3 Prevention & Control of Enteric Diseases

3.1 Foodborne Illness Complaints

Foodborne illness occurs when a person eats foods that contain harmful organisms such as bacteria or viruses. A foodborne illness complaint is submitted by a member of the public reporting a suspected food poisoning. If multiple complaints are received, it triggers follow-up inspections by the Health Department.

Complaints are received from:

Salt Lake County Health Department (SLCoHD) Environmental Health Food Protection Office

Igotsick UDHHS online foodborne illness reports

Utah Poison Control Center

United States Department of Agriculture

3.2 Notable Enteric Outbreaks and Investigations

In comparison to 2022, 2023 was a busy year for enteric disease activity. There was a 205% increase on inspection requests; this was due to a large increase in Cryptosporidiosis cases.

Notable Outbreaks:

There was a total of 17 Norovirus outbreaks (confirmed and suspected) in 2023, the average case count was 12 cases per outbreak. 53% of outbreaks occurred in groups who reported their illnesses after eating at a restaurant establishment. 41% of outbreaks occurred in a school or daycare setting. 6% of outbreaks occurred in a long term care or group living setting.

There were three identified Cryptosporidiosis outbreaks that contributed to the highly elevated case counts for 2023. The largest outbreak had 23 cases who swam at one recreation center over the course of the summer. This center was most likely the main source for continued cryptosporidiosis cases in the county. There was a large response that took place during the end of July with public health officials and management to prevent additional cases.

During November 2023 there was an outbreak associated with a catered event. Within 48 hours of the event, most of the attendees started having gastrointestinal symptoms. Our epidemiology staff were able to get information on 25 people who experienced symptoms after the catered event. Lab results confirmed Salmonella Enteritidis as the pathogen. There were also 5 other cases who ate at the same restaurant but did not attend the catered event. A thorough environmental inspection was conducted at the restaurant. It was discovered that the storage containers which were used to hold washed lettuce was insulated and therefore could not cool quickly. Steps to keep lettuce below 40 degrees during the washing process were implemented.

Reported in April, there was a large family group who purchased at least two cooked and ready to eat whole pigs from a local market for a family gathering. Beginning a day after the gathering, there were multiple reports of gastrointestinal illness. In total, 15 individuals associated with the family party were reported with symptoms; 7 individuals sought medical care, of which, 3 were diagnosed with Salmonella serovar l4,[5],12:i:-. Salmonella-positive isolates from the leftover pork samples closely related to clinical samples from the family confirm the whole roast pig as the food vehicle in this outbreak. An investigation completed at the market found steps in the cook process that likely left the pig undercooked.

A large outbreak of Cyclosporiasis was discovered after a food handler initially tested positive for Cryptosporidiosis. After completing the patient interview, it was apparent that many staff members had also been ill with similar gastrointestinal symptoms. Onset dates ranged from 5/29-6/22. Once the outbreak concluded, the total case count was 12 staff and 12 patrons of the restaurant who were identified as confirmed or probable cases. After analyzing staff surveys and patron food history questionnaires it was suspected that baby arugula was the source of the illnesses. Nationally, cyclosporiasis was elevated as well. As of October 24, 2023, 41 jurisdictions, including 40 states and New York City, reported a total of 2,272 laboratory-confirmed cases of cyclosporiasis (including the clusters that were under investigation by the FDA). These individuals had not traveled outside of the United States during the 14 days before they got sick. Sick people ranged in age from 2 – 96 years, with a median age of 51, and 57% were female. The median illness onset date was June 24, 2023 (range: April 1 – August 31). Of 2,242 people with information available, 186 were hospitalized. Zero deaths occurred.