I mentioned last week that I was going to do “Weird Things Your Kids Do and when you should worry” this week. I will start tomorrow. I spent the weekend trying to ignore my kids. I will have to pay attention to them today so I have some material. Instead, salmonella. This morning, I taped a show for Good Morning America Health on this topic. I am hoping someday to discuss something a little sexier than cold sores and diarrhea. Of course, if I have to talk about sex, I’ll probably be bright red the whole time – which actually might make for good TV. The recent Salmonella outbreak and subsequent ground turkey recall has heightened awareness, but it should always be in the backs of our minds. I can’t remember exactly what I said on this morning. I feel a little like Seinfeld’s Elaine when she met JFK Jr. “He asked me my name and I think I said Elaine, but who the hell knows …” The information that is important for you to know, that I probably neglected to say on camera is …
1. How serious is it? While salmonellosis is usually self-limited, lasting 4-7 days, it can be more severe, even fatal. The very young, the very old and the immunosuppressed are at the highest risk. Because of the massive amounts of diarrhea, dehydration is the most common complication. Salmonella can also cause meningitis and bacteremia – serious infections of the spinal fluid and blood respectively. Post-infection, some people will develop Reiter’s syndrome. This presents with eye irritation, painful urination and joint pain, often lasting for months. Chronic, hard to treat arthritis is another long term side effect. While the initial symptoms may be gone within a week, patients may not feel well for months following a salmonella infection.
2. How common is it? The CDC reports about 1.4 million cases of salmonellosis per year with 400 deaths in the U.S. alone. We never hear about most cases because they are isolated. When clusters of cases are reported, the CDC steps in and tries to track down the source of the bacteria. Most frequently, it is caused by improper handling of food and poor hygiene.
3. How does it spread? Salmonella and most every food-bourne illness is spread via a fecal to oral route – yuk, right? This means that the feces from an infected animal or human somehow contaminated the food we eat. The salmonella bacteria can be excreted from the intestinal tract for up to one year after signs of infection. There are more than 2,000 strains of salmonella and the same strain that makes us sick, may not make animals sick.
4. Prevention – There are standards that must be met along every step of the farm-to-table food chain. You can only control your end of things. You cannot see, smell or taste a difference in food that has been contaminated, so it is best to always practice safe food handling. Keep your meat and poultry products separate in your grocery cart, in your fridge and on your counter tops. Wash counters, cutting boards and utensils in hot soapy water. Wash your hands for at least 20 seconds after handling pet “clean-up”, handling any reptiles, using the bathroom or changing a diaper. Wash hands before and after food prep. Use two cutting boards – one for fresh produce and one for meat and poultry. Never reuse bread crumbs or anything else that has touched raw poultry. Cook meat and fish to an internal temperature of 145. Cook ground meat, poultry and egg dishes to an internal temperature of 165. Refrigerate your leftovers within 2 hours. If it is hot outside, refrigerate within 1 hour. Salmonella poisoning is more prevalent during the warm months. Reheat your leftovers thoroughly. Marinate your meats in the fridge. (Why is there a “d” in fridge but not in refrigerator?)
5. Treatment – Initial treatment is supportive. Fluid replacement during the acute illness is critical. After the worst symptoms subside, resume a bland diet and then ease slowly back to a normal diet. It’s a great way to lose a few pounds. If you think you or your child is becoming dehydrated, call your doctor. Hospitalization with IV fluids may be necessary. If the infection is severe, antibiotics will be prescribed. You want to avoid using anti-diarrheals when possible, as it may prolong the infection.
Most people who are infected with salmonella will recover in a few days with no sequelae. But as anyone who has ever had food poisoning knows, it is no picnic. You literally lie on your bathroom floor wondering if it wouldn’t just be easier to die. Then you start to think about people all over the world who die from intestinal diseases and have no access to medical care. Then, you feel guilty for thinking death would be better in the first place … o.k., so maybe I am the only one who thinks this way, but even without the guilt trip, even without long term consequences, it is really horrible to go through. It is much better by far to prevent it in the first place. Employees aren’t the only ones who should be required to wash their hands.