During March 2002, Public Health - Seattle & King County initiated an investigation of a Campylobacter jejuni outbreak at a ski resort restaurant in British Columbia associated with a common fondue dinner. This report reviews the epidemiology of campylobacterosis and potential hazards associated with fondue-style dining where raw meat products are handled at the table.

Campylobacter jejuni is a gram-negative bacterium that causes gastrointestinal symptoms of diarrhea, stomach cramps, fever, nausea, or vomiting typically within 2-5 days of ingestion. Guillain-Barre syndrome is now recognized as a post-infection complication (incidence <1/1000) of C. jejuni infection. Although most C. jejuni infections do not require antibiotic treatment, quinolone-resistance is not uncommon in infections acquired by travelers, and has also been described in U.S. cases. The extensive use of quinolones in the poultry industry has been suggested as the cause resistant Campylobacter infections.

Though campylobacterosis is most commonly associated with raw chicken, contaminated water and unpasteurized milk, other risk factors include contact with farm animals, swine, puppies, kittens, birds and other pets. According to the CDC, a single drop of raw chicken juice could cause infection by Campylobacter.

Approximately 300 campylobactereriosis cases are reported in King County residents and over 10,000 cases nationally are reported to the Centers for Disease Control and Prevention each year, making it the most commonly reported food-borne infection in the U.S. Most infections occur in children under 5 years old and young adults in their twenties. Immunocompromised individuals are at increased risk for infection. Contamination of cutting surfaces and cooking utensils, and bare-hand contact with raw poultry are common modes of transmission.

Fondue-style dining is a popular group event that presents potential food safety hazards. Often, fondue is served with raw meat, such as chicken or beef, and prepared by the consumer. The meat is dipped into hot oil and either consumed directly or placed on a serving plate. Raw meat may be presented to the consumer on the same platter as raw vegetables leading to potential contamination of the vegetables that may not be adequately cooked. Cross contamination of utensils or self-inoculation with contaminated juices from raw meat may occur. Cheese fondue may also be hazardous if raw vegetables are not washed prior to use. When groups share a common fondue pot, the oil temperature decreases substantially as meat is placed in the pot; therefore, the amount of time necessary to adequately cook any meat product in the fondue pot may be lengthened. Chicken should be cooked to a minimum internal temperature of 165° F.

Prevention tips:

Antibiotic treatment for campylobactereriosis is not always necessary but may be indicated if the infection is prolonged or severe. Obtaining stool cultures for bacterial enteric pathogens will allow identification of diseases of public health importance and provide isolates for antimicrobial susceptibility testing. Although laboratories are not required to submit Campylobacter isolates to Public Health, we highly encourage antibiotic resistance testing for all Campylobacter isolates. For more information, please visit our website at: www.metrokc.gov/health/prevcont/campyl.htm