Published online December 1, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. 2380-2387 (doi:10.1542/10.1542/peds.2006-1218)
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ARTICLE

A Case-Control Study of the Epidemiology of Sporadic Salmonella Infection in Infants

Timothy F. Jones, MDa, L. Amanda Ingram, MPHa, Kathleen E. Fullerton, MPHb, Ruthanne Marcus, MPHc, Bridget J. Anderson, PhDd, Patrick V. McCarthy, PhDe, Duc Vugia, MD, MPHf, Beletshachew Shiferaw, MDg, Nicole Haubert, BSh, Stephanie Wedel, MPHi and Frederick J. Angulo, DVM, PhDb

a Tennessee Department of Health, Nashville, Tennessee
b Centers for Disease Control and Prevention, Atlanta, Georgia
c Connecticut Emerging Infections Program, New Haven, Connecticut
d New York State Department of Health, Albany, New York
e Center for Food Safety and Applied Nutrition, Food and Drug Administration, Washington, DC
f California Department of Health Services, Berkeley, California
g Oregon Department of Human Services, Portland, Oregon
h Colorado Department of Public Health and Environment, Denver, Colorado
i Minnesota Department of Health, Minneapolis, Minnesota

OBJECTIVE. Rates of Salmonella infection are highest in infants, but little is known about potential sources of infection in this high-risk population. We performed a case-control study to identify dietary and environmental risk factors for sporadic salmonellosis among infants.

PATIENTS AND METHODS. In 2002–2004, the Foodborne Diseases Active Surveillance Network conducted a population-based, case-control study of sporadic salmonellosis among infants <1 year of age in 8 states. Cases were identified via active laboratory-based surveillance. Healthy controls were frequency matched by age and identified through birth registries or published birth announcements. We assessed diet and environmental exposures in the 5 days before illness onset or interview. Data were analyzed by using logistic regression adjusting for age.

RESULTS. The study enrolled 442 subjects and 928 controls. Compared with healthy controls, infants with Salmonella infection were less likely to have been breastfed and more likely to have had exposure to reptiles, to have ridden in a shopping cart next to meat or poultry, or to have consumed concentrated liquid infant formula during the 5-day exposure period. Travel outside the United States was associated with illness in infants 3 to 6 and >6 months of age. Attending day care with a child with diarrhea was associated with salmonellosis in infants >6 months of age.

CONCLUSIONS. We identified a number of modifiable protective and risk factors for salmonellosis in infants. Attention should be directed at developing effective preventive measures for this high-risk population.

Key Words: Salmonella • infant • epidemiology

Abbreviations: FoodNet—Foodborne Diseases Active Surveillance Network • OR—odds ratio • CI—confidence interval

Accepted Jun 8, 2006.


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