SALMONELLA POONA OUTBREAK – APRIL 2002

Name ______Telephone number ______

Age ______Sex:  Male  Female

City______County/Region______

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FOR CASES:

1. Confirm onset date ______

2. Did you travel outside the United States or Canada in the 2 weeks prior to

onset of your illness?

 Yes  No

3. Were you hospitalized?  Yes  No

4. During the 5 days before you got ill, do you remember eating or even tasting any of the following foods? (read list)

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FOR CONTROLS:

5. During the last five days do you remember eating or even tasting any of the following foods? (read list)

VEGETABLES
Y N DK
a.    alfalfa sprouts
b.    bean/other sprouts
c.    uncooked tomatoes
d.    uncooked carrots
e.    uncooked celery
f.    uncooked green onions (scallions)
g.    radishes
h.    parsley
i.    cilantro
j.    lettuce / FRUITS
Y N DK
a.    watermelon
b.    honeydew melon
c.    whole cantaloupe d.    pre-cut cantaloupe
e.    cantaloupe in fruit salad or as a garnish
g.    other melon
h.    strawberries
i.    blueberries
j.    other berries
g.    pineapple
h.    apple
i.    mango
j.    grapes / OTHER EXPOSURES
Y N DK
a.    deli-style sandwiches
b.    raw (natural) almonds
c.    peanuts
d.    other nuts
e.    contact with reptiles
f.    contact with other people with diarrhea

For those who report eating cantaloupe, continue to Cantaloupe questions. If cantaloupe was not consumed, thank the respondent and end the interview.

1. For CASES: During the week before you got sick, did you eat cantaloupe from more than one source?
For CONTROLS: During the last 5 days, did you eat cantaloupe from more than one source? /  Yes
 No
 Don’t know/not sure
For each time cantaloupe was eaten from a different source, ask: (use supplemental sheets if necessary)
Source # ______
2. Where did you get the cantaloupe [where was the cantaloupe purchased?] /  Supermarket
 Small grocery store
 Warehouse store
 Farmer’s market
 Roadside stand
 Restaurant
 Other ______
 Don’t know/not sure
3. Indicate name & address of establishment where purchased, date of purchase, and if respondent has a receipt for purchase (use other side of questionnaire if more than one source) / Name______
Address______
Date of purchase______
Receipt available?  Yes  No
4.At the [store], was the cantaloupe … /  Refrigerated
 On ice
 Unrefrigerated (e.g., in produce bin)
5. When you purchased the cantaloupe was it . . . /  Whole (uncut)
 Cut in pieces with the rind on (e.g.,
halves, wedges) [Skip to #12]
 Cut in pieces without rind (e.g., cubes, balls, pre-mixed with other fruit) [Skip to #14]
 Don’t know/not sure
6. From when you left the [store], how much time passed before the cantaloupe was first cut? / ______hours ______days
7. How much of the time was it refrigerated? / ______hours ______days
8. Before cutting the cantaloupe, did you do anything to clean it (mark all that apply) /  Nothing
 Dipped in standing water
 Rinsed off under running water
 Scrubbed surface with a brush
 Washed with detergent or soap
 Dipped in a disinfectant solution
 Don’t know/not sure
9. How did you first cut up the cantaloupe? /  Halves or quarters
 Smaller pieces with rind on
 Cut off rind and scooped/cut out balls/cubes/other shapes
 Don’t know/not sure
10. After it was initially cut, how much time passed before you started to eat the cantaloupe? / _____minutes _____hours _____days
11.How much of the time was it refrigerated? / _____minutes _____hours _____days
12. Were multiple pieces of cut cantaloupe with the rind on stored together so that the rind of one could contact another piece (e.g., mixed in a bowl or storage container?) /  Yes
 No
 Don’t know/not sure
13. Did you chew on the rind or put the rind in your mouth to bite off part of the insides? /  Yes
 No
 Don’t know/not sure
14. From when [you] left the [store], how much time passed before you started eating the cantaloupe? / ______hours ______days
15. How much of the time was it refrigerated? / ______hours ______days
16. Was the cantaloupe eaten all at once? /  Yes
 No
 Don’t know/not sure
17. From when you started, how long was it before you ate the last of it? / ______hours ______days
18. How much of the time was it refrigerated? / ______hours ______days

[When information about each source has been obtained] These are all of the questions I have for you. Thank you for your time. Do you have any questions or comments? (Record comments)