Researchers have called for increased awareness to reduce the risk of Campylobacter outbreaks linked to incorrectly cooked chicken liver dishes.

Communication from food safety and public health authorities may be required. Any strategy should ensure the risk profile of poultry liver-containing dishes is raised and availability of evidence-based preventative strategies for food preparation promoted, according to the study published in the journal Epidemiology and Infection.

There were 19 people who got campylobacteriosis linked to an outbreak in England 2016; seven confirmed and 12 probable cases. Chicken liver pâté was most strongly associated with illness. Three cases reported an incubation period of less than 24 hours, consistent with other outbreaks of campylobacteriosis associated with poultry liver.

Diversorium Ltd., the company which owned and operated the Downe Arms, a hotel in Wykeham near Scarborough, was fined £8,000 ($10,300) in November 2017 for two food hygiene related offences related to the outbreak.

Christmas Campylobacter
In England and Wales, campylobacteriosis is the most common gastrointestinal infection, with more than 56,000 laboratory reports in 2017.

In January 2017, an environmental health team in North Yorkshire was contacted by a person reporting cases of gastroenteritis following a Christmas party at the Downe Arms in December 2016. They contacted Public Health England (PHE), which set up an outbreak control team.

Three Christmas parties were held at the hotel on that day in December with 47, 10 and 16 attendees, respectively or 73 in total. All three ate from the same set menu which included a choice of starter, main course and dessert.

Out of 53 completed online questionnaires, 19 met one of the case definitions. Cases had onset of illness between four hours and four days after the meal. Almost all of them reported diarrhea; other symptoms included abdominal pain, nausea, headache, fever, body aches, bloody stools and vomiting.

Chicken liver pâté was the food most strongly associated with illness and explained 17 of 19 infections. All confirmed cases reported consuming it.

Five other people with gastroenteritis ate at the hotel five to seven days after the Christmas Party, two of which were confirmed as having Campylobacter infection.

“As the same batch of chicken liver pâté was not likely to have been served, it seems probable that whatever ineffectual preparation methods were used on Dec. 17 were also applied days later. Following the outbreak, the hotel was advised by environmental health to stop making chicken liver pâté without being able to provide documented evidence to validate the cooking process. No further outbreaks have been reported,” said researchers.

Potential for cross contamination during busy period
Following a prosecution by Scarborough Borough Council, Diversorium pleaded guilty to two offences. The business was given a food hygiene rating of 1 meaning major improvement necessary but after a re-inspection in August 2017, it was awarded a rating of 4, meaning good.

There was no food left from meals consumed by cases. In early January 2017, eight environmental swabs and two food samples including chicken liver pâté prepared on Dec. 31 and a bagged leaf salad were taken. No food or environmental samples tested positive for Campylobacter spp. and all tests were satisfactory for indicator organisms.

Condition of the kitchen was reasonable, with most food items labelled and stored correctly. Temperatures of refrigeration equipment were good. No observations of cross-contamination were witnessed, but several issues were seen as not being consistent with good hygiene practices and indicated a potential for it to occur.

Food safety management records were incomplete with the process for preparing the chicken liver pâté not validated by appropriate temperature monitoring and recording, according to authorities.

Preparation of chicken liver pâté, as described by the chef, involved cooking the chicken livers, using a probe to see the largest had reached a temperature of 75 degrees C (167 degrees F). The livers were then blended with butter and eggs, passed through a sieve and confit of pork folded into the blended livers before cooking again at 100 degrees C (212 degrees F) for 60 minutes. No written records were able to support these processes other than occasional probe checks on joints of meat.

“Despite the hotel being aware of the need to cook chicken livers properly to reduce the risk of campylobacteriosis when producing chicken liver pâté, poor record keeping could not exclude inadequate cooking during a busy period in the kitchen leading to 19 cases of acute food poisoning,” said researchers.