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We Were Not Free of Salmonella Saintpaul on the 4th of July; And Probably Still Aren’t

Remember one of the lessons of the movie classic "Butch Cassidy & the Sundance Kid?"  If you are being chased and the distance on the ground between you and them isn’t changing; your losing!

For days now, the Centers for Disease Control & Prevention has been able to look in its rear view mirror and ten days back see the last onset of the Salmonella Saintpaul illness.  The CDC today reported latest date for when Salmonella Saintpaul made was July 4th.

"Butch" and "Sundance" kept saying: "Who are those guys?"  CDC folk are probably saying a few things under their breath as well.  Its latest report has 1,148 confirmed cases of Salmonella Saintpaul.  CDC has 28 investigators in the field, trying to figure out the source of this outbreak.   All it has been able to come up with so far, is a salad bowl of possibilities.  CDC today said:

Three larger clusters have been intensively investigated. In one, illnesses were linked to consumption of an item containing fresh tomatoes and fresh jalapeno peppers.

In the other two, illnesses were linked to an item containing fresh jalapeno peppers and no other of the suspect items. The accumulated data from all investigations indicate that jalapeno peppers caused some illnesses but that they do not explain all illnesses.

Raw tomatoes, fresh serrano peppers, and fresh cilantro also remain under investigation. Investigators from many agencies are collaborating to track the source of the implicated peppers and other produce items.

Read the Extended Entry for the complete press release with map from CDC:

CDC is collaborating with public health officials in many states, the Indian Health Service, and the U.S. Food and Drug Administration (FDA) to investigate an ongoing multi-state outbreak of human Salmonella serotype Saintpaul infections. An initial epidemiologic investigation in New Mexico and Texas comparing foods eaten by persons who were ill in May to foods eaten by well persons identified consumption of raw tomatoes as strongly linked to illness. A similar but much larger, nationwide study comparing persons who were ill in June to well persons found that ill persons were more likely to have recently consumed raw tomatoes, fresh jalapeno peppers, and fresh cilantro. These items were commonly, though not always, consumed together, so that study could not determine which item(s) caused the illnesses.

Cases infected with the outbreak strain of Salmonella Saintpaul, United States, by state, as of July 13, 2008 9pm EDT

Cases infected with the outbreak strain of Salmonella Saintpaul, United States, by state, as of July 13, 2008 9pm EDT

Recently, many clusters of illnesses have been identified in several states among persons who ate at restaurants. Most clusters involve fewer than 5 ill persons. Three larger clusters have been intensively investigated. In one, illnesses were linked to consumption of an item containing fresh tomatoes and fresh jalapeno peppers. In the other two, illnesses were linked to an item containing fresh jalapeno peppers and no other of the suspect items. The accumulated data from all investigations indicate that jalapeno peppers caused some illnesses but that they do not explain all illnesses. Raw tomatoes, fresh serrano peppers, and fresh cilantro also remain under investigation. Investigators from many agencies are collaborating to track the source of the implicated peppers and other produce items.

Since April, 1148 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in 42 states, the District of Columbia, and Canada. These were identified because clinical laboratories in all states send Salmonella strains from ill persons to their State public health laboratory for characterization. No new states report ill persons. The number of ill persons identified in each state is as follows: Alabama (2 persons), Arkansas (14), Arizona (52), California (9), Colorado (15), Connecticut (4), Florida (2), Georgia (25), Idaho (6), Illinois (104), Indiana (16), Iowa (2), Kansas (17), Kentucky (1), Louisiana (1), Maine (1), Maryland (32), Massachusetts (26), Michigan (21), Minnesota (19), Mississippi (2), Missouri (17), New Hampshire (4), Nevada (11), New Jersey (12), New Mexico (102), New York (32), North Carolina (14), Ohio (8), Oklahoma (25), Oregon (10), Pennsylvania (12), Rhode Island (3), South Carolina (2), Tennessee (8), Texas (448), Utah (2), Virginia (31), Vermont (2), Washington (17), West Virginia (1), Wisconsin (11), and the District of Columbia (1). Four ill persons are reported from Canada; all four appear to have been infected while traveling in the United States.

Among the 804 persons with information available, illnesses began between April 10 and July 4, 2008, including 348 who became ill on June 1 or later. Many steps must occur between a person becoming ill and the determination that the illness was caused by the outbreak strain of Salmonella; these steps take an average of 2-3 weeks. Therefore, an illness reported today may have begun 2-3 weeks ago. Patients range in age from <1 to 99 years; 50percent are female. The rate of illness is highest among persons 20 to 29 years old; the rate of illness is lowest in children 10 to 19 years old and in persons 80 or more years old. At least 220 persons were hospitalized. A man in his eighties who died in Texas from cardiopulmonary failure had an infection with the outbreak strain at the time of his death; the infection may have contributed to his death. A man in his sixties who died in Texas from cancer had an infection with the outbreak strain of at the time of his death; the infection may have contributed to his death.

Only 6 persons infected with this strain of Salmonella Saintpaul were identified in the country during April through June of 2007. The previous rarity of this strain and the distribution of illnesses in all U.S. regions suggest that the implicated food is distributed throughout much of the country. Because many persons with Salmonella illness do not have a stool specimen tested, it is likely that many more illnesses have occurred than those reported. Some of these unreported illnesses may be in states that are not on today�s map.

Health officials have worked continuously since late May to investigate this outbreak. CDC has sent 28 people to the field to work with other public health officials. The investigation is complex and difficult. One difficult aspect is that people often have difficulty remembering exactly what foods they ate, and remembering specific ingredients in those foods is even more difficult. Although laboratory testing of foods might help identify the source, perishable foods that were consumed by ill persons are often not available to test. When food items are mixed together and consumed in the same dish, all the items may be statistically linked to illness. In that case, determining by statistical means which item caused the illness can be difficult or impossible. Tracing suspect produce items back to processors and growers is an integral part of the effort to identify a single source and a possible means of contamination.