the original production lot remained for testing.

Although local, state, and federal investigators could not conclusively identify a contaminated product that caused an outbreak of Salmonella Enteriditis among customers at Bullock’s BBQ Restaurant, epidemiologic data clearly linked consumption of a dessert with meringue topping to the confirmed Salmonella infections experienced by 22 Bullock’s customers as well as the illnesses in an additional 43 customers who were not laboratory confirmed.  The investigation was closed on June 23, 2010.

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