Salmonella outbreak in an American child development center in Germany

In July 1993, an outbreak of Salmonella occurred in a U.S. Army child care center in Heidelberg, Germany. Sixteen children and 4 staff members had confirmed positive cultures; the center had an average census of 135 children during the time of the outbreak. Rectal swabs were done on all the children in rooms with symptomatic children or staff or in rooms with confirmed cases. A total of 246 rectal swabs was done initially, with 216 representing paired specimens. A case was defined as a staff member, child, or family member of an ill staff member or child who attended the center with diarrhea or abdominal pain with at least one of the following symptoms: diarrhea, fever, nausea, loss of appetite, abdominal pain, vomiting, or lethargy. The attack rate for the children was 40 of 86 (47%), and the attack rate for staff was 15 of 47 (32%). No associations were found when looking at the attack rates in each of the 10 rooms in the center. Complete environmental investigation revealed that the cook was preparing food 1 day before it was served. In addition, he was running the dishwasher without a sufficient amount of soap. Although food was not available for testing, the source of the Salmonella outbreak appears to be uncooked or inadequately cooked and prepared food with some person-to-person transmission.