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Salmonella Outbreak Strikes Transplant-Athletes

Tainted tomatoes tied to illnesses at sports event in Florida

THURSDAY, Aug. 8, 2002 (HealthDayNews) -- Many athletes took home medals from this year's U.S. Transplant Games, but many spectators brought back something quite a bit different -- and far less glorious.

Health officials say at least 141 people who attended the event in Orlando, Fla., including some competitors, came down with a potentially serious form of food poisoning. Tests of the germ revealed it to be a strain of salmonella called Javiana. Disease investigators have traced the illnesses to a bad batch of diced Roma tomatoes shipped to the Disney Wide World of Sports Complex, where the games were held in June.

Because of their compromised immune systems, transplant patients are at a greater risk of severe salmonella infection. However, no one died in the outbreak, although a handful were hospitalized, officials say.

Salmonella sickens an estimated 1.4 million Americans each year, and the Javiana strain is the fifth most common form of the bug, according to the Centers for Disease Control and Prevention. The agency issued a report today on the outbreak, which will appear in tomorrow's issue of the CDC publication Morbidity and Mortality Weekly Report.

Infection with the germs can cause high fever, diarrhea, abdominal pain, and even death in people with other ailments or weakened immune systems. As many as 35 percent of kidney recipients develop recurrent salmonellosis.

The infection usually resolves on its own, but transplant patients may do better with antibiotics, say Dr. Padmini Srikantiah, a CDC food poisoning expert and a co-author of the report.

Hints of the outbreak surfaced in mid-July, when two people in Minnesota who had attended the games were diagnosed with the Javiana strain. Subsequent investigations, including an Internet survey, widened the scope of the problem to 141 cases in 32 states.

The survey covered 369 households with members who attended the event. A quarter were affected by the foodborne illness, tallying 141 people in all. A more detailed analysis showed that nearly 60 percent of 82 people who reported food poisoning were transplant recipients, and slightly more than half were taking immune-dampening therapy.

The last illness was reported July 8, Srikantiah says, adding the CDC has "no indication at this point that there are ongoing infections."

Marilyn Waters, a Disney spokeswoman, says the company was contacted in July about the outbreak. After the Roma tomatoes were fingered as the source, the theme park pulled them from its restaurants and food courts and switched suppliers, she says. Waters says the only previous food poisoning at Disney's Florida theme parks occurred in 1995, and involved contaminated fresh-squeezed orange juice.

The games are open to anyone who's had a lifesaving organ transplant. Health officials have urged doctors with transplant patients who attended the sporting event to watch for signs of salmonella infection, and to consider taking blood samples in those who are ill.

The National Kidney Foundation, a co-sponsor of the games, sent a letter July 31 to graft recipients and their physicians alerting them to the outbreak. The group said it contacted team managers about the risk of illness, and was in the process of mailing special notices to athletes who participated in the tournament.

Salmonella Javiana is particularly common in the southeastern United States. Earlier this year, the CDC reported a rash of infections with the germ among Mississippi children who'd been handling frogs and other amphibians.

What To Do

For more on salmonellosis, try the Centers for Disease Control and Prevention. Learn about the Transplant Games from the National Kidney Foundation.

SOURCES: Padmini Srikantiah, M.D., medical epidemiologist, Centers for Disease Control and Prevention, Atlanta; Marilyn Waters, spokeswoman, Walt Disney World Co., Orlando, Fla.; National Kidney Foundation; Aug. 9, 2002, Morbidity and Mortality Weekly Report
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