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Friday, June 20, 2008
Tomato Link Found in N.M.
By Olivier Uyttebrouck
Journal Staff Writer
New Mexico health workers helped link tomatoes to a nationwide outbreak of salmonella.
Five cases of salmonella Saintpaul poisoning turned up at Northern Navajo Medical Clinic in Shiprock before Memorial Day, May 26, officials said.
Indian Health Service workers at the clinic promptly began surveys to help determine the source of the outbreak.
"We always jump when there is something unusual," said Kimberlae Houk, an epidemiologist and public health nurse at the clinic.
Data collected by Houk's team and other New Mexico health officials led the state Department of Health to draw a prompt conclusion that tomatoes were the source of contamination.
Houk said Saintpaul, a rare and virulent form of salmonella, sickened people who typically shrug off a mild case of the illness.
"We had 30- and 40-year-olds in the hospital with dehydration for two or three days," she said.
Salmonella Saintpaul hammered the Navajo Nation, which claimed at least 30 percent of the 78 New Mexicans who were sick, a state Department of Health official said.
The reason for the concentration of illnesses at the Navajo reservation remains a mystery, said Paul Ettestad, the state's epidemiologist.
"I'm not sure we're ever going to know why such a high proportion of cases come from the Navajo reservation," Ettistad said Thursday.
Tests on tomato samples by New Mexico and other states have so far turned up no evidence of the source of the salmonella outbreak that has sickened at least 383 people in 30 states.
"It's been very frustrating," Ettestad said. Technicians have tried for weeks to grow salmonella cultures from tomato samples purchased randomly at stores. "Nobody's been able to do it yet."
An Arizona man treated in Gallup in early May was possibly the first case of salmonella Saintpaul identified in New Mexico, Ettestad said.
By May 22, the Health Department had identified three cases in Gallup, Clovis and Las Cruces. The agency had observed 19 cases statewide by May 26, about half originating on the Navajo reservation, he said.
Health officials there have a long history of experience with dangerous diseases such as Hantavirus and plague, Houk said.
IHS workers applied many of the same techniques investigating the salmonella outbreak, she said.
"Our job is to drop whatever we're doing and take care of a communicable disease," she said.
Much of that job involved performing detailed surveys to determine what foods salmonella patients had eaten in the week preceding the onset of symptoms, Houk said.
Health workers also surveyed a control group of people who were not sick, she said.
Many people lack telephones on the Navajo reservation, requiring health workers to drive huge distances to administer the surveys. Similar techniques have been used to identify the source of Hantavirus, plague, measles and other diseases, Houk said. She has worked 24 years for the IHS on the Navajo reservation.
On May 23, Houk said she informally polled about a dozen nurses at the Shiprock clinic about which food might have caused the outbreak.
"Half the nurses thought it was tomatoes and half the nurses thought it was lettuce," she said.