The Pennsylvania Department of Health is investigating four Salmonella outbreaks at healthcare facilities in southeastern Pennsylvania.

The Pennsylvania Department of Health is investigating four Salmonella outbreaks at healthcare facilities in southeastern Pennsylvania. To date, we have identified 29 case-patients who spent time during their incubation periods in one of four healthcare facilities experiencing outbreaks, which include two hospitals and two long-term care facilities (LTCFs). Known onset dates range from November 19-November 30, 2019. Case identification is ongoing, which is essential to identify exposure risks, ensure appropriate clinical management, and implement prevention strategies.

Symptoms of Salmonella include diarrhea, abdominal pain, and fever. Diarrhea is sometimes bloody. Symptoms usually begin within 12 to 72 hours after exposure, but they can begin up to a week or more after exposure. Salmonella infections usually resolve in 5 to 7 days, but may require hospitalization, especially for patients who are immunocompromised. Invasive infections (for example, blood stream infections, meningitis) may occur. In rare cases, Salmonella infections can lead to death.

According to the CDC, since the last update on November 1, 2019, one additional ill person has been reported from Washington. As of November 19, 2019, a total of 11 people infected with the outbreak strain of Salmonella Dublin have been reported from seven states – Washington, California, Colorado, Kansas, Oklahoma, Texas and Iowa.

Illnesses started on dates ranging from August 8, 2019, to October 20, 2019. Ill people range in age from 39 to 74 years, with a median age of 66. Seventy-three percent of ill people are male.

Of nine ill people with information available, eight (89%) were hospitalized. One death has been reported in California. In five (45%) ill people, Salmonella was found in samples of blood, which indicates their illnesses may have been more severe. Salmonella Dublin is known to commonly cause more severe illnesses than other Salmonella strains, particularly in older people.

USDA-FSIS and state partners traced the source of some of the ground beef eaten by one ill person in this outbreak to Central Valley Meat Co., Inc.  On November 15, 2019, Central Valley Meat Co., Inc. recalled 34,222 pounds of ground beef produced that may be contaminated with Salmonella Dublin.

At this time, a single supplier, distributor, or brand of ground beef has not been identified that can account for all the illnesses in this outbreak. The investigation is ongoing and CDC will update the public if more information becomes available.

As of November 1, 2019, a total of 10 people infected with the outbreak strain of Salmonella Dublin have been reported from 6 states.  There has been on reported death in California.

Illnesses started on dates ranging from August 8, 2019, to September 22, 2019. Ill people range in age from 48 to 74 years, with a median age of 68. Eighty percent of ill people are male. Of nine ill people with information available, eight (89%) were hospitalized, which is much higher than we would expect for Salmonella infections. The hospitalization rate is usually about 20%. One death has been reported in California. In five (50%) ill people, Salmonella was found in samples of blood, which indicates their illnesses may have been more severe. Typically, Salmonella Dublin illnesses are more severe because they can cause bloodstream infections, which are serious and require hospitalization.

Illnesses might not yet be reported due to the time it takes between when someone becomes ill and when the illness is reported. This takes an average of 2 to 4 weeks.

Whole genome sequencing analysis did not identify any antibiotic resistance in 16 bacterial isolates from 10 ill people and 6 food specimens. Testing of clinical isolates using standard antibiotic susceptibility testing methods by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) is underway.

Epidemiologic and laboratory evidence indicates that ground beef might be contaminated with Salmonella Dublin and is making people sick. At this time, the investigation has not identified a single, common supplier of ground beef.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Of eight people interviewed, six (75%) reported eating ground beef at home. This percentage is significantly higher than results from a survey of healthy people in which 40% of respondents reported eating any ground beef at home in the week before they were interviewed. Ill people reported buying ground beef from various stores.

Laboratory testing identified the outbreak strain of Salmonella Dublin in repackaged leftover ground beef collected from an ill person’s home in California. The outbreak strain of Salmonella Dublin has also been identified in six samples of raw beef products from slaughter and processing establishments. Samples from slaughter and processing establishments were collected as part of FSIS’s routine testing under the Salmonella performance standards. WGS showed that the Salmonella strain from these samples was closely related genetically to the Salmonella from ill people. These results provide more evidence that people in this outbreak got sick from eating ground beef. At this time, the investigation has not identified a single, common supplier of ground beef.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella and other foodborne illness outbreaks and have recovered over $650 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants.  The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.

If you or a family member became ill with a Salmonella infection, including Reactive Arthritis or Irritable bowel syndrome (IBS), after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Salmonella attorneys for a free case evaluation.

Additional Resources

George’s Prepared Foods, a Caryville, Tenn. establishment, is recalling approximately 6,444 pounds of ready-to-eat (RTE) pork sausage patty and turkey sausage patty products that may be contaminated with Salmonella, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The ready-to-eat pork and turkey sausage patty items were produced on April 19, 2019, April 27, 2019, May 7, 2019 and May 9, 2019. The following products are subject to recall:

  • 24.92-oz. packages containing “Great Value Fully Cooked Original Pork Sausage Patties” with use by date of 10/16/19 and lot code 1091971894.
  • 24.92-oz. packages containing “Great Value Fully Cooked Original Breakfast Turkey Patties” with use by date of 10/24/19 and lot code 1171971897.
  • 35.6-oz. packages containing “Family Size Great Value Fully Cooked Original Pork Sausage Patties” with use by date of 11/03/19 and lot code 1271972894 or use by date 11/05/19 and lot code 1291972894.

The products subject to recall bear establishment number “EST. M2206T or P-2260T” printed on the package. These items were shipped to retail locations nationwide.

The problem was discovered when the firm notified FSIS that the firm’s third-party cold storage facility had inadvertently shipped the ready-to-eat products to commerce.

There have been no confirmed reports of adverse reactions due to consumption of these products. Anyone concerned about an injury or illness should contact a healthcare provider.

Consumption of ready-to-eat food contaminated with Salmonella can cause salmonellosis, one of the most common bacterial foodborne illnesses. The most common symptoms of salmonellosis are diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating the contaminated product. The illness usually lasts 4 to 7 days. Most people recover without treatment. In some persons, however, the diarrhea may be so severe that the patient needs to be hospitalized. Older adults, infants, and persons with weakened immune systems are more likely to develop a severe illness. Individuals concerned about an illness should contact their health care provider.

FSIS is concerned that some product may be frozen and in consumers’ refrigerators or freezers or both. Consumers who have purchased these products are urged not to consume them.

According to various press reports, Moby Dick House of Kabob has voluntarily suspended sale of hummus at its Maryland, Virginia, and DC locations after multiple cases of Salmonella infections have been reported.

The Maryland Health Department reports that they are investigating Salmonella infections in people who say they ate at Moby Dick House of Kabob. Sixteen cases have been confirmed since September 10. Eight of the first nine individuals say they ate the restaurant’s hummus.

The Virginia Health Department is investigating “at least eight confirmed or probable cases” of Salmonella infections associated with Moby Dick.

DC says they don’t have a confirmed case yet, but they are investigating several cases of Salmonella that might be connected to Moby Dick.

Health authorities say that if you have any hummus from Moby Dick, it should not be eaten.

House of Spices (India) is recalling different lots of “MDH SAMBAR MASALA”, 3.5oz (100g) UPC code 6291103750327. This product is produced by R-PURE AGRO SPECIALITIES and distributed by HOUSE OF SPICES (INDIA). This product was tested by FDA through a certified laboratory to be positive for Salmonella.

The recalled MDH SAMBAR MASALA was distributed in northern California retail stores. The Lot Codes and Expiration dates are as follows:

LOT CODE EXPIRATION DATE
107 NOV 2021
48 DEC 2021
47 DEC 2021

 

The product comes in a 3.5 oz (100g), in a box with red and white MDH Logo. Below are pictures of the product.

The recall was initiated after it was discovered by the FDA that the Salmonella contaminated products were distributed.

Consumption of food contaminated with Salmonella can cause salmonellosis, one of the most common bacterial foodborne illnesses. The most common symptoms of salmonellosis are diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating the contaminated product. The illness usually lasts 4 to 7 days. Most people recover without treatment. In some persons, however, the diarrhea may be so severe that the patient needs to be hospitalized. Older adults, infants, and persons with weakened immune systems are more likely to develop a severe illness. Individuals concerned about an illness should contact their health care provider.

The Chicago Department of Public Health (CDPH) is investigating an outbreak of Salmonella, a bacteria that is a common cause of food poisoning. Since the beginning of July 2019, at least four people became ill after consuming pork tamales or carnitas served from the deli section of the Sun View Produce establishment at 6110 W 63rd St, Chicago, IL 60638.

If you have pork tamales, carnitas or other hot foods purchased from the deli section of this establishment since July 1, 2019 in your freezer, do not eat—discard.

If you ate food purchased from the deli section since July 1, 2019, you may have been exposed to Salmonella. If you are experiencing severe diarrhea, symptoms of dehydration or high fever, seek medical attention.

As of August 5, 2019, implicated food items are no longer available at the store. There is no evidence that food made after this date was contaminated. CDPH performed an environmental assessment of the grocery store and provided guidance on safe food handling practices and environmental cleaning to prevent further spread of disease. CDPH has also issued an alert to area physicians about the outbreak, providing medical guidance.

Salmonella symptoms usually last four to seven days and most individuals recover without any treatment. Most people who are infected develop diarrhea, fever and abdominal cramps between 12 and 72 hours after eating contaminated food. Although most infections resolve without antibiotics, older individuals or those with weakened immune systems may need medical evaluation and treatment.

Additional Resources

Nassau County Department of Health is investigating a cluster of cases of salmonellosis associated with people who consumed food or drink at the restaurant Brixx and Barley, located at 152 West Park Ave in Long Beach, NY. Potential exposures to Salmonella at the restaurant could date back to early July. Nassau County Department of Health has closed Brixx and Barley while the investigation as to the source of Salmonella is investigated.

Salmonella is typically transmitted during warmer months and is usually food borne. Most people who contract Salmonella will experience mild symptoms of gastrointestinal illness such as cramping and diarrhea, and symptoms usually start 12-72 hours after exposure. The majority of cases resolve on their own, without treatment, typically within 4-7 days. In some people, the symptoms can be more severe, requiring hospitalization. This is more likely to occur in infants, the elderly, and those immune suppressed.

Salmonella also can be spread from animal waste, and also from people to people. NCDOH recommends washing hands after contact with animals, washing hands often during preparation of food, and also washing your hands after using the toilet, changing diapers, or helping someone with diarrhea clean up after using the toilet.

If you have a Salmonella infection, or symptoms of vomiting and diarrhea, you should not prepare food or drinks for others until you no longer have diarrhea. Food handlers should avoid preparing food until their stool is clear of salmonella, which would be confirmed by the Department of Health.

Image (c) Dennis Kunkel Microscopy, Inc.

CDC and FDA are now advising people not to buy or feed any pig ear dog treats to pets, including any that may already be in homes.

People can get sick after handling the treats or caring for dogs who ate the treats. Dogs might get sick after eating them.

Since the last update on July 17, 2019, a total of 34 ill people have been added to this investigation.

A total of 127 people infected with the outbreak strains of Salmonella have been reported from 33 states.

26 ill people (30%) have been hospitalized. No deaths have been reported.

24 illnesses (21%) are among children younger than 5 years.

State health and regulatory officials in several states and the FDA have tested pig ear dog treats at various suppliers and identified many different strains of Salmonella. No single supplier, distributor or common brand of pig ear treats has been identified that could account for all the illnesses.

This is why CDC and FDA are now advising people to not buy or feed any pig ear dog treats to pets.

Background

On April 19, 2019, the Minnesota Department of Health (MDH) Public Health Laboratory (PHL) determined that two clinical Salmonella Braenderup isolates submitted through routine surveillance had indistinguishable pulsed-field gel electrophoresis (PFGE) patterns (Minnesota designation BR134). Initial interviews with these cases revealed that both had eaten food from the Green Mill in Bloomington in the week before their illness onset. City of Bloomington Environmental Health Division (CBEH) was notified, and an investigation was initiated.

Methods

Cases were defined as individuals who tested positive for S. Braenderup with PFGE pattern BR134, or a Green Mill – Bloomington patron who developed diarrhea (≥3 stools in a 24-hour period) that was at least 3 days in duration or was accompanied by a fever, after eating food from the restaurant. Stool samples collected from consenting individuals were submitted to the MDH PHL for bacterial and viral testing. PFGE and whole genome sequencing (WGS) was performed on isolates.

MDH staff collected online orders, information for catering groups, and receipts from April 5, 8, 9, and 10, and patrons were called to find additional cases and controls.

All restaurant employees were required to submit two stool samples to the MDH PHL for Salmonella testing. Any employee reporting illness on or after March 15 was excluded from work in food service until two consecutive stool samples tested negative for Salmonella by culture. Employees who tested positive for Salmonella by culture were excluded until two consecutive stool samples tested negative.

Results

Eighty-nine restaurant patrons and 18 additional catered training event attendees were interviewed. Seven cases (7%) were identified, including five laboratory-confirmed cases. Two patrons reported illness but did not meet the case definition and were excluded from further analysis. Cases reported meal dates of March 22 (n=1), April 5 (n=3), April 8 (n=4), April 9 (n=3), April 10 (n=3). Four cases had 2 to 3 meal dates. Onsets of illness ranged from March 29 to April 16. The median age of cases was 39 years (range, 6 to 65 years), and four (57%) cases were male. All seven cases reported diarrhea and cramps, five (71%) fever, one (14%) vomiting, and one (14%) bloody stool. Four (57%) cases visited a healthcare provider, but none were hospitalized or died. The median incubation for the three cases with only one meal date was 115 hours (range, 1.5 to 175 hours).

Three laboratory-confirmed cases attended the same training event catered by the Green Mill restaurant on April 8, 9, and 10. All other cases were sit-down restaurant patrons or had take-out. One case tested negative for Salmonella, and the other case did not return a stool kit. In a univariate analysis including all laboratory-confirmed cases and controls from the catered training event and restaurant patrons from April 5 and 8, there were no significant findings. At the ingredient level, consumption of diced tomatoes (5 of 5 cases vs. 18 of 60 controls; odds ratio [OR], undefined; p = 0.004), any tomatoes (5 of 5 cases vs. 21 of 60 controls; OR, undefined; p < 0.008) and romaine lettuce (5 of 5 cases vs. 23 of 60 controls; OR, undefined; p < 0.012) were significantly associated with illness. In a multivariable analysis, no items remained independently associated with illness, likely because of the high degree of collinearity between tomatoes and romaine lettuce.

CBEH sanitarians visited Green Mill on April 19. All 53 employees were interviewed, and 5 employees were excluded because they reported vomiting, diarrhea, or fever since March 17. The illness onset dates for employees were April 1, April 9, April 11, April 19, and April 24. All five of these employees negative twice for Salmonella on their first two samples.

Two employees who did not initially report any gastrointestinal symptoms tested positive for S. Braenderup that matched by PFGE and whole genome sequencing to patron isolates. Both positive employees were banquet servers. One positive employee reported not having any gastrointestinal symptoms, and worked on April 5, 8, 9, and 10. The second positive employee, who initially reported having no illness, later reported diarrhea, chills, and abdominal pain but was unable to identify an onset date. This employee worked on April 5.

Sanitarians identified numerous issues. The Victory produce wash was plumbed to the 3-compartment sink. The paper towel dispenser was empty on the cook line. An employee was observed touching pizza with bare hands. An employee was observed rinsing the pizza cutter in the hand sink. The pressure gauge was not functional on the dish washing machine.

Fresh produce, including tomatoes and romaine lettuce, were delivered on the morning of April 5. Tomatoes are rinsed with Victory wash in the sink, diced or sliced, and then stored in the walk-in cooler and line flip top cooler. The romaine lettuce is delivered pre-cut and pre-shredded. Food for catered banquets and restaurant patrons are prepared in different areas.

Conclusion

This was an outbreak of S. Braenderup infections associated with the Green Mill restaurant in Bloomington and identified through routine disease surveillance. Tomato and romaine lettuce consumption were statistically associated with illness. Two banquet servers tested positive for the outbreak strain of S. Braenderup. Food workers infected with Salmonella may have been the source of contamination, but other sources of contamination could not be ruled out.