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Gary Evans writes Hospital Infection Control & Prevention (HIC), Hospital Employee Health (HEH) and contributes to IRB Advisor (IRB). As senior writer at AHC, Evans has written numerous articles on infectious disease threats to both patients and health care workers, including pandemic influenza, MERS and Ebola. He has been honored for excellence in analytical reporting five times by the National Press Club in Washington, DC.
Much as millions of families and friends will do this Thanksgiving, on Nov. 23, 1995 six people gathered at a home in Clark County, NV. Pleasantries were no doubt exchanged, perhaps a libation or two poured, as the Detroit Lions and Minnesota Vikings faced off in the background on the living room TV.
In the kitchen a 13-pound turkey was cooking in the oven. It was bought frozen the day before, thawed for 6 hours in a sink filled with cold water, then refrigerated overnight. However, on Thanksgiving Day, parts of the turkey were still frozen. Nevertheless, the turkey was filled with a stuffing made from bread, giblets, and three raw eggs, then placed in an oven set at 350 F for 1 hour. The setting was then lowered to 300 F and the turkey cooked for another 4 hours. The turkey was removed from the oven when the exterior had browned, but no meat thermometer was used. Bon appétit.
The symptoms began to hit sometime Nov. 25th, as the six people who shared the holiday meal began suffering cramps, vomiting and diarrhea. A seventh person who ate some of the leftovers was in similar condition. Two of the seven people in the outbreak were hospitalized due to dehydration. Another one of the diners was found comatose at home, dying of severe dehydration and sepsis. Stool cultures obtained from the fatal case and two of the survivors yielded Salmonella Enteritidis (SE). Turkey and stuffing were the only foods eaten by all seven ill persons, though no leftovers were available for culture.
On November 28th the county coroner's office notified the Clark County Health District in Las Vegas about a death suspected to have resulted from a foodborne disease. Investigators -- who were able to question the cook -- determined that key factors in the outbreak were inadequate thawing, use of raw eggs in the stuffing, and undercooking the turkey. The browned color of the turkey may have caused the cook to believe that the turkey and stuffing were thoroughly cooked. Use of a meat thermometer could have possibly prevented the outbreak. Although the original source of the Salmonella could not be determined, the raw eggs used in the stuffing probably contained SE, which survived because the eggs were likely undercooked, investigators concluded.
Undercooking may occur more commonly in turkeys that contain stuffing, they warned, citing the following additional food safety tips from public health authorities:
* The risk for SE infection can be reduced by cooking stuffing outside the turkey. Those who choose to cook stuffing should prepare stuffing immediately before it is placed inside the turkey, stuffing the turkey loosely, inserting a meat thermometer into the center of the stuffing, and ensuring that the thermometer attains a temperature of at least 165 F (74 C).
* Thaw the turkey completely before cooking
* Cook it an oven set no lower than 325 F, using a meat thermometer to ensure that the innermost part of the thigh attains a temperature of 180 F.