About Salmonella and Salmonellosis

Salmonella is a bacterium that causes one of the most common enteric (intestinal) infections in the United States. In 2006, over 40,000 cases were reported to the Centers for Disease Control and Prevention (CDC). Overall, the incidence of Salmonella in the United States has not changed significantly since 1996. Only a small proportion of all Salmonella infections are diagnosed and reported to health departments. The CDC estimates that 1.4 million cases, 15,000 hospitalizations, and 400 deaths are caused by Salmonella infections in the United States every year.

People are infected by ingesting the bacteria. Salmonella are found in the intestinal tract of wild and domesticated animals and humans. Contaminated foods of animal origin, such as poultry, pork, beef, unpasteurized milk, or eggs, are often the source of infection. However, all foods, including vegetables, may become contaminated. Since Salmonella is found in the feces of animals, people may become infected when coming into contact with animals or their environment. Pets such as snakes, turtles, lizards and other reptiles, frogs and baby chicks/ducklings are known to transmit Salmonella to people. Also, an infected person can transmit the bacteria via the fecal-oral route.


Symptoms of Salmonella infection

The most common clinical presentation of a Samonella infection is acute gastroenteritis. Symptoms include diarrhea, and abdominal cramps, often accompanied by fever of 100°F to 102°F. Other symptoms may include bloody diarrhea, vomiting, headache and body aches. The incubation period, or the time from ingestion of the bacteria until the symptoms start, is generally 6 to 72 hours, however, in there is evidence that sometimes the incubation can be as long as 10 days. People with salmonellosis usually recover without treatment within 3 to 7 days.

In approximately 5 percent of non-typhoidal infections, patients develop bacteremia (Salmonella found in the blood). In a small proportion of those cases, the bacteria can cause a focal infection, where it becomes localized in a tissue and causes an abscess, arthritis, endocarditis, or other severe illness. A small proprotion of persons with a Salmonella infection develop a complication called reactive arthritis (Reiter’s Syndrome). Symptoms include inflammation of the joints, the genitourinary tract, or the eyes.


S. Typhi and Paratyphi generally cause a bacteremic illness of long duration. This illness is called enteric, typhoid, or paratyphoid fever. Symptoms start gradually, and include fever, headache, malaise, lethargy, and abdominal pain. In children, it can present as a non-specific fever. The incubation period for S. Typhi is usually 8 to 14 days, but it can range from 3 to 60 days.


Detection and treatment of Salmonella infection

Salmonella bacteria can be detected in stool. In cases of bacteremia or invasive illness, the bacteria can also be detected in the blood, urine, or on rare occasions in tissues. The test consists of growing the bacteria in culture.

Salmonella infections usually resolve in 3 to 7 days, and many times require no treatment. Persons with severe diarrhea may require rehydration. Antimicrobial therapy (or treatment with antibiotics) is not recommended for uncomplicated gastroenteritis. However, antimicrobial therapy is recommended for persons at increased risk of invasive disease, including infants younger than 3 months of age. When antibiotic treatment is indicated, ampicillin, amoxicillin, or trimethoprim/sulfamethoxazole is recommended. Ceftriaxone, cefotaxime or flouroquinolones are effective options for antimicrobial-resistant strains; except, fluoroquinolones are not approved for persons under 18 years of age. For persons with invasive disease, treatment with an expanded-spectrum cephalosporin is recommended, until it is known if the bacteria is susceptible to one of the more commonly used antibiotics listed above.

The selection of effective antibiotics is critical for the treatment of invasive Salmonella infections, but has become more difficult as antibiotic-resistance has increased. Antibiotic-resistant Salmonella have been isolated from various food products, and have been the causative agent in several foodborne disease outbreaks in the United States. Traceback investigations in outbreak settings have shown animals to be the ultimate source of infection. Antibiotic use in the animal industry is thought to contribute greatly to the prevalence of multidrug-resistant infections in humans.


Preventing Salmonella infection

To prevent salmonellosis, always wash your hands before and during cooking, and before eating. Cook poultry, pork, beef and eggs thorughly. Poultry should reach an internal temperature of 165 ºF, ground beef and pork should reach 160ºF, and eggs until the yoke is solid or until they reach 160ºF. Do not eat or drink foods containing raw eggs (e.g., homemade eggnog, hollandaise sauce, and undercooked French toast). Never drink raw (unpasteurized) milk. Wash hands, kitchen work surfaces, and utensils with soap and water immediately after they have been in contact with raw foods of animal origin. Avoid cross-contamination, by keeping raw foods of animal origin separate from foods that do not require further cooking.

 

Wash hands with soap after after contact with animals, their environment or their feces.
Reptiles, amphibians or birds, or any elements of their housing (such as water bowls) should never be allowed in the kitchen. Avoid eating in animal barns, and wash your hands with soap and water after visiting petting zoos or farm settings.

Avoid preparing food for others when you are experiencing diarrhea or vomiting, and wash your hands thoroughly after going to the bathroom.

 

Usually All Is Well In Lee's Summit, MO; But Not Today--Salmonella Sends Two Little Ones To The Hospital

Richardson Elementary School students in Lee's Summit, MO were sent home with warning letters yesterday after two kindergartners were hospitalized with salmonella.

A boy, listed in fair condition, and a girl, whose condition was not being released, were enrolled in Richardson's Kids Country during the school year.

Health officials could not say if the illnesses are school related.

Salmonella is often spread through contaminated food and less frequently from person-to-person or on toys and other objects. The school has instructed its district custodians to do additional cleaning and disinfecting at Richardson Elementary as a precaution.

FOX-4 in Kansas City is covering the situation here.

Tested Positive For Salmonella Last September, Union International Just Gets Around To Recalling White Peppers With Red Labels

Somebody must have hit the "re-send" button overnight at the Food & Drug Administration (FDA) as we received a number of recall notices from earlier May that we've already written about.

One that is somewhat new, however, is from last Friday when Union International Food Company recalled Lian How Brand White Peppers with red labels because of possible Salmonella contamination.   

The City of Industry, CA-based company said the Lian How Brand White Peppers were packaged in 5 pound containers with red labels for distribution to Southern California restaurants and wholesalers between Sept. 2008 and March 2009.   So, the possibility of any of these White Peppers still being around is probably pretty small.

Why it has taken so long to identify this problem is not clear.  Union says the recall was the result of a testing done on a shipment of peppers that was purchased around September of 2008 which revealed that the finished products contained the salmonella bacteria. 

Why it took until May 29, 2009 to issue a recall on products that tested positive for salmonella in September 2008 is question we do not know the answer to.  Union claims it is cooperating fully with FDA; and no illnesses are yet associated with this recall.

Consumers who have purchased the affected white peppers with red label product are urged to return it to the place of purchase for a full refund. Consumers with questions may contact the company at (626) 854-8880

Here's what the FDA has on it.

 

Food & Drug Administration (FDA) Makes Its 483 Inspection Report of Setton Pistachio Public

 

In a 483 Inspection Report released today, FDA inspectors identified multiple food-safety shortcomings at the Setton Pistachio of Terra Bella California that was linked to a Salmonella outbreak earlier this year:

1. The company detected the bacteria in roasted pistachios in October but did not change its processing procedures until March

2. In one instance, the company re-roasted pistachios that had tested positive for Salmonella and blended them together with other nuts for sale.

3. Inspectors identified a "failure to manufacture, package and store foods under conditions and controls necessary to minimize the potential for growth of microorganisms and contamination."

4. Specific physical problems ranged from a rusty hole in the roof above one pistachio roaster to "thick layers of dust and debris" in a packaging room.

5. Procedural shortcomings included failure to monitor roasting temperatures and allowing raw and roasted pistachios to potentially come into contact.

6. Between October 2008 and March 2009, the report noted that "there were at least eight reported Salmonella-positive test results" coming out of the Terra Bella plant. When the firm learned of the private laboratory test results, inspectors said, there were no "procedures in place" to respond appropriately.

7. Prior to January, inspectors added, the Terra Bella plant did not monitor roasting temperatures, roasting times or the depth of pistachios placed on the roasting conveyor belts.

8. Inspectors checked records for 14 lots of roasted pistachios. In a potentially dangerous step, 10 of these lots had raw pistachios packed on the same packaging equipment prior to the roasted pistachios being run.

Does this not sound just a bit like the 483 Inspection report at the Peanut Corporation of America?  Setton is just lucky they did not sicken and kill people or they may too be facing bankruptcy and jail time.  When are companies going to get a clue?

WAL*MART Cantaloupes In Carolinas And South Hill, Virginia Recalled After Testing Positive For Salmonella

 How big is "a lot?" Raleigh, NC-based L&M Companies, Inc. has recalled "one lot of whole cantaloupes because it has the potential to be contaminated with Salmonella.

One lot must be a lot because there were enough cantaloupes to fulfill the needs of Walmart Supercenter Stores in North Carolina and South Carolina, and in the Walmart Supercenter Store located at 315 Furr Street in South Hill, Virginia. The cants were sold between the 10th and 15th of this month.

No illnesses have yet been associated with the recall.

"Consumers who have purchased whole cantaloupes from these Walmart stores during this time period should not consume them, and should destroy the product," L&M said in its recall statement.

The recall comes after a cantaloupe at a small farm from which L&M Companies sources product tested positive for Salmonella. L&M has ceased shipments from this farm, and the grower continues to investigate the cause of the problem.

L&M's statement can be found on the FDA's website here.

The Smoking Hot Pepper Has Been Found, Just Across The Rio Grande



They managed to do it with a little drum roll before a Congressional committee.   The smoking hot pepper has been captured across the Rio Grande in Mexico.   Here's a bit of what the Washington Post reported just a short time ago:

Investigators discovered the Salmonella saintpaul strain in irrigation water and serrano peppers on a farm in Mexico, where jalapeno peppers are also grown.

"We have a smoking gun it appears," said Lonnie King, a director at the federal Centers for Disease Control and Prevention.

The Food and Drug Administration, which earlier issued a warning about jalapeno peppers, is now warning consumers also to avoid raw serrano peppers grown and packed in Mexico.

Here's how the dots were connected:

The farm where the contaminated water was found grows only jalapeno and Serrano peppers. It supplied a packing facility in Mexico that also did business with Agricola Zaragosa, the McAllen, Tex., distributor where FDA inspectors found tainted jalapeno peppers last week. The farm and the packing facility are located in Nuevo Leon, a state in northeastern Mexico. A portion of Nuevo Leon borders Texas.

FDA is also awaiting the results of samples collected from a different farm in Tamaulipas, Mexico  It  supplied the tainted jalapeno peppers found at Agricola Zaragosa,  It's possible that the contamination occurred not at that farm but at a distribution center.

Both Nuevo Leon and Tamaulipas are separated from the U.S. only by the Rio Grande and the farms are easily accessbile to U.S. distributors.

Check out the entire Wapo story here.

Tomatoes, Jalapeño Peppers, Serrano Peppers, and Cilantro still linked to Salmonella Saintpaul Illnesses in United States and Canada

According to the CDC since April, 1237 persons infected genetic fingerprint have been identified in 43 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. One new state, Montana, reported a case. The number of ill persons identified in each state is as follows: Alabama (2 persons), Arkansas (16), Arizona (54), California (9), Colorado (16), Connecticut (4), Florida (3), Georgia (28), Idaho (6), Illinois (113), Indiana (18), Iowa (2), Kansas (19), Kentucky (2), Louisiana (1), Maine (1), Maryland (36), Massachusetts (28), Michigan (24), Minnesota (22), Mississippi (2), Missouri (20), Montana (1), New Hampshire (5), Nevada (12), New Jersey (12), New Mexico (102), New York (38), North Carolina (23), Ohio (10), Oklahoma (25), Oregon (10), Pennsylvania (12), Rhode Island (3), South Carolina (2), Tennessee (9), Texas (475), Utah (2), Virginia (31), Vermont (2), Washington (17), West Virginia (1), Wisconsin (13), and the District of Columbia (1). Five ill persons are reported from Canada; four appear to have been infected while traveling in the United States, and one illness remains under investigation.

Also, according to the CDC, Illnesses have been linked to consumption of an "item" containing fresh tomatoes and fresh jalapeño peppers.  Illnesses were also linked to an "item" containing fresh jalapeño peppers and no other of the suspect items.  The accumulated data from all investigations indicate that jalapeño peppers caused some illnesses but that they do not explain all illnesses.  Raw tomatoes, fresh serrano peppers, and fresh cilantro also remain under investigation.

The FDA has a slightly different take on this:

Consumers may resume enjoying any type of fresh tomato, including raw red plum, raw red Roma, and raw red round tomatoes.

While we are changing our consumer guidance about tomatoes, we reiterate our guidance to consumers that those in vulnerable populations (infants, the elderly, and immune-compromised people) should avoid eating jalapeño and serrano peppers as the investigation continues. The Centers for Disease Control and Prevention (CDC) has found that many, but not all, of the people who have become ill during the outbreak also reported eating jalapeño or serrano peppers.

Salmonella Saintpaul Still Making People Sick; 851 Confirmed Cases Latest Count In 36 States And D.C.

Persons infected with the outbreak strain of Salmonella Saintpaul, by state, as of 9pm EST June 29, 2008

Since April, 851 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in 36 states and the District of Columbia. These were identified because clinical laboratories in all states send Salmonella strains from ill persons to their State public health laboratory for characterization. The number of ill persons identified in each state is as follows: Arkansas (10 persons), Arizona (39), California (10), Colorado (11), Connecticut (4), Florida (1), Georgia (18), Idaho (3), Illinois (91), Indiana (11), Kansas (14), Kentucky (1), Maine (1), Maryland (29), Massachusetts (21), Michigan (6), Minnesota (2), Missouri (12), New Hampshire (3), Nevada (4), New Jersey (4), New Mexico (90), New York (26), North Carolina (5), Ohio (6), Oklahoma (19), Oregon (10), Pennsylvania (8), Rhode Island (3), Tennessee (6), Texas (346), Utah (2), Virginia (22), Vermont (2), Washington (4), Wisconsin (6), and the District of Columbia (1). The map above and the state-by-state breakdown was provided late today (6/30/08); and is complete through yesterday at 9 p.m.   Please note: a.) the increase in the total number of cases to 851; and b.) the latest date for when someone contracted Salmonella Saintpaul has advanced to June 20th, just ten days ago. 

More from the Centers For Disease Control & Prevention can be found in the extended reading section.

From the Centers For Disease Control & Prevention (CDC):

An initial epidemiologic investigation comparing foods eaten by ill and well persons identified consumption of raw tomatoes as strongly linked to illness. Recently, many clusters of illnesses have been identified in Texas and other states among persons who ate at restaurants.

These clusters have led us to broaden the investigation to be sure that it encompasses food items that are commonly consumed with tomatoes. Since April, 851 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in 36 states and the District of Columbia. These were identified because clinical laboratories in all states send Salmonella strains from ill persons to their State public health laboratory for characterization.

Among the 581 persons with information available, illnesses began between April 10 and June 20, 2008, including 173 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; 49% are female. The number of illnesses is highest among persons 20 to 29 years old; the number of illnesses is lowest in children 10 to 19 years old and persons greater than 60 years old. At least 105 persons were hospitalized. No deaths have been officially attributed to this outbreak. However, a man in his sixties who died in Texas from cancer had an infection with the outbreak strain of Salmonella Saintpaul at the time of his death. The infection may have contributed to his death.

Salmonella Saitpaul hits 810 in 36 States - Was it Really Tomatoes?

From a CDC/FDA Press Conference today:

As salmonella cases continue to climb, the government is checking if tainted tomatoes really are to blame for the record outbreak - or if the problem is with another ingredient, or a warehouse that is contaminating newly harvested tomatoes. Federal health officials say there's no evidence clearing tomatoes. But inspectors haven't yet found the outbreak's source even as cases continue to rise - to 810 confirmed ill. Most worrisome, the latest victim became sick on June 15. Patricia Griffin of the Centers for Disease Control and Prevention says the agency is looking into other ingredients, just in case tomatoes were not to blame.

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 epidemiologic investigation comparing foods eaten by ill and well persons has identified consumption of raw tomatoes as the likely source of the illnesses. The specific type and source of tomatoes is under investigation; however, the data suggest that illnesses are linked to consumption of raw red plum, red Roma, or round red tomatoes, or any combination of these types of tomatoes, and to products containing these raw tomatoes.

Since April, 810 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in 36 states and the District of Columbia. These were identified because clinical laboratories in all states send Salmonella strains from ill persons to their State public health laboratory for characterization. Maine and Minnesota have been added to the list of states with ill persons. The number of ill persons identified in each state is as follows: Arkansas (10 persons), Arizona (39), California (10), Colorado (8), Connecticut (4), Florida (1), Georgia (18), Idaho (3), Illinois (78), Indiana (11), Kansas (14), Kentucky (1), Maine (1), Maryland (25), Massachusetts (18), Michigan (4), Minnesota (2), Missouri (12), New Hampshire (3), Nevada (4), New Jersey (4), New Mexico (85), New York (25), North Carolina (5), Ohio (6), Oklahoma (19), Oregon (7), Pennsylvania (6), Rhode Island (3), Tennessee (6), Texas (342), Utah (2), Virginia (22), Vermont (1), Washington (4), Wisconsin (6), and the District of Columbia (1).

Will the Great Salmonella Saintpaul Tomato Outbreak End With A Bang or A Whimper?

This weekend began with news from both the U.S. Food & Drug Administration (FDA) and the Centers for Disease Control & Prevention (CDC).

The FDA gave the impression it was closing in on the source of the contaminated tomatoes, sending teams into areas of both Mexico and Florida to some specific farms that might finally turn up who is responsible for the outbreak.    FDA said:

The FDA is now working to narrow the investigation. As part of this, the agency is sending teams of multi-disciplinary experts to both Mexico and Florida this weekend to conduct joint inspections of the farms and other critical points on the supply chain where the tomatoes may have become contaminated.
The FDA investigators will conduct joint inspections with regulators in Mexico and Florida at the farms and other distribution points. Meanwhile, the FDA will continue to collect samples of tomatoes and conduct traceback activities.
To further narrow the investigation, the FDA is working with the state of Texas to traceback a cluster of illnesses recently found by the state of Texas. We are hopeful that this will provide additional information to bring the agency closer to the source of the contamination.
The FDA is working jointly with Mexico and Florida and other states to update the list of areas not associated with the outbreak and will continue to post the information on the web site.

While painting a target on Mexico, FDA at the same time added most Mexican states to the
list of "safe" tomato growing areas.

The "safe" areas now include  include the Mexican states of: Aguascalientes, Baja California Norte, Baja California Sur, Campeche, Colima, Chiapas, Chihuahua, Distrito Federal, Durango, Guanajuato, Guerrero, Hidalgo, México, Michoacán, Morelos, Nayarit, Nuevo León, Oaxaca, Puebla, Querétaro, Quintana Roo, San Luis Potosí, Sonora, Tobasco, Tamaulipas, Tlaxcala, Veracruz, Yucatán, Zacatecas.

The only Mexican state bordering on the U.S. not on the "safe" list is Coahuila.

CDC's list of confirmed cases of Salmonella Saintpaul connected to the tainted tomatoes was 552 as the weekend began.   It said 32 states and the District of Columbia were involved.   New Jersey and Rhode Island were the latest states added to the outbreak list.

So, will FDA close the case or be left so befuddled that the agency makes Lou Dobbs look profound?   What will it say about Mexico or Florida if either area is named when the music stops?
How high will CDC's confirmed number of cases go?   Might CDC say something about the liklihood from previous studies that something like 38 people go untreated for every confirmed case of salmonella? 

That, gentle readers, means about 21,000 people are now victims of Salmonella Saintpaul due to bad tomatoes.

As of 6/20/08, CDC said:

Since April, 552 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in 32 states and the District of Columbia. These were identified because clinical laboratories in all states send Salmonella strains from ill persons to their State public health laboratory for characterization.

The marked increase in reported ill persons since the last update is not thought to be due to a large number of new infections. The number of reported ill persons increased mainly because some states improved surveillance for Salmonella in response to this outbreak and because laboratory identification of many previously submitted strains was completed. In particular, the number of ill persons reported from Texas markedly increased, and two new states, New Jersey and Rhode Island, reported ill persons.

The number of ill persons identified in each state is as follows: Arkansas (3 persons), Arizona (29), California (8), Colorado (4), Connecticut (4), Florida (1), Georgia (11), Idaho (3), Illinois (34), Indiana (8), Kansas (9), Kentucky (1), Maryland (18), Michigan (4), Missouri
(10), New Hampshire (1), New Jersey (1), New Mexico (73), New York (10), North Carolina (1), Ohio (3), Oklahoma (5), Oregon (5), Pennsylvania (5), Rhode Island (2), Tennessee (4), Texas (265), Utah (2), Virginia (20), Vermont (1), Washington (1), Wisconsin (5), and the District of Columbia (1).

Among the 281 persons with information available, illnesses began between April 10 and June 10, 2008. Patients range in age from <1 to 88 years; 49 percent are female. At least 53 persons were hospitalized. No deaths have been officially attributed to this outbreak. However, a man in his sixties who died in Texas from cancer had an infection with the outbreak strain of Salmonella Saintpaul at the time of his death. The infection may have contributed to his death.

CDC Tomato/Salmonella Update: 383 Confirmed Cases In 30 States Plus D.C.

States with persons with the outbreak strain of Salmonella Saintpaul, by state of residence.

Here are the money lines from today's update on the Salmonella Saintpaul outbreak involving tomatoes from the Centers on Disease Control & Prevention:

Since April, 383 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in 30 states and the District of Columbia: Arkansas (2 persons), Arizona (26), California (8), Colorado (2), Connecticut (2), Florida (1), Georgia (8), Idaho (3), Illinois (34), Indiana (8), Kansas (9), Kentucky (1), Maryland (10), Michigan (3), Missouri (9), New Hampshire (1), New Mexico (70), New York (9), North Carolina (1), Ohio (3), Oklahoma (5), Oregon (4), Pennsylvania (2), Tennessee (4), Texas (131), Utah (2), Virginia (17), Vermont (1), Washington (1), Wisconsin (5), and the District of Columbia (1).

These were identified because clinical laboratories in all states send Salmonella strains from ill persons to their State public health laboratory for characterization. The marked increase in reported ill persons is not primarily due to a large number of new infections. The number of reported ill persons increased markedly mainly because some states improved surveillance for Salmonella in response to this outbreak and because laboratory identification of many previously submitted strains was completed.

Among the 243 persons with information available, illnesses began between April 10 and June 5, 2008. Patients range in age from <1 to 88 years; 47 percent are female. At least 48 persons were hospitalized. No deaths have been officially attributed to this outbreak. However, a man in his sixties who died in Texas from cancer had an infection with the outbreak strain of Salmonella Saintpaul at the time of his death. The infection may have contributed to his death.

 

More Cases In New States and D.C.

Since yesterday’s update of the numbers from the Centers for Disease Control, it appears that new cases of Salmonella Saintpaul have turned up in Ohio, Kentucky, and the District of Columbia.

The Columbus Dispatch reports:

Three cases of salmonella have been reported in central Ohio and linked to the national outbreak involving tomatoes, according to Columbus Public Health.

The Ohio story is here.

The Lexington Herald-Leader reports:

The Salmonella outbreak linked to tomatoes has reached Kentucky.
A Louisville woman has been diagnosed with the same strain of Salmonella that has sicked people in 23 other states, the Kentucky Department of Public Health announced Friday.

Go here for more from Kentucky.

And the Washington, D.C. Examiner reports:

The District of Columbia has reported its first case of salmonella linked to the current tomato-related outbreak.
The D.C. Department of Health said a resident tested positive for Salmonella Saintpaul, the uncommon type of salmonella that has sickened at least 228 other people in 23 states.
Officials say the resident appears to have eaten many tomatoes recently.

The D.C. story can be found here.

The New Map - States with persons with the outbreak strain of Salmonella Saintpaul, by state of residence.

The CDC website's updated map showing states with persons with the outbreak strain of Salmonella Saintpaul, by state of residence.

Tomato Outbreak of Salmonella Saintpaul Grows To 17 States

States with persons with the outbreak strain of Salmonella Saintpaul, by state of residence.

The Centers for Disease Control & Prevention offers the following summary of the outbreak as of today:

Since mid-April, 167 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in 17 states: Arizona (12 persons), California (2), Colorado (1), Connecticut (1), Idaho (2), Illinois (27), Indiana (7), Kansas (5), Michigan (2), New Mexico (39), Oklahoma (3), Oregon (3), Texas (56), Utah (1), Virginia (2), Washington (1), and Wisconsin (3). These were identified because clinical laboratories in all states send Salmonella strains from ill persons to their State public health laboratory for characterization. Among the 73 persons who have been interviewed, illnesses began between April 16 and May 27, 2008. Patients range in age from 1 to 82 years; 49% are female. At least 23 persons were hospitalized.

CDC Comments on How Rarity of Salmonella Saintpaul

Only 3 persons infected with this strain of Salmonella Saintpaul were identified in the country during the same period in 2007. The previous rarity of this strain and the distribution of illnesses in all U.S. regions suggest that the implicated tomatoes are distributed throughout much of the country. Because of inherent delays in reporting and because many persons with Salmonella illness do not have a stool specimen tested, it is likely many more illnesses have occurred than those reported.

US Food & Drug Administration(FDA) Adds 12 States to "Safe" List

The "safe" list of states and countries has been expanded by FDA with the addition of 12 more states.  (In bold face type ) The seven countries on the list remain unchanged. FDA recommends consuming raw red plum, raw red Roma, or raw red round tomatoes only if grown and harvested from the areas that HAVE NOT BEEN ASSOCIATED WITH THE OUTBREAK:

STATES

Alabama                       
Arkansas
California
Georgia
Hawaii
Louisiana
Maine
Maryland
Minnesota
Mississippi
New York
Nebraska
North Carolina
Ohio
Pennsylvania
South Carolina
Tennessee
Texas
West Virginia

FOREIGN COUNTRIES

Belgium
Canada
Dominican Republic
Guatemala
Israel
Netherlands
Puerto Rico

A Second Source Says: "It Must Be Mexico"

Bob Drobatz is president of operations for Petaluma Market in Santa Rosa, CA.  He told the Santa Rosa Press Democrat that the tomatoes he was pulling from grocery shelves came from Mexico.

Mexico is one of the biggest suppliers of red round tomatoes and the country was conspicuously absent from the FDA  “safe” list,  Drobatz said.

I assume it must be Mexico where the suspect tomatoes are from,” he said.

Yesterday we reported Dr. Michael Landen, deputy state epidemiologist with the New Mexico Department of Health, said  “Preliminary data indicates the tomatoes we are having problems with are from Mexico."

How much longer must we wait for FDA to come out with the Unsafe List? 
Bill Marler asked the same question on the Marler blog.

So, where the Hell did the Salmonella Tomatoes and E. coli Romain Lettuce come from?


He also asks:  In the days of the risk of bio-terrorism, and with the advent of computer technology to pin-point where our books from Amazon are, you would think we would be able to trace-back contaminated tomatoes and lettuce a bit quicker?


Here Are the Latest Salmonella Saintpaul Numbers; State-by-State

The Centers for Disease Control, along with several state health agencies and the federal Indian Health Service says the investigation into the Salmonella Saintpaul outbreak has identified consumption of raw tomatoes as the likely source of the illnesses in New Mexico and Texas.

The specific type and source of tomatoes is under investigation; however, preliminary data suggest that large tomatoes, including Roma and red round are the source.

Here from CDC are the official numbers, as of yesterday (6/4/08):

Since late April, 57 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in Texas (24 persons) and New Mexico (33 persons). These were identified because clinical laboratories in all states send Salmonella strains from ill persons to their State public health laboratory for characterization. Among the 38 persons who have been interviewed, illnesses began between April 23 and May 27, 2008. Patients range in age from 3 to 82 years; 48% are female. At least 17 persons were hospitalized. No deaths have been reported.

In addition, 29 persons with the outbreak strain of Salmonella Saintpaul have been reported since mid-April in residents of Arizona (6 persons), Colorado (1), Idaho (2), Illinois (12), Indiana (1), Kansas (3), Utah (1), Virginia (1), and Wisconsin (2). Investigations are underway to determine if consumption of raw tomatoes is also associated with illness in these states.

CDC's consumer and other information on the outbreak can be found here.

CDC Salmonella Saintpaul Outbreak Map

Persons infected with the outbreak strain of Salmonella Saintpaul, United States, by state, April 15 to June 4, 2008

Salmonella outbreaks being investigated in Pennsylvania, Montana

salmonellaThe Lancaster News reported that at least eleven people have been culture-confirmed with Salmonella infections since eating food from Mazzi, a restaurant whose owner also co-owns the Leola Village Inn & Suites.  According to  the story:
John Calabrese, who owns Mazzi and co-owns Leola Village Inn & Suites with his wife, Deborah Shirk, said about 50 people attended the Dec. 10 party at the restaurant, which is part of the Leola Village complex off Route 23.

When the workers got sick with nausea, fever, chills and other symptoms, "we couldn't figure out what was going on" and immediately notified the Health Department, Calabrese said. The restaurant also quarantined some areas "and sanitized everything," he said.

Stacy Kriedeman, a spokeswoman for the Department of Health, said Friday that there were 11 confirmed laboratory cases of salmonella involving people who ate at Mazzi on Dec. 10, 11 and 12, and 39 more people who reported feeling ill.
Both diners attending private parties at Mazzi and diners who attended the Leola Village Christmas gathering experienced Salmonella infection.  The health department continues its work to determine which foods can be associated with illness. 

Elsewhere, KULR TV reported that Yellowstone County, Montana, residents have become ill with a strain of Salmonella that has also been isolated from residents of Texas and Pennsylvania.  The investigation into what has caused this apparent outbreak is ongoing:
The information will then be sent to the Centers for Disease Control and Prevention where experts will pinpoint the source of contamination. "The CDC will run it through an EPI program, and it's like a sorting program that goes through all the interviews and sorts through what item it could be," said Tamalee Taylor, communicable disease specialist at Yellowstone County Health Department.

Salmonella outbreaks traced to tomatoes

Vindy.com today reported on the resolution of one of the last Sheetz Salmonella cases that stemmed from the 2004 Salmonella outbreak traced to contaminated tomatoes.  According to the newspaper report:
Anslinger's case was notable because it was the vehicle for the complicated discovery process — the pretrial exchange of evidence — used to determine where the tomatoes originated, said Anslinger's attorney, William Marler.

salmonella tomatoesThe settlement terms are confidential, according to Sheetz attorney Gary Zimmerman and Marler, who represented more than 130 of the sickened customers.

In August, Blair County Judge Jolene Kopriva concluded that Altoona-based Sheetz and its vegetable wholesaler, Coronet Foods, could not pinpoint where the tainted tomatoes originated. So, Kopriva dismissed claims brought by Anslinger and other customers against two tomato suppliers and six farms or other businesses that may have grown the tomatoes.
The Sheetz Salmonella outbreak was not the only one traced back to contaminated tomatoes, as evidenced by the recent outbreak at Quizno's that was caused by consumption of tomatoes.   In addition:
  • In 1990, a reported 174 Salmonella javiana illnesses, as part of a four state outbreak, were linked to raw tomatoes.
  • In 1993, 84 reported cases of Salmonella Montevideo were part of a three state outbreak that was linked to raw tomatoes.
  • In January 1999, Salmonella Baildon was recovered from 86 infected persons in eight states.
  • In July 2002, an outbreak of Salmonella javiana occurred associated with attendance at the 2002 U.S. Transplant Games held in Orlando, Florida during late June of that year. Ultimately, the outbreak investigation identified 141 ill persons in 32 states who attended the games.
  • During August and September 2002, a Salmonella Newport outbreak affected the East Coast. Ultimately, over 404 confirmed cases were identified, in over 22 states. Epidemiological analysis indicated that tomatoes were the most likely vehicle, and were traced back to the same tomato packing facility in the mid-Atlantic region. 
  • In early July 2004, as many as 564 confirmed cases of salmonellosis associated with consumption of contaminated tomatoes purchased at Sheetz Convenience Store were reported in five states, Pennsylvania, Maryland, Ohio, West Virginia, and Virginia. Seventy percent were associated with tomatoes in food prepared at Sheetz convenience stores. 
  • In 2006 two outbreaks of Salmonella-tainted tomatoes where reported by the FDA. According to Ms. Murphy, the Food & Drug Administration is now investigating two tomato-related outbreaks, with the latest blamed for nearly 100 illnesses in 19 states. FDA was already tracing tomatoes involved in another outbreak involving 183 people in 21 states. Federal authorities said that fresh tomatoes contaminated with Salmonella typhimurium served in restaurants were the likely cause of that outbreak.

Salmonella outbreaks

WBTV published a press release from the Catawba County Public Health Department on its website regarding the Salmonella outbreak that has recently plagued customers of Carniceria y Taqueria Hermanos Chavez located in Newton. Following is an excerpt from the press release:
Catawba County Public Health is continuing to investigate a food borne illness outbreak. There have been 176 cases of illness reported so far. The lab has confirmed 25 cases being positive for Salmonella. “As of this afternoon, we are encouraged by the fact that there have been no further reports of people presenting with symptoms at local emergency rooms,” stated Doug Urland, Health Director at Catawba County Public Health.

Most of the people with symptoms report having eaten at Carniceria y Taqueria Hermanos Chavez located in Newton off U.S. 321 business. On Friday, November 2nd Public Health made a site visit to the restaurant and the owner was very concerned about the health of his patrons so he voluntarily closed the restaurant on that evening as a precautionary measure and it has remained closed. The owner is working closely with Public Health Officials to meet the required measures including; discarding restaurant food and sanitizing the establishment.
Not surprisingly, this week's food safety infosheet from the International Food Safety Network  focuses on Salmonella outbreaks.  The infosheet, titled, "What's up with all the Salmonella? Is it that common?" can be found below.
Salmonella Infosheet

Update: North Carolina Salmonella Outbreak

WSOC TV reported yesterday that the Newton, North Carolina restaurant associated with a large Salmonella outbreak may not reopen after the health department concludes its investigation into the source of the outbreak. 
Experts with the Catawba County Public Health Office said they may never know for sure what caused the outbreak at the Carniceria y Taqueria off U.S. 321 Business. The owner has scrubbed the place down, but he said he knows some customers will never come back.

Health officials are concerned the outbreak could continue to spread even though the restaurant has stopped serving. That’s because some of those who ate at the restaurant work at other restaurants in town, where they could spread the illness that has symptoms that include shaking, a high fever and diarrhea.
So far, 15 people have been confirmed ill with Salmonellosis, and over 100 people reported becoming ill after eating at Carniceria y Taqueria. 

Salmonella found in chocolate

BBC News reported recently that Fox's Confectionery had discovered Salmonella in its Leicester chocolate plant.  According to the BBC report, the plant has not been open since October 15, but plans to reopen soon.  Also included in the report was the following:
Chocolate Salmonella InfosheetFox's said the contamination was most likely to have come from a batch of Brazil nuts at its Leicester plant.

The contamination was first discovered two weeks ago, but none of the affected products were released. The plant could start production again on Thursday.

The contaminated nuts - used to make the firm's Just Brazils product range - were found during routine testing.







This week's Food Safety Infosheet from the International Food Safety Network provides information regarding a number of recent chocolate recalls due to Salmonella contamination.

24 salmonella cases investigated in Sierra Vista area

State health officials confirmed three more salmonella cases in the Sierra Vista area, raising the number investigated to 24.

The cause of the outbreak remains unknown.

A cluster of salmonella was first identified last week in the area when 20 confirmed cases were reported, mostly in young children and adults.
 

Salmonella Lawsuit Filed Against Wal-Mart

A lawsuit was filed today against Wal-Mart Stores, Inc., the company whose Greenwood, Indiana, store was the source of a Salmonella outbreak. The lawsuit was filed in Johnson County Superior Court on behalf of a Greenwood resident whose son became violently ill and was hospitalized after consuming foods purchased at the Wal-Mart deli. The lawsuit was filed by Marler Clark, a Seattle-based law firm that has represented hundreds of victims of Salmonella outbreaks.

The complaint alleges that Mr. Merritt purchased ham and cheese from the Wal-Mart deli. Mr. Merritt’s son, Noah, consumed the ham and cheese in the subsequent days and became ill; Noah’s symptoms became severe, and he was seen in the Emergency Room at St. Francis Hospital in Indianapolis. Noah was subsequently admitted to the hospital; while hospitalized, Noah provided a stool sample that tested positive for Salmonella.

“The Indiana State Health Department reported that at least 84 customers who ate foods from the deli and bakery departments at Wal-Mart from May to August were part of this Salmonella outbreak,” said William Marler, attorney for Mr. Merritt. “We’ve seen this before and will see it again,” Marler continued. “Businesses who fail to enforce strict handwashing policies will continue to be the source of outbreaks, and will be held responsible for their failures through the legal system.”

Towards improved surveillance of food poisoning cases in Europe

Public health professionals will soon have a clearer picture of the magnitude of food poisoning across Europe, thanks to a new European project which aims to improve the surveillance of food-borne infections across the continent.

The project is part of the Med-Vet-Net initiative, a European Network of Excellence which brings together experts from a range of fields to improve research into diseases transmitted from animals to humans, including food-borne infections.

The new project will focus on two of the most common food-borne infections in Europe: Salmonella and Campylobacter. Between them, these bacteria cause hundreds of thousands of cases of gastrointestinal illness every year. Salmonella is found principally in meat, meat products and eggs. Campylobacter is also found mostly in meat, but it has also been detected in fish products, cheese and vegetables.

Ultimately, the researchers hope that by painting a more accurate picture of the incidence of these diseases, public health officials will be able to implement better disease control methods.

From farm to food to outbreak

Change in food-borne illness control became necessary because of the way food is distributed in the United States, reports Susan Brink of the Times. In the old days of food poisoning, the source usually could be traced back to a local event: potato salad at a family picnic or bad chicken at a church supper. Today, with massive amounts of food going from farms to food processing centers and then mixing with food from other farms before heading to tables in all 50 states, outbreaks are far less likely to be local, and thus, far more difficult to notice.

The change that came out of the 1993 Jack-In-The-Box tragedy is called PulseNet, a partnership between the CDC and state health departments. Stool samples are sent to state public health departments by doctors. The health departments then use DNA analysis to subtype pathogenic bacteria present in the stools. The resulting DNA fingerprints can identify not only species but also strains of such bacteria as E. coli, salmonella, shigella, listeria and Campylobacter.

Then the information gets sent to a central CDC database. This can quickly let public health officials know if cases strewn far and wide across the country carry identical fingerprints.

Epidemiologists also weigh in, fanning out within affected states and using food questionnaires to find out what people had eaten before getting sick (in the current outbreak, identifying pre-washed, bagged spinach).

But this is still not a perfect system, says Bala Swaminathan, acting senior advisor for laboratory science at CDC's division of food-borne safety.. It typically takes three to four days for a patient's symptoms to kick in, a day or two before the patient seeks medical care, then up to three days for results from a stool sample to reach the physician. And frustrating slowdowns can come from something as simple as how long it takes for positive results to make their way from a physician's office to state labs and then into the PulseNet database.

In some states, reporting can happen the same day the physician gets lab results. In others, it can take up to a week. And all this time, Americans — oblivious to any problem — continue to eat the contaminated food.

Chicken entrees may include raw meat

Some frozen chicken entrees, such as Chicken Kiev and Chicken Cordon Bleu, have been linked to salmonella poisoning in consumers who thought they were microwaving pre-cooked meat. In fact, the entrees contained raw meat and the microwave did not sufficiently cook them.

At least 48 people have been stricken with salmonella poisoning over the past 19 months when they ate undercooked frozen chicken entrees that were microwaved, according to the Minneapolis Star Tribune.

The labels sometimes indicate "ready-to-cook" when referring to a raw product. Testing also found that some microwave cooking times were inadequate for safe preparation. New warning labels will appear before November, ordered by the USDA. Meanwhile, two manufacturers have changed their labels to suggest only conventional-oven preparation.

Is It Food Poisoning?

Food-borne illnesses can strike after meals at restaurants or at home, and young children, who can get dehydrated quickly, are at greatest risk.

It's easy to forget about the looming threat of food poisoning during end-of-summer picnics and barbecues and lingering over outdoor suppers, says Beth Turner. The scary truth: Staples like burgers, fresh seafood, chicken, egg salad, and even watermelon can make your family sick if you don't wash, handle, cook, and store them properly.

Fortunately, most pathogens are killed by high temperatures, so even problem foods are safe as long as you cook them thoroughly. Refrigerating or freezing foods prevents most bacteria from multiplying. But if you leave lightly contaminated hot food -- or your baby's bottle of formula -- at room temperature for hours, the number of organisms can skyrocket. The bacteria Staphylococcus aureus grows easily in moist, salty foods -- such as a ham sandwich -- and produces a toxin that causes intense vomiting.

Even when food poisoning is caused by bacteria, pediatricians usually don't prescribe antibiotics, says Ari Brown, MD, author of Toddler 411. Some forms of E. coli can lead to kidney failure in young children, and experts believe that antibiotics can trigger this serious complication. And when a child has been infected with Salmonella, antibiotics may actually prolong the time it takes for the bacteria to leave the intestinal tract. However, antibiotics do help treat severe diarrhea caused by Shigella. Before prescribing antibiotics for your child, your pediatrician will probably do a stool culture to identify the organism.

Turner outlines 10 key steps the public may not be taking:

  • Thaw frozen seafood, meat, and poultry in the refrigerator overnight, not on the counter. If you need to thaw food quickly, seal it in a plastic bag and put it in cold water for an hour, or microwave it on "defrost" and cook it immediately.
  • If you plan to cook seafood, meat, or poultry within two days after you buy it, store it in the coldest part of the refrigerator. Otherwise, freeze it.
  • Don't buy cooked seafood, such as shrimp or crab, that is displayed in the same case as raw fish.
  • Marinate food in the refrigerator, not on the counter. If you want to use the marinade as a dip or sauce, boil it before serving it.
  • Keep hot food hot and cold food cold. Bacteria multiply rapidly between 40 degrees F. and 140 degrees F. Refrigerate leftovers after no longer than two hours.
  • Periodically check that your fridge temperature is no higher than 40 degrees F. and your freezer is 0 degrees F.
  • Sanitize your cutting board in the dishwasher or with hot, soapy water after and between cutting raw meat, poultry, or fish. It's best to keep two boards on hand; designate one for fresh produce and the other for meats and seafood.
  • Buy a meat thermometer. It makes it much easier to tell when meat or chicken is cooked thoroughly. Be sure to wash it between uses.
  • Remove and discard the outer leaves of heads of lettuce, and thoroughly rinse bagged lettuce.
  • Look for the new freshQ labels on packages of meat and poultry at the supermarket; the stickers -- developed using military-defense sensor research -- change color when the meat is spoiled.
     

Salmonella found in more than 26% of egg-producing farms

Salmonella, a bacteria that can cause potentially fatal food poisoning, was detected in more than 26 percent of egg-producing farms surveyed by the Japan Poultry Association.

Although the figure is on par with the 20-30 percent estimated average in the European Union, questions remain about the infection rate in Japan. The United States and some European countries conduct nationwide salmonella surveys on a regular basis. However, Japan has not done so. Local governments or layer farm operators have so far conducted salmonella surveys only after strong suspicions arise that hens are infected.

The farm ministry plans to conduct a larger-scale survey over five years from next fiscal year at an estimated cost of about $739,418. The Ministry of Agriculture, Forestry and Fisheries' survey will cover poultry farms, wholesalers and retailers.

WENDY'S HOMESTYLE GARLIC CROUTONS MAY CONTAIN SALMONELLA BACTERIA

The Canadian Food Inspection Agency and Wendy's Restaurants of Canada, Inc. are warning the public not to consume Wendy's Homestyle Garlic Croutons because the product may be contaminated with Salmonella.

The affected product has been sold at Wendy’s restaurants in Ontario and Quebec. A voluntary recall of the affected product from the marketplace has been initiated by Wendy’s.

There have been no reported illnesses associated with the consumption of this product.

Three confirmed salmonella cases in Polk

The Rutherford-Polk-McDowell District Health Department has confirmed three salmonella cases in Polk County. All three cases involve Polk County High School students but no connection among them has yet been established. At least one of the confirmed patients had to be hospitalized.

Helen White, RN, PHN Supervisor at Rutherford-Polk-McDowell District Health Department, says the health department has worked well with the N.C. Department of Health and Human Services and the Polk County School system to test and monitor students. Officials asked students what and where they ate as far back as 72 hours prior to developing symptoms.

According to the N.C. HHS, Salmonella is on the rise in North Carolina, with as many as five times the number of cases as usual so far this year.

Pasteurization helps kill bacteria in egg recipe dishes

Pasteurization kills bacteria present in food. As long as cross-contamination does not occur (from hands, utensils or other foods) pasteurized foods should be safe for even those in high risk groups.

To pasteurize recipes containing eggs, 160 degrees F must be reached or 140 degrees F reached and held for three minutes.

To pasteurize eggs at home, Debbie Wilburn of Poultry Today suggests the following method:

Combine at least 2 tablespoons of the liquid in the recipe for each beaten egg or egg yolk (4 egg yolks, 8 tablespoons liquid). Liquids used can be water, juice, milk or flavorings; but not oil or margarine.
Cook this mixture over medium-low heat, stirring constantly, until it just starts to bubble. Mixture should be thickened and should coat a spoon; if a candy thermometer is handy, use it.
If the mixture looks like it might start to curdle, remove it from heat and stir rapidly, return to low heat and continue cooking.

This pasteurization technique can be used for all recipes calling for uncooked eggs or egg yolks, containing at least 2 tablespoons of liquid per egg. More liquid can be used if the recipe contains more.

What is Salmonella?

Salmonella is one of the most common intestinal infections in the U.S. The reported incidence of Salmonella illnesses are about 17 cases per each 100,000 persons.

Salmonella is a type of bacteria that causes typhoid fever and many other infections of intestinal origin. Typhoid fever, rare in the U.S., is caused by a particular strain designated Salmonella typhi. But illness due to other Salmonella strains, called "salmonellosis," is common in the U.S. Today, the number of known strains of this bacterium total over 2,300.

Over 40,000 actual cases are reported and confirmed yearly in the U.S. As only about 3% of Salmonella cases are officially reported nationwide, and many milder cases are never diagnosed, the true incidence is undoubtedly much higher. It is more common in the warmer months of the year. Approximately 500 to 1,000 persons, or 31% of all food-related deaths are caused by Salmonella infections in the U.S. every year.

In 1885, pioneering American veterinary scientist, Daniel E. Salmon, discovered the first strain of Salmonella from the intestine of a pig. This strain was called Salmonella choleraesuis, the designation that is still used to describe the genus and species of this common human pathogen.

More on Wal-Mart and Salmonela

Indiana State health officials over the last two weeks reported that the source of the recent salmonella outbreak as the Wal-Mart in Greenwood. The deli and bakery departments were identified as the source of the recent salmonella outbreak in northern Johnson and southern Marion counties.

The likely cause of the outbreak was determined to be ill workers handling food.

Currently, 84 cases of salmonella have been reported to be part of the outbreak, which began in May 2006.  Marler Clark has been contacted by over a dozen sickened individuals.  A lawsuit was filed last week on behalf of one family.
 

Salmonella lawsuit filed against Wal-Mart

A lawsuit was filed today against Wal-Mart Stores, Inc., the company whose Greenwood, Indiana, store was the source of a Salmonella outbreak between May and August, 2006.

The lawsuit was filed by Marler Clark and Greenwood attorney John M Reames on behalf of Ryan Merritt, a Greenwood resident whose son became violently ill and was hospitalized after consuming foods purchased at the Wal-Mart deli.

The attorneys allege that Mr. Merritt purchased ham and cheese from the Wal-Mart deli on August 13.  Mr. Merritt’s son, Noah, consumed the ham and cheese in the subsequent days and became ill on August 18.  Noah’s symptoms became severe, and he was admitted to the ER at St. Francis Hospital in Indianapolis. While hospitalized, Noah provided a stool sample that tested positive for Salmonella.

An Indiana State Department of Health investigation into the Salmonella outbreak led ISDH to believe that infected food workers who did not exhibit symptoms of Salmonellosis, or who were a-symptomatic carriers of the bacterium, contaminated the deli and bakery foods.

“We’ve seen this before and will see it again,” Marler continued. “Businesses who fail to enforce strict handwashing policies will continue to be the source of outbreaks, and will be held responsible for their failures through the legal system.”