The Philadelphia Department of Public Health (PDPH) is working with the Pennsylvania Department of Health (PADOH) to investigate a recent increase in Salmonella infections among persons associated with 4 healthcare facilities (2 hospitals and 2 long-term care facilities) in southeastern Pennsylvania. PDPH has identified 3 affected facilities in the City. Salmonella serotype Javiana has been identified among cases at 3 of 4 facilities.
Initial investigation findings indicate that fresh cut fruit mixes/cut fruits (cantaloupe, honeydew, pineapple, grapes) distributed to institutional facilities and supplied by Tailor Cut Produce in North Brunswick Township, NJ may be associated with the Salmonella infections. Given all affected facilities provide care to vulnerable patients who are more likely to develop severe infection, we recommend that facilities in the City discontinue serving these fresh cut fruit products from Tailor Cut Produce at this time. As the investigation progresses and more information is received, PDPH will provide updates or changes to control actions, since currently available information is preliminary.
Recognition, Testing, and Management: Salmonella symptoms include diarrhea, abdominal pain, fever, nausea, and vomiting. Diarrhea is sometimes bloody. Dehydration among infants and the elderly may be severe. Symptoms usually begin within 12 to 72 hours after exposure, but incubation periods of a week or more are also possible. Salmonella infections usually resolve in 5 to 7 days. However, infection may lead to more severe invasive disease (for example, blood stream infections, meningitis) and in rare cases, death. Immunocompromised patients, infants, and the frail elderly are more likely to experience severe Salmonella infections with complications that require hospitalization. Patients who are at-risk for severe infection or have invasive infections should be treated with antibiotic therapy.
Given the recent local increases, area providers should consider the potential for Salmonella infection among patients presenting with diarrheal symptoms, especially for patients who also present with fever or were admitted to a healthcare facility during their exposure period. When Salmonella is suspected, providers should:
- Order stool cultures and obtain isolates for antimicrobial susceptibility testing. Given the association with healthcare settings, PDPH recommends stool culture testing for possible nosocomial diarrhea. Positive culture-independent diagnostic tests (CIDT), such as Polymerase Chain Reaction (PCR) tests, should be reflexed to culture. Additionally, laboratories should send all Salmonella isolates or CIDT positive stool samples in Cary Blair medium to the PADOH Bureau of Laboratories for further testing. Given seasonal increases, norovirus PCR testing of stool or vomitus specimens also should be conducted.
- Advise suspected and confirmed cases to practice good hand washing, especially after using the bathroom. For inpatient healthcare and congregate living settings (e.g., long-term care facilities), arrange for a private bathroom for cases if possible. Staff should take infection control precautions when handling feces and soiled clothing and linens from cases.
- Notify PDPH of any patient with suspected or confirmed Salmonella infection and suspected gastrointestinal outbreaks including those occurring in healthcare facilities. To report, call (215) 685-6742 during business hours or (215) 686-4514 (after hours, ask for Division of Disease Control on-call staff).
Originally released by the Philadelphia Department of Public Health on December 6, 2019.