CAMDEN, Maine — One person died and another was hospitalized in the last two weeks after a salmonella outbreak swept through Quarry Hill, a retirement and assisted living facility.
Seven positive cases of salmonella among the residents have been identified so far, according to Dr. Stephen Sears, acting director of the Maine Center for Disease Control and Prevention.
“The resident who died repeatedly declined treatment before being admitted to the hospital,” Christopher Burke, director of marketing and communications at Pen Bay Health Care, said Wednesday morning.
Pen Bay Health Care is the parent organization of Quarry Hill and also of Penobscot Bay Medical Center in Rockport, where the person died on Feb. 2.
Quarry Hill offers independent living, assisted living, short- and long-term nursing care and rehabilitation and specialized memory-loss care to just over 150 people. Staff at the facility first became aware of the outbreak on Jan. 24, when several residents became ill with symptoms that included diarrhea, cramps, headache, fever and vomiting.
The affected residents lived in the assisted living and memory impairment assisted living wings of the facility, Burke said. The person who died lived in the assisted living wing. The other person hospitalized is recovering and expected to return to Quarry Hill on Thursday.
The Maine CDC sent two epidemiologists to the health care facility to try to find other sick residents and to identify a possible source. The experts also worked with facility staff to increase their education about salmonellosis, the infection caused by the salmonella bacteria.
Sears said efforts to track the cause of the outbreak have so far been fruitless.
“It’s usually food-borne to start with. We looked to try to find a food source,” he said. “Oftentimes when we start investigating, the food’s gone. It’s gone, it’s been consumed, there isn’t any way to find one thing that everybody ate.”
The strain of salmonella in the Camden outbreak has been identified as javiana, Sears said.
He said that the Maine CDC has not seen other salmonella outbreaks from that strain in the state recently and that the problem appears to be “slowing down” at Quarry Hill, with no new cases reported in days.
Salmonella is associated with “every type of food known,” Sears said, but is most often found in animals and animal products, including chickens and eggs.
The salmonella outbreak occurred at the same time that the state has had an outbreak of norovirus, which can cause acute vomiting and diarrhea in people. It is the most common cause of food-borne outbreaks, and Sears said that there may be some norovirus “mixed in” with the salmonella cases.
According to the website for the Centers for Disease Control and Prevention, most people who have been infected by salmonella germs develop symptoms between 12 and 72 hours, and the illness usually lasts 4-7 days. Every year, about 40,000 cases of salmonellosis are reported in the United States, with approximately 400 people dying of the infection. Young children, the elderly and those with compromised immune systems are most likely to have severe infections.
Sears said that Maine has between 120 and 140 cases each year, but added that it’s hard to know how many people die of the infection annually.
“Some people do die,” he said. “It’s hard to say whether they die of salmonella or with salmonella because they have underlying conditions.”
About 2,000 people were sickened and half a billion eggs recalled last summer after a national outbreak of salmonella.
Sarah Klein, an attorney with the consumer advocacy Food Safety Program at the Washington, D.C.-based Center for Science in the Public Interest, said that salmonella is one of the most dangerous and common pathogens she sees. Outbreaks happen with “alarming” frequency at places like nursing homes and hospitals, she said.
“Any handling error on the part of producers can sicken a lot more people than you could in your kitchens at home,” Klein said. “What you’ve got is kind of the perfect storm — a vulnerable population being served in mass quantity.”
She called food-borne illnesses preventable, even though the bacteria can occur in comestibles as varied as undercooked meat, raw produce and processed foods like peanut butter.
“There are all these different steps in the chain from farm to fork. In almost every step you can prevent people from getting sick at the end, if you do the right thing,” she said.
The attorney said that it is almost never a consumer’s fault when outbreaks happen. Klein instead attributed blame to what she called endemic problems in the national food production system.
“Pretty much across the board, nobody is actually inspecting as much as they say they are or they should be,” she said. “When you don’t have enough health inspectors — boots on the ground — to ensure that people are properly trained for food safety, [outbreaks are] almost inevitable.”
After the Camden outbreak began, Penobscot Bay Medical’s infectious disease specialist, Dr. Cheryl Liechty, and the Maine CDC recommended closing Quarry Hill to incoming residents.
“There was no coming and going for a 48-hour period, as a precaution,” Burke said. “They have resumed accepting residents.”
Pen Bay Health Care sent a letter to all residents, or residents’ families, to provide them with all the information available about the outbreak, he said.
“We are encouraging them to contact Quarry Hill directly if they have questions,” he said. “We have communicated with them widely.”
Quarry Hill staff has been doing a “careful and rigorous cleaning,” since the outbreak began, Burke said.
The facility has had multiple visits by inspectors from the Maine Department of Health and Human Services Division of Licensing and Certification since the outbreak began, along with epidemiologists from the Maine CDC, Burke said.
“According to both agencies, appropriate infection precautions have been taken,” Burke said. “It’s a terrific facility and very highly regarded in the community.”
“This happened to occur in an organization that has good hygiene,” he said.
He also urged people not to worry overmuch about safety in long-term care facilities in Maine.
“Just because you’re in a long-term care facility doesn’t mean you’re at risk of these organisms,” he said.
Some tips for consumers to prevent salmonella, according to the CDC:
• Cook poultry, ground beef and eggs thoroughly. Do not eat or drink foods containing raw eggs or raw milk.
• Don’t hesitate to send undercooked meat, poultry or eggs back at a restaurant for further cooking.
• Wash hands, kitchen work surfaces and utensils with soap and water immediately after they have been in contact with raw meat or poultry.
• Be particularly careful with foods prepared for infants, the elderly and the immuno-compromised.
• Wash hands with soap after handling reptiles, birds or baby chicks and after contact with pet feces.
• Avoid direct or even indirect contact with reptiles, birds or baby chicks.