Green Mill Outbreak – MN DOH Records
Background
On April 19, 2019, the Minnesota Department of Health (MOH) Public Health Laboratory (PHL) determined that two clinical Salmonella Braenderup isolates submitted through routine surveillance had indistinguishable pulsed-field gel electrophoresis (PFGE) patterns (Minnesota designation BR134). Initial interviews with these cases revealed that both had eaten food from the Green Mill in Bloomington in the week before their illness onset. City of Bloomington Environmental Health Division (CBEH) was notified, and an investigation was initiated.
Methods
Cases were defined as individuals who tested positive for 5. Braenderup with PFGE pattern BR134, or a Green Mill – Bloomington patron who developed diarrhea ( 3 stools in a 24-hour period) that was at least 3 days in duration or was accompanied by a fever, after eating food from the restaurant. Stool samples collected from consenting individuals were submitted to the MOH PHL for bacterial and viral testing. PFGE and whole genome sequencing (WGS) was performed on isolates.
MOH staff collected online orders, information for catering groups, and receipts from April 5, 8, 9, and 10, and patrons were called to find additional cases and controls.
All restaurant employees were required to submit two stool samples to the MOH PHL for Salmonella testing. Any employee reporting illness on or after March 15 was excluded from work in food service until two consecutive stool samples tested negative for Salmonella by culture . Employees who tested positive for Salmonella by culture were excluded until two consecutive stool samples tested negative.
Results
Eighty-nine restaurant patrons and 18 additional catered training event attendees were interviewed. Seven cases (7%) were identified, including five laboratory-confirmed cases. Two patrons reported illness but did not meet the case definition and were excluded from further analysis. Cases reported meal dates of March 22 (n=l), April 5 (n=3), April 8 (n=4), April 9 (n=3), April 10 (n=3). Four cases had 2 to 3 meal dates. Onsets of illness ranged from March 29 to April 16. The median age of cases was 39 years (range, 6 to 65 years), and four (57%} cases were male . All seven cases reported diarrhea and cramps, five (71%) fever, one (14%} vomiting, and one (14%) bloody stool. Four (57%) cases visited a healthcare provider, but none were hospitalized or died. The median incubation for the three cases with only one meal date was 115 hours (range, 1.5 to 175 hours).
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