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The Louisiana’s Department of Health is investigating a Salmonella outbreak in Caldwell Parish that has sickened more than 100 and may have contributed to one death. Local and state authorities trying to determine if the death of a 56-year-old man, Duane Reitzell, was connected to a mass illness.

Samantha Hartmann, press officer for the Louisiana Department of Health, said preliminary tests of samples have returned positive for Salmonella.

As of Thursday, 49 cases of a gastrointestinal illness were confirmed with 31 people hospitalized, the Department of Health reported. The ages of those with a confirmed illness range from 15 to 70.

State officials also reported Thursday samples taken from five people have tested positive for salmonella.

Sheriff Clay Bennett, who also is sick, said more than 100 residents have sought medical treatment. Bennett said workers at the sheriff’s office also fell ill Tuesday afternoon. He said employees ate jambalaya from a local softball fundraiser, but no one was certain about the origin of the illness. Bennett said the illness could have come from anything.

Virginia Health officials say about 150 people living in eight states have been sickened by salmonella after attending a chili cook-off in Virginia.

Dr. David Matson, director of the state’s Eastern Shore Health District, said by phone Wednesday that half of them have sought medical treatment. Some have been hospitalized.

More than 2,000 people attended the 18th Annual Chincoteague Chili Chowder Cook-Off and Car Show on Sept. 30.

Matson said most people sickened by the bacteria have already become ill with diarrhea, vomiting and fever.

Officials are asking cook-off attendees to fill out a survey as they determine the bacteria’s source.

People who’ve gotten sick live in Virginia, Maryland, Delaware, New Jersey, New York, Pennsylvania, West Virginia and North Carolina.

 

The Washington State Department of Agriculture (WSDA) is advising consumers not to drink Pride & Joy Dairy organic retail raw milk because it may be contaminated with salmonella, an organism that can cause serious illness.

This public health notice was initiated after routine sampling by WSDA found salmonella in bottled organic retail raw milk collected from the Pride & Joy Dairy in Toppenish. The product has a best-by date of October 4 (OCT 4). WSDA and the company continue to investigate the source of the problem. Currently, there are no reported cases of human illnesses associated with this product.

Salmonella can cause serious and sometimes fatal infections in humans. Young children, the elderly, and those with compromised immune systems are especially at risk. Healthy persons infected with salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain. In rare circumstances, infection with salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis. Anyone experiencing these symptoms should immediately contact a health care provider.

The company sells its products in pint, quart, half-gallon, and one-gallon plastic containers. This public health notice includes all container sizes.

According to Pride & Joy Dairy’s website, the firm distributes their products to the following locations in Washington state:

Eastern Washington:

Pride & Joy Dairy farm store (Granger)

Bear Foods (Chelan)

Better Life Natural Foods (Ellensburg)

Settler’s Country Market (Ephrata and Moses Lake)

Sage Mountain Natural Foods (Leavenworth)

The Mazama Store (Mazama)

Yoke’s Fresh Market (Richland)

Glover Street Market (Twisp)

Lemongrass Natural Foods (Wenatchee)

Rhubarb Market (Wenatchee)

Wenatchee Natural Foods (Wenatchee)

Mill Creek Natural Foods (Union Gap)

Rosauers Supermarkets (Yakima)

Drop-off group locations:

Cle Elum

Ellensburg

Leavenworth

Selah

Wenatchee

Western Washington:

Marvel Food and Deli (Auburn)

Battle Ground Produce (Battle Ground)

The Family Grocer (Duvall)

Sno-Isle Food Co-op (Everett)

Marlene’s Market & Deli (Federal Way and Tacoma)

San Juan Island Food Co-op (Friday Harbor)

Nature’s Market (Kent)

Sunshine Corners Nutrition (Kent)

Skagit Valley Food Co-op (Mount Vernon)

Central Co-op (Seattle)

Arnada Naturals (Vancouver)

Chuck’s Produce (2 locations in Vancouver)

Drop-off group locations

Auburn

Bellevue

Bothell

Issaquah/Tiger Mountain

Kenmore

Kent/Covington

Kirkland

Lake City

Lynnwood

North Bend

Puyallup

Sammamish

Seattle/Seward Park

Shoreline

This outbreak is one of four separate outbreaks currently under investigation that are linked to imported Maradol papayas from Mexico

This past spring, CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration investigated a multistate outbreak of Salmonella Anatum infections.

Fourteen people infected with the outbreak strain of Salmonella Anatum were reported from three states. Illnesses started on dates ranging from December 20, 2016, to April 8, 2017. Five ill people were hospitalized. One death was reported from California.

On September 4, 2017, FDA testing identified the outbreak strain of Salmonella Anatum from a sample taken from an imported papaya at the U.S.-Mexico border. Epidemiologic, laboratory, and traceback evidence indicates that Maradol papayas imported by Bravo Produce Inc. of San Ysidro, California, are the likely source of this multistate outbreak. On September 10, 2017, Bravo Produce Inc. recalled Maradol papayas packed by Frutas Selectas de Tijuana, S. de RL de CV. The papayas were distributed to California from August 10 to August 29, 2017.

A total of 201 people infected with the outbreak strains of Salmonella Thompson (131), Salmonella Kiambu (57), Salmonella Agona (8), or Salmonella Gaminara (5) have been reported from 23 states.

Sixty-five ill people have been hospitalized. One death was reported from New York City.

The CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Salmonella infections.

This outbreak includes four different types of Salmonella: Thompson, Kiambu, Agona, and Gaminara. The same strain of these types of Salmonella were found in samples collected from papayas and from ill people.

Epidemiologic and laboratory evidence indicates that Maradol papayas from the Carica de Campeche farm in Mexico are the likely source of this multistate outbreak.

Two additional outbreaks of Salmonella infections linked to imported papayas from two other farms in Mexico, Caraveo Produce and El Zapotanito, have been identified. Available information indicates that illnesses in these two outbreaks are not linked to papayas from the Carica de Campeche farm and are being investigated separately.

CDC recommends that consumers not eat, restaurants not serve, and retailers not sell Maradol papayas from the Carica de Campeche, Caraveo Produce, or El Zapotanito farms in Mexico.

Because three separate outbreaks linked to papayas from different farms have been identified, CDC is concerned that papayas from several other farms in Mexico might be contaminated with Salmonella and have made people sick.

A total of 173 people infected with the outbreak strains of Salmonella Kiambu (51), Salmonella Thompson (111), Salmonella Agona (7), or Salmonella Gaminara (4) have been reported from 21 states.  Connecticut 6, Delaware 4, Iowa 2, Illinois 3, Kentucky 4, Louisiana 1, Maryland 8, Massachusetts 8, Michigan 1, Minnesota 4, Missouri 1, North Carolina 5, New Jersey 36, New York 50, Ohio 1, Oklahoma 4, Pennsylvania 8, Tennessee 1, Texas 9, Virginia 16, Wisconsin 1.  Fifty-eight ill people have been hospitalized. One death was reported from New York City.

The CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Salmonella infections. This outbreak includes four different types of Salmonella: Kiambu, Thompson, Agona, and Gaminara. The same strain of these types of Salmonella were found in samples collected from papayas and from ill people.

 

Epidemiologic and laboratory evidence indicates that Maradol papayas from the Carica de Campeche farm in Mexico are the likely source of this multistate outbreak. Three brands of Maradol papayas have been recalled: Caribeña brand, distributed by Grande Produce; certain Cavi brand papayas distributed by Agroson’s; and Valery brand papayas, distributed by Freshtex Produce, LLC. If anyone has these papayas in their home, they should dispose of them immediately. The FDA has also added the Carica de Campeche farm to Import Alert (IA) 99-35, after testing found multiple strains of Salmonella present in the fruit. Thus far, Salmonella strains matching the outbreak patterns by PFGE were only isolated from papayas from the Carica de Campeche farm.

As of August 9, 2017, 141 people infected with the outbreak strains of Salmonella Kiambu (51) or Salmonella Thompson (90) have been reported from 19 states. Connecticut 5, Delaware 4, Iowa 2, Illinois 2, Kentucky 3, Louisiana 2, Maryland 8, Massachusetts 6, Michigan 1, Minnesota 4, North Carolina 3, New Jersey 27, New York 39, Ohio 1, Oklahoma 4, Pennsylvania 8, Texas 7, Virginia 14, Wisconsin 1, Total 141
Illnesses started on dates ranging from May 17, 2017 to July 27, 2017. Ill people range in age from less than 1 year to 95, with a median age of 39. Among 136 ill people with available information, 83 (61%) are female. Among 98 people with available information, 66 (67%) are of Hispanic ethnicity. Among 103 people with available information, 45 (44%) have been hospitalized. One death was reported from New York City.

Illnesses that occurred after July 14, 2017, might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 4 weeks.

Based on information collected to date, CDC is now recommending that consumers not eat Maradol papayas from the Carica de Campeche farm in Mexico. If consumers aren’t sure if their Maradol papaya came from the Carica de Campeche farm, they should ask the place of purchase. When in doubt, don’t eat it; just throw it out. Restaurants and retailers should not serve or sell Maradol papayas from the Carica de Campeche farm.

As was reported in the last update on August 4, FDA tested other papayas imported from Mexico and isolated several types of Salmonella bacteria, including Salmonella Agona, Salmonella Kiambu, Salmonella Gaminara, Salmonella Thompson, and Salmonella Senftenberg. CDC is working to determine if there are any illnesses with these other types of Salmonella linked to this outbreak.

The FDA is advising consumers not to eat Maradol papayas from the Carica de Campeche farm in Mexico because they are linked to an outbreak of salmonellosis.

Three brands of Maradol papayas have been recalled: Caribeña brand, distributed by Grande Produce; certain Cavi brand papayas distributed by Agroson’s; and Valery brand papayas, distributed by Freshtex Produce, LLC. If anyone has these papayas in their home, they should dispose of them immediately.

The CDC reports today that the outbreak investigation has expanded to include another strain of Salmonella.

Sixty-four more ill people from 15 states were added to this investigation since the last update on July 21, 2017.

Six more states have reported ill people: Connecticut, Delaware, Michigan, North Carolina, Oklahoma, and Wisconsin

Laboratory tests showed that the strain of Salmonella Thompson isolated from papayas collected in Maryland is closely related genetically to clinical isolates from ill people.

FDA tested other papayas imported from Mexico and found they were contaminated with several types of Salmonella.

A total of 109 people infected with the outbreak strains of Salmonella Kiambu (48) or Salmonella Thompson (61) have been reported from 16 states – Iowa, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Texas, Utah, Virginia, Connecticut, Delaware, Michigan, North Carolina, Oklahoma, and Wisconsin

Thirty-five ill people have been hospitalized. One death has been reported from New York City.

Epidemiologic and laboratory evidence indicates that Maradol papayas imported from Mexico are the likely source of this multistate outbreak.

At this time, Caribeña brand papayas from Mexico have been identified as one brand linked to the outbreak. On July 26, Grande Produce recalled Caribeña brand Maradol papayas that were distributed between July 10 and July 19, 2017.

Through testing, the FDA has also identified Maradol papayas from the Carica de Campeche papaya farm in Mexico as a likely source of the outbreak. The agency is working to identify other brands of papayas that may have originated from Carica de Campeche and facilitate recalls.

CDC recommends that consumers not eat, restaurants not serve, and retailers not sell Maradol papayas from Mexico.

WHAT IS SALMONELLA?

It has long been said that, in 1885, pioneering American veterinary scientist, Daniel E. Salmon, discovered the first strain of Salmonella. Actually, though, Theobald Smith, research-assistant to Dr. Salmon, discovered the first strain of SalmonellaSalmonella cholerae suis. But, being in charge, Dr. Salmon received all of the credit. Today, the number of known serotypes of Salmonella bacteria totals over two thousand. Concerns have been raised in recent years, as particular strains of Salmonella have become resistant to traditional antibiotics.

The term Salmonella refers to a group or family of bacteria that variously cause illness in humans. The taxonomy and nomenclature of Salmonella have changed over the years and are still evolving. Currently, the Centers for Disease Control and Prevention (CDC) recognizes two species of Salmonella, which are divided into seven subspecies. These subspecies are divided into over 50 serogroups based on somatic (O) antigens present. The most common Salmonella serogroups are A, B, C, D, E, F, and G. Serogroups are further divided into over 2,500 serotypes, and are typically identified through a series of tests of antigenic formulas listed in a document called the Kauffmann-White Scheme, which is published by the World Health Organization Collaborating Centre for Reference and Research on Salmonella.[1]

Three Salmonella serotypes—Enteritidis, Typhimurium, and Newport—have persisted as the serotypes most often isolated in patients and reported to the CDC over the last decade. In 2009, these three serotypes accounted for 42% of all reported cases of Salmonella.[2]

Where Does Salmonella Come From?

Salmonella is an enteric bacterium, which means that it lives in the intestinal tracts of humans and other animals. Salmonella bacteria are usually transmitted to humans by eating foods contaminated with animal feces, or foods that have been handled by infected food service workers who have practiced poor personal hygiene. Contaminated foods usually look and smell normal and are often of animal origin, such as beef, poultry, milk, or eggs. But all foods, including vegetables, may become contaminated. Many raw foods of animal origin are frequently contaminated, but thorough cooking kills Salmonella. Though, the food handler who neglects to thoroughly wash his or her hands with soap and warm water after using the bathroom may contaminate foods that have otherwise been properly prepared.

What are the Symptoms of Salmonellosis?

Once in the lumen of the small intestine, the bacteria penetrate the epithelium, multiply, and enter the blood within 24 to 72 hours. Variables such as the health and age of the host, and virulence differences among the serotypes, affect the nature of the diagnosis. Infants, the elderly, individuals hospitalized, and the immune-suppressed are the populations that are most susceptible to Salmonellosis and suffer the most severe symptoms.

“The majority of persons infected with Salmonella have diarrhea, fever, and abdominal cramps 12-72 hours after exposure. The illness usually lasts 4-7 days, and the majority of persons recover without treatment.” MMWR Weekly, supra at 684. However, much longer incubation periods of 120 hours to 31 days have been documented in previous Salmonella outbreaks.[3]

The acute symptoms of Salmonella gastroenteritis include the sudden onset of nausea, abdominal cramping, and bloody diarrhea with mucous. As already noted, there is no real cure for a Salmonella infection; treatment, therefore, tends to be palliative – although prescription of antibiotics is common, even if usually contraindicated.

Medical treatment is acutely important, though, if the patient becomes severely dehydrated or if the infection spreads from the intestines. Persons with severe diarrhea often require re-hydration, usually with intravenous (IV) fluids. But antibiotics are not necessary or indicated unless the infection spreads from the intestines, at which time the infection can be treated with ampicillin, gentamicin, trimethoprim/sulfamethoxazole, or ciprofloxacin. Unfortunately, though, some Salmonella bacteria have become resistant to antibiotics, largely as a result of the use of antibiotics to promote the growth of feed animals.

MEDICAL COMPLICATIONS

Reactive Arthritis

The term reactive arthritis refers to an inflammation of one or more joints, following an infection localized at a site distant from the affected joints. The predominant site of the infection is the gastrointestinal tract. And reactive arthritis can be post infection, meaning that the infection may not be active when diagnosed. Several bacteria, including Salmonella, can reactive arthritis.[4]  And although the resulting joint pain and inflammation can resolve completely over time, permanent joint damage can occur.[5]

Reiter’s syndrome, a form of reactive arthritis, is an uncommon but debilitating syndrome caused by gastrointestinal or genitourinary infections. The reactive arthritis associated with Reiter’s may develop after a person eats food that has been tainted with bacteria. In a small number of persons, the joint inflammation is accompanied by conjunctivitis (inflammation of the eyes), and uveitis (painful urination). Id. This triad of symptoms is called Reiter’s Syndrome.[6]    Salmonella is one of the most common gastrointestinal bacteria involved with Reiter’s Syndrome. And although Reiter’s syndrome is characterized by a triad of arthritis, conjunctivitis, and urethritis, not all three symptoms occur in all affected individuals.[7]

Even though the initial infection may not be recognized, reactive arthritis can still occur. Reactive arthritis typically involves inflammation of one joint (monoarthritis), or four or fewer joints (oligoarthritis), preferentially affecting those of the lower extremities; the pattern of joint involvement is usually asymmetric. Inflammation is common at the places where ligaments and tendons attach to bone (enthuses), especially the knee and the ankle.

Salmonella has been the most frequently studied bacteria associated with reactive arthritis. Overall, studies have found rates of Salmonella-associated reactive arthritis to vary between six and thirty percent.[8] The frequency of post-infectious Reiter’s Syndrome, however, has not been well described. In a Washington State study, while twenty-nine percent of research participants developed arthritis, only three percent developed the triad of symptoms associated with Reiter’s syndrome.[9] In addition, individuals of Caucasian descent were found to be potentially more likely than those of Asian descent to develop reactive arthritis,[10] and children potentially less susceptible than adults to reactive arthritis following infection with Salmonella.[11]

A clear association has been made between reactive arthritis and a genetic factor called the human leukocyte antigen (HLA) B27 genotype. HLA is the major histocompatibility complex in humans; these are proteins present on the surface of all body cells that contain a nucleus, and are in especially high concentrations in white blood cells (leukocytes). It is thought that HLA-B27 may affect the elimination of the infecting bacteria or an individual’s immune response.[12]  HLA-B27 has been shown to be a predisposing factor in one-half to over two-thirds of individuals with reactive arthritis.[13] While HLA-B27 does not appear to predispose to the initial infection itself, it increases the risk of developing arthritis that is more likely to be severe and prolonged. This risk may be slightly greater for Salmonella and Yersinia-associated arthritis than with Campylobacter, but more research is required to clarify this.[14]

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic disorder characterized by alternating bouts of constipation and diarrhea, both of which are generally accompanied by abdominal cramping and pain.[15] In one recent study, over one-third of IBS sufferers had lived with IBS for more than ten years, and their symptoms remained fairly constant over time.[16] The study found that IBS sufferers typically experienced symptoms for an average of 8.1 days per month.[17]

Another recently-published study—The Walkerton Health Study (WHS)—surveyed the extant scientific literature and noted that post-infectious irritable bowel syndrome (PI-IBS) is a common clinical phenomenon first-described over five decades ago.[18] The WHS further notes that between five and thirty percent of patients who suffer an acute episode of infectious gastroenteritis develop chronic gastrointestinal symptoms, despite clearance of the inciting pathogens.[19] In terms of its own data, the WHS “confirm[ed] a strong and significant relationship between acute enteric infection and subsequent IBS symptoms.”[20] The WHS also identified risk-factors for subsequent IBS including: younger age; female sex; and four features of the acute enteric illness—diarrhea for > 7days, presence of blood in stools, abdominal cramps, and weight loss of at least ten pounds.[21]

As would be expected from a chronic disorder with symptoms of such persistence, IBS sufferers were found to require more time off work, spend more days in bed, and to more often cut down on usual activities, when compared with non-IBS sufferers.[22] And even when able to work, a significant majority (67%) of IBS sufferers felt less productive at work because of their symptoms.[23] IBS symptoms also have a significantly deleterious impact on social well-being and daily social activities, such as undertaking a long drive, going to a restaurant, or taking a vacation.[24] And finally, although a patient’s psychological state may influence the way in which he or she copes with illness and responds to treatment, there is no evidence to supports the theory that psychological disturbances in fact cause IBS or its symptoms.[25]

[1]     Grimont, PAD, Weill, F.  Antigenic formulae of the Salmonella serovars, 2007, 9th Edition. WHO Collaborating Centre for Reference and Research on Salmonella. Paris: Pasteur Institute.  http://www.pasteur.fr/ip/portal/action/WebdriveActionEvent/oid/01S-000036-089.

[2]     http://www.cdc.gov/ncezid/dfwed/PDFs/SalmonellaAnnualSummaryTables2009.pdf, Table 1.

[3]     O’ Mahony, et al.  An outbreak of Salmonella Heidelberg infection associated with a long incubation period.  J. Public Health (1990) 12 (1): 19-21;  Abe, et al.  Prolonged Incubation Period of Salmonellosis Associated with Low Bacterial Doses.  J. Food Protection (2004) Vol. 67, No. 12; 2735-2740.

[4]     See Reactive Arthritis. “Questions and Answers About.” N.p., n.d. Web. 12 Nov. 2015.

[5]     Id.

[6]     IdSee also, Dworkin, et al.  “Reactive Arthritis and Reiter’s Syndrome following an outbreak of gastroenteritis caused by Salmonella enteritidis,” Clin. Infect. Dis., 2001 Oct. 1;33(7): 1010-4; Barth, W. and Segal, K.  “Reactive Arthritis (Reiter’s Syndrome),” American Family Physician, Aug. 1999, online at www.aafp.org/afp/990800ap/499.html.

[7]     Hill Gaston JS, Lillicrap MS.  (2003).  Arthritis associated with enteric infection.  Best Practices & Research Clinical Rheumatology.  17(2):219-239.

[8]     Id.

[9]     Dworkin MS, Shoemaker PC, Goldoft MJ, Kobayashi JM.  “Reactive arthritis and Reiter’s syndrome following an outbreak of gastroenteritis caused by Salmonella enteritidis.”  Clin. Infect. Dis. 33(7):1010-1014.

[10]    McColl GJ, Diviney MB, Holdsworth RF, McNair PD, Carnie J, Hart W, McCluskey J.  “HLA-B27 expression and reactive arthritis susceptibility in two patient cohorts infected with Salmonella Typhimurium,” Australian and New Zealand Journal of Medicine.  30(1):28-32 (2001).

[11]    Rudwaleit M, Richter S, Braun J, Sieper J.  “Low incidence of reactive arthritis in children following a Salmonella outbreak,” Annals of the Rheumatic Diseases, 60(11):1055-1057 (2001).

[12]    Hill Gaston and Lillicrap, supra Note 7.

[13]    Id.; Barth WF, Segal K., “Reactive arthritis (Reiter’s syndrome).” American Family Physician, 60(2):499-503, 507 (1999).

[14]    Hill Gaston and Lillicrap, supra Note 7.

[15]    A.P.S. Hungin, et al.  Irritable Bowel Syndrome in the United States: Prevalence, Symptom Patterns and Impact, Aliment Pharmacol. Ther., 2005:21 (11); 1365-75.

[16]    Id. at 1367.

[17]    Id.

[18]    J. Marshall, et al.  Incidence and Epidemiology of Irritable Bowel Syndrome After a Large Waterborne Outbreak of Bacterial Dysentery, Gastro., 2006; 131;445-50 (hereinafter “Walkerton Health Study” or “WHS”).  The WHS followed one of the largest E. coli O157:H7 outbreaks in the history of North America.  Contaminated drinking water caused over 2,300 people to be infected with E. coli O157:H7, resulting in 27 recognized cases of HUS, and 7 deaths.  Id. at 445.  The WHS followed 2,069 eligible study participants.  Id.  For Salmonella specific references, see Smith, J.L., Bayles, D.O., Post-Infectious Irritable Bowel Syndrome: A Long Term Consequence of Bacterial Gastroenteritis.  Journal of Food Protection, 2007:70(7);1762-1769.

[19]    Id. at 445 (citing multiple sources).

[20]    WHS, supra note 34, at 449.

[21]    Id. at 447.

[22]    Id. at 1368.

[23]    Id.

[24]    Id.

[25]    Amy Foxx-Orenstein, DO, FACG, FACP.  IBS—Review and What’s New.  General Medicine, 2006:8(3) (Medscape 2006) (collecting and citing studies).  Indeed, PI-IBS has been found to be characterized by more diarrhea but less psychiatric illness with regard to its pathogenesis.  See Nicholas J. Talley, MD, PhD.  Irritable Bowel Syndrome: From Epidemiology to Treatment, from American College of Gastroenterology 68th Annual Scientific Meeting and Postgraduate Course (Medscape 2003).

Seattle-King County Public Health Friday announced it is investigating a salmonellosis outbreak caused by Salmonella Stanley, an uncommon strain of Salmonella bacteria.

Six persons infected with Salmonella Stanley were reported to Public Health during July 17–July 24.

On July 26-27, genetic fingerprinting results for four of the six cases became available, and all had the same genetic fingerprint, suggesting that they have some common source of infection; genetic fingerprinting for the other two cases is pending.

This fingerprint has only been seen twice before in King County where two to six cases of Salmonella Stanley have been reported annually over the past several years. Public Health is attempting to interview each case to gather information about possible risk factors for infection.

The source of the outbreak is still under investigation.

The median age of the cases is 21 years; three cases are female and three are male. None of the cases are known to have been hospitalized. Additional details on the investigation will be posted as they are available.

Salmonellosis is a bacterial infection that is often spread through the fecal-oral route, through contaminated food and water, or through contact with animals and their environments. Symptoms of salmonellosis include nausea, vomiting, diarrhea, headache, fever, chills, and abdominal cramping. Illness typically lasts several days and people can spread infection to others even after symptoms resolve.

To prevent Salmonella infection:

  • Wash hands with soap and water after going to the bathroom, changing diapers, touching animals, and before eating or preparing food.
  • Cook all meats thoroughly, especially poultry.
  • Wash cutting boards and counters used for meat or poultry preparation immediately after use to avoid cross contaminating other foods.
The CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Salmonella Kiambu infections.As of July 21, 2017, 47 people infected with the outbreak strain of Salmonella Kiambu have been reported from 12 states. Illnesses in Iowa, 1, Kentucky, 1, Louisiana, 1, Maryland, 5, Massachusetts, 1, Minnesota, 1, New Jersey, 12, New York, 13, Pennsylvania, 4, Texas, 1, Utah, 1 and Virginia, 6. WGS showed that isolates from people infected with Salmonella Kiambu are closely related genetically. This close genetic relationship means that people in this outbreak are more likely to share a common source of infection.

Illnesses started on dates ranging from May 17, 2017 to June 28, 2017. Ill people range in age from less than 1 year to 95, with a median age of 27. Among ill people, 67% are female. Among 31 people with available information, 18 (58%) are of Hispanic ethnicity. Among 33 people with available information, 12 (36%) report being hospitalized. One death was reported from New York City.

Epidemiologic and laboratory evidence collected to date indicate that yellow Maradol papayas are a likely source of this multistate outbreak. This investigation is ongoing.

An illness cluster in Maryland was identified. An illness cluster is defined as two or more people who do not live in the same household who report eating at the same restaurant location, attending a common event, or shopping at the same location of a grocery store in the week before becoming ill. In Maryland, several ill people reported eating papayas purchased from the same location of a grocery store. Salmonella Kiambu and Salmonella Thompson were isolated from samples collected from ill people. Investigating illness clusters provides critical clues about the source of an outbreak. If several unrelated ill people ate or shopped at the same location of a restaurant or store within several days of each other, it suggests that the contaminated food item was served or sold there.

The Maryland Department of Health collected papayas from the grocery store associated with the illness cluster to test for Salmonella. One sample yielded the outbreak strain of Salmonella Kiambu and another sample yielded Salmonella Thompson. Both samples were from yellow Maradol papayas. WGS showed that the Salmonella Kiambu papaya isolate is closely related genetically to the Salmonella Kiambu isolates from ill people. This result provides more evidence that people in this outbreak got sick from eating contaminated yellow Maradol papayas. CDC is working to collect additional information to determine whether the recent Salmonella Thompson illness in Maryland is part of this multistate outbreak.

Based on the available evidence, CDC recommends that consumers not eat, restaurants not serve, and retailers not sell yellow Maradol papayas until we learn more.