Two Outbreaks of Salmonella enteritidis Associated with Monte Cristo Sandwiches

We report on two outbreaks of Salmonella enteritidis which occurred in 1992; both were associated with Monte Cristo sandwiches. The first outbreak, which occurred in Woods Hole, Massachusetts, was investigated as a case-control study, and involved 74 persons. The second outbreak, investigated as a cohort study, occurred in Brewster, Massachusetts, and involved 32 persons. Monte Cristo sandwiches were strongly implicated in both outbreaks; the odds ratio in the case-control study was 43, and the relative risk in the cohort study was 13. Food-preparation procedures were reviewed and food handlers were educated about safe food-preparation practices. Because of the short grilling time for Monte Cristo sandwiches, (usually several minutes) the eggs used in the preparation may only be partially cooked. As a result, this food should be viewed as high risk for S. enteritidis . Pasteurized eggs should be used to prepare Monte Cristo sandwiches, especially in a commercial setting.