Two Salmonella outbreaks have been found to be associated with kebab shops in an Australian state with people falling sick in 2021 and 2022, according to recent reports.

The first included 12 cases of Salmonella Agona, with nine patients reporting eating chicken from the same kebab shop in Canberra, in the Australian Capital Territory. The second involved two cases of Salmonella Virchow who both ate chicken from another kebab shop. Environmental samples detected Salmonella linked to the respective outbreak cases.

Investigations identified similar food safety issues at both businesses, including improper cleaning of kebab shaving equipment and serving cut rotisserie meat without further cooking.

The outbreaks highlight the importance of cleaning and sanitizing kebab shaving equipment and use of a second cooking step after kebab meat is shaved from the rotisserie, found the study published in Communicable Diseases Intelligence.

Problem cleaning equipment
Between February and April 2022, eight cases of Salmonella Agona were detected. Typically one or two are recorded per year. Another two patients were reported in late April. A review of past reports identified two more patients from September and December 2021.

Patients ranged in age from 6 to 62 with a median of 28 years old. Males and females were equally affected. All cases reported diarrhea and three had blood in their stool. Five people went to the emergency department and one person was hospitalized.

Environmental investigations identified concerns including inadequate cleaning and sanitizing processes. Staff was unable to detach the blade from the electric kebab shaving equipment used to cut rotisserie meat, which limited proper cleaning. Kebab meat was either cut from the rotisserie and served directly to customers, particularly when the business was busy, or placed in a holding unit and further cooked on a hot plate before serving.

Salmonella Agona was detected from the chicken and lamb shaving blades, a chicken scoop pan, and from samples of lamb and chicken. A cleaning cloth was culture positive for this Salmonella type.

Findings pointed to intermittent contamination of food products. Environmental and laboratory investigations demonstrated widespread contamination, according to the report. Salmonella was detected on four swabs taken from the inner and outer aspects of two shaving blades, suggesting the source was repeated contamination of rotisserie meat from inadequately cleaned shavers.

Second outbreak and similar issues
In June 2022, interviews with two patients with Salmonella Virchow revealed both had eaten at the same kebab shop. They had a median age of 33.5 years, and neither was hospitalized. Findings from the recent first outbreak led to rapid identification of the second.

Investigations uncovered similar issues as in the first outbreak. Staff had difficulty dismantling the kebab shaver for cleaning. Shaved meat was placed in a double boiler at 80 degrees C (176 degrees F) and served without a second cooking step. When the business was busy, additional meat was placed on top. A cleaning cloth was positive for Salmonella Virchow.

In the outbreaks, inadequate temperature control of meat may have been a contributing factor. Food businesses are required to store heated chicken at 60 degrees C (140 degrees F) and above. For both outlets, the temperature of shaved meat was measured at 56 degrees C (133 degrees F).

Both businesses were issued with Improvement Notices requiring issues to be addressed. Food preparation areas were cleaned and sanitized, and the staff was given food safety education and training. Follow-up found meat shavers were disassembled daily for cleaning and cut rotisserie meat was subjected to a second cook step before serving. Repeat swabs were negative for Salmonella.

Results contributed to proactive public health activities in the ACT, including a targeted food sampling program for kebab businesses, education on cleaning and sanitizing of electric meat shavers, and a review of the need for a second kill step for shaved meats.

With the increasing uptake of third-party food delivery services, the role of these businesses in foodborne outbreak investigations should be explored, said researchers.