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Typhoid fever in San Antonio, Texas: an outbreak traced to a continuing source
Abstract:
Eighty cases of typhoid fever occurred in San Antonio, Texas, with dates of onset from August 18, 1981, to October 26, 1981. Preliminary epidemiological investigations of the first 24 cases suggested a Mexican food takeout restaurant as the common source. A case-control study confirmed this association (P less than or equal to .001). Barbacoa , a mixture of muscle, lips, ears, tongue, and eyes from steamed bovine heads, was identified as the source of Salmonella typhi (P = .03). S typhi was cultured from the stool of one of 31 restaurant employees. Closure of the restaurant resulted in termination of the outbreak within a single incubation period. The restaurant was allowed to reopen after the remaining employees had demonstrated lack of excretion of S typhi in stools. This outbreak represents the largest restaurant-associated typhoid fever outbreak reported in the United States in greater than 50 years.
Insights
A 1981 typhoid fever outbreak in San Antonio was linked to a Mexican restaurant. Barbacoa made from steamed bovine heads was identified as the source of Salmonella typhi.
Area of Science:
- Epidemiology
- Foodborne Illness
- Public Health
Background:
- Typhoid fever is a serious bacterial infection.
- Restaurant-associated outbreaks pose significant public health challenges.
- Timely identification of the source is crucial for outbreak control.
Purpose of the Study:
- To investigate the cause and control of a large typhoid fever outbreak in San Antonio, Texas.
- To identify the specific food vehicle responsible for the transmission of Salmonella typhi.
- To evaluate the effectiveness of public health interventions.
Main Methods:
- Descriptive epidemiology to identify initial cases and potential sources.
- Case-control study to statistically confirm the association between the restaurant and illness.
- Microbiological culturing of Salmonella typhi from food handlers and environmental samples.
- Monitoring of outbreak trends following intervention.
Main Results:
- Eighty cases of typhoid fever occurred between August and October 1981.
- A Mexican food takeout restaurant was identified as the common source.
- Barbacoa, prepared from steamed bovine heads, was confirmed as the contaminated food item (P = .03).
- Salmonella typhi was isolated from one restaurant employee.
Conclusions:
- Restaurant closures and employee screening effectively terminated the outbreak.
- Contaminated food, specifically barbacoa, was the source of Salmonella typhi.
- This outbreak was the largest restaurant-associated typhoid fever event in the US in over 50 years.