For the study, CDC compiled data on Salmonella outbreaks associated with NRTE breaded, stuffed chicken products during 1998–2022 by searching its Foodborne Disease Outbreak Surveillance System (FDOSS), outbreak questionnaires, web postings, and data from the Minnesota Department of Health (MDH) and USDA’s Food Safety and Inspection Service (FSIS). A total of 11 outbreaks were identified in FDOSS, accounting for 187 cases of illness, 42 hospitalizations, and no deaths. Among cultured samples from products obtained from outbreak patients’ homes and from retail stores during ten outbreaks, a median of 57 percent of cultures per outbreak yielded Salmonella.

Of the total outbreaks, seven were caused by Salmonella serotype Enteritidis, two by S. Typhimurium, one by S. Heidelberg, and one by S. I 4,[5],12:i-. In ten of the 11 outbreaks, the products were prepared in private homes. Outbreak illnesses were identified in 21 U.S. states, with five of six single-state outbreaks occurring in Minnesota, and with illnesses occurring in Minnesota during every multistate outbreak.

The implicated NRTE breaded, stuffed chicken products were produced in at least three establishments. In the seven most recent outbreaks, 0–75 percent of sickened respondents reported cooking the product in a microwave and reported that they thought the product was sold fully cooked or did not know whether it was sold raw or fully cooked.

Among 47 patients in four outbreaks during 1998–2006, which was before product labeling changes, who provided data on the appliance used to cook the product, a median of 85 percent of people per outbreak reported cooking the product in a microwave. Among 57 patients who provided information from seven outbreaks during 2008–2021, after labeling changes, a median of 20 percent per outbreak reported cooking the product in a microwave.

NRTE breaded, stuffed chicken products can be made with various types of chicken, including comminuted, trimmings, or other parts. Certain chicken types are subject to FSIS performance standards, which are used to measure an establishment’s process control. At present, the comminuted chicken used to make the products has the highest allowable percentage (25 percent) of Salmonella positives. NRTE breaded, stuffed chicken products were made with comminuted chicken in the three 2015 and 2021 outbreaks. The type of chicken used during earlier outbreaks was not documented. FSIS issued product recalls in six outbreaks and public health alerts in seven.

However, On April 25, 2023, USDA’s FSIS released a proposed determination to declare Salmonella an adulterant in breaded stuffed raw chicken products when a very low level of Salmonella contamination is exceeded. Under the proposed determination, FSIS would consider an adulterated product to be any breaded stuffed raw chicken product including a chicken component that tests positive for Salmonella at 1 colony forming unit (CFU) per gram prior to stuffing and breading. If the chicken component in covered products does not meet the FSIS standard, the product lot represented by the sampled component would not be permitted for use in the final breaded stuffed raw chicken products. The chicken component represented by the sampled lot would need to be diverted to a use other than breaded stuffed raw chicken products.

CDC noted that outbreaks associated with NRTE breaded, stuffed chicken products have continued to occur despite changes to product labels that better inform consumers that the products are raw and provide instructions on safe preparation, indicating that consumer-targeted interventions are not sufficient. Therefore, CDC concluded that additional Salmonella controls at the manufacturer level to reduce contamination in ingredients (such as those proposed by USDA) might reduce illnesses attributable to NRTE breaded, stuffed chicken products.