Epidemiology and Infection

Research Article

Recurrent outbreaks of Salmonella Enteritidis infections in a Texas restaurant: phage type 4 arrives in the United States

T. G. Boycea1, D. Kooa1, D. L. Swerdlowa1, T. M. Gomeza2, B. Serranoa3, L. N. Nickeya4, F. W. Hickman-Brennera1, G. B. Malcolma1 and P. M. Griffina1

a1 Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Mailstop A-38, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA

a2 Veterinary Services, Animal and Plant Health Inspection Service, United States Department of Agriculture, Atlanta, GA, USA

a3 Texas Department of Health, Public Health Regions 9 & 10, El Paso, TX, USA

a4 El Paso City-Country Health and Environmental District, El Paso, TX, USA


In recent years infection caused by Salmonella serotype Enteritidis (SE) phage type 4 has spread through Europe but has been uncommon in the USA. The first recognized outbreak of this strain in the USA occurred in a Chinese restaurant in El Paso, Texas, in April 1993; no source was identified. In September 1993, a second outbreak caused by SE phage type 4 was associated with the same restaurant. To determine the cause of the second outbreak, we compared food exposures of the 19 patients with that of two control groups. Egg rolls were the only item significantly associated with illness in both analyses (first control group: oddsratio [OR] 8·2, 95% confidence interval [CI] 2·3–31·6; second control group: OR 13·1, 95% CI 2·1–97·0). Retrospective analysis of the April outbreak also implicated egg rolls (OR 32·4, 95% CI 9·1–126·6). Egg roll batter was made from pooled shell eggs and was left at room temperature throughout the day. These two outbreaks of SE phage type 4 likely could have been prevented by using pasteurized eggs and safe food preparation practices.

(Accepted February 16 1996)