Controlling Spread of Salmonellosis

Table of Contents

For uncomplicated cases, no antibiotic treatment is recommended.  Antibiotics may encourage the development of the carrier state and may lead to resistant strains or more severe infections. However, infants under 2 months of age, the elderly, the debilitated, those with sickle disease, persons infected with HIV, or patients with continued or high fever or manifestations of extra intestinal infection, should be given antibiotic therapy.

A. Isolation and Quarantine Requirements

Exclude persons with salmonellosis from food preparation and direct child and patient care until diarrhea is resolved.  Children in child care should be excluded until diarrhea ceases. Consult with the staff at CADE if any clarification is needed.

B. Protection of Contacts of a Case

None

C. Managing Special Situations

Child Care

Since salmonellosis can be transmitted person-to-person through fecal-oral transmission, it is important to carefully follow up on cases of salmonellosis in a child care. General recommendations include:

  • Children or staff with Salmonella infection who have diarrhea should be excluded until their diarrhea is gone.
  • Good hand hygiene must be practiced at all times.

School

Since salmonellosis may be transmitted person–to-person through fecal-oral transmission, it is important to follow up carefully on cases of salmonellosis in a school.  General recommendations include:

  • Students or staff with Salmonella infection who have diarrhea should be excluded until their diarrhea is gone.
  • Good hand hygiene must be practiced at all times.

Community Residential Programs

Actions taken in response to a case of salmonellosis in a community residential program will depend on the type of program and the level of functioning of the residents.  Exclude persons with salmonellosis from food preparation and patient care until diarrhea is resolved.

In long-term care facilities, residents with salmonellosis should be placed on Standard and Contact Precautions until their symptoms subside. Staff members who give direct patient care (e.g. feed patients, give mouth or denture care, or give medications) are considered food handlers and are subject to food handler restrictions.  Exclude persons with salmonellosis from food preparation, direct child and patient care until diarrhea is resolved.  In addition, staff members with Salmonella infection who are not food handlers should not work until their diarrhea is gone.

In residential facilities for the developmentally disabled, staff and clients with salmonellosis must refrain from handling or preparing food for other residents until their diarrhea has subsided. In addition, staff members with Salmonella infection who are not food handlers should not work until their diarrhea is gone.

Reported Incidence Is Higher than Usual/Outbreak Suspected

If the number of reported cases of Salmonella in any city or town is higher than usual, or if an outbreak is suspected, investigate to determine the source of infection and mode of transmission. A common vehicle (such as food or association with a child care center) should be sought and applicable preventive or control measures should be instituted. Control of person-to-person transmission requires special emphasis on personal cleanliness and sanitary disposal of feces. Consult with the regional epidemiologist or CADE if assistance is needed. CADE can help determine a course of action to prevent further cases and can perform surveillance for cases that may cross jurisdictional lines.

Preventive Measures

Environmental Measures

Implicated food items must be removed from the environment. A decision about testing them can be made in consultation with CADE and the State Hygienic Laboratory (SHL). CADE can help coordinate pickup and testing of food samples.  If a commercial product is suspected, the Department of Inspections and Appeals (DIA), or their contracted agency, will coordinate follow-up with relevant agencies.

Note: The role of the DIA is to provide policy and technical assistance with the environmental investigation. This includes interpreting the Iowa Code, conducting a HACCP risk assessment, initiating enforcement actions and collecting food samples.

The general policy of the University of Iowa State Hygienic Laboratory (SHL) is to only test food samples implicated in suspected outbreaks, not in single cases, except when botulism is suspected.  The LPHA may suggest that the holders of food implicated in single case incidents locate a private laboratory that will test food or store the food in their freezer for a period in case additional reports are received. However, a single, confirmed case with leftover food consumed within the incubation period most likely will not be considered for testing.

Since Salmonella is sometimes implicated in foods that have wide, sometimes national, distribution, it is critical that all Salmonella isolates be sent to SHL for PFGE testing (DNA fingerprinting). This allows investigators to connect Iowa illnesses and those in other parts of the country.

Preventive Measures/Education

To avoid future exposures, recommend that people:

  • Always wash hands thoroughly with soap and water before eating or preparing food, after using the toilet, after changing diapers, and after touching their pets or other animals (especially reptiles).
  • Wash the child’s hands as well as their own after changing diapers.
  • Dispose of feces in a sanitary manner in all settings.
  • Keep food that will be eaten raw, such as vegetables, from becoming contaminated by animal-derived food products.  Wash all foods that will be eaten rare before eating.
  • Avoid letting infants or young children touch reptiles, such as turtles, snakes or iguanas, or their cages.
  • Avoid reptiles when choosing pets if there are infants, elderly or immunocompromised people in the home.
  • Do not use reptiles as classroom pets in a child care or schools with children younger than 5 years old.
  • Avoid sexual practices that may permit fecal-oral transmission. Latex-barrier protection should be emphasized as a way to prevent the spread of salmonellosis to sexual partners as well as to prevent the exposure to, and transmission of, other pathogens.

Iowa Dept. of Public Health, Revised  7/15