We investigated a diarrhea outbreak in 2 universities to identify the etiological agent responsible, the source of infection, the mode of transmission, and the risk factors. A case-controlled study was conducted using case students and asymptomatic control students who were selected randomly and frequency-matched according to class and age, and the source of food or water intake was investigated. Of the total 22,404 students at the universities, 0.25% developed Salmonella Infections. A total of 96% (54/56) of the case students and 30% (35/117) of the control students consumed bread products provided by the same vendor (odds ratio [OR] = 63.3; 95% confidence interval [CI], 14.9-550.7). Among the students who consumed bread, 96% (52/54) of the case students and 9% (3/35) of the control students ate egg sandwiches (OR = 277.3; 95%CI, 43.9-1,750.8). Seven strains of Salmonella enteritidis and 6 strains of S. chester were isolated from the case students or food samples. Pulsed-field gel electrophoresis typing showed the same patterns. The outbreak of gastroenteritis was caused mainly by egg sandwiches contaminated with different serotypes of Salmonella.
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