Salmonella Information

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A total of 907 people infected with the outbreak strains of Salmonella Poona were reported from 40 states. A list of states and the number of cases in each can be found on the Case Count Map page.

Among people for whom information was available, illnesses started on dates ranging from July 3, 2015 to February 29, 2016. Ill people ranged in age from less than 1 year to 99, with a median age of 18. Forty-nine percent of ill people were children younger than 18 years. Fifty-six percent of ill people were female. Among 720 people with available information, 204 (28%) were hospitalized. Six deaths were reported from Arizona (1), California (3), Oklahoma (1), and Texas (1).

Epidemiologic, laboratory, and traceback investigations identified imported cucumbers from Mexico and distributed by Andrew & Williamson Fresh Produce as the likely source of the infections in this outbreak.

Several state health and agriculture departments collected and tested cucumbers from retail locations and isolated the outbreak strains of Salmonella Poona. Information indicated that these cucumbers were distributed by Andrew & Williamson Fresh Produce. Additionally, testing of cucumbers collected from the Andrew & Williamson Fresh Produce facility isolated the outbreak strains of Salmonella Poona.

Traceback information collected from the 11 illness clusters indicated that cucumbers eaten by ill people were imported from Mexico and distributed by Andrew & Williamson Fresh Produce.

Two recalls of garden variety cucumbers distributed by Andrew & Williamson Fresh Produce were announced because the cucumbers were likely contaminated with Salmonella. Recalled cucumbers were grown in Baja California, Mexico and distributed to many U.S. states. On September 4, 2015, Andrew & Williamson Fresh Produce voluntarily recalled all cucumbers sold under the Limited Edition brand label from August 1, 2015 through September 3, 2015. On September 11, 2015, Custom Produce Sales voluntarily recalled all cucumbers sold under the Fat Boy brand label starting August 1, 2015. These cucumbers were sent to Custom Produce Sales from Andrew & Williamson Fresh Produce.

Sid Wainer and Son of New Bedford, MA, is voluntarily recalling Jansal Valley brand Raw Macadamia Nuts because the product has the potential to be contaminated with Salmonella. 

The product is packaged in a plastic bag labeled as Jansal Valley Raw Macadamia Nuts and is packaged in both a one-pound and eight-ounce size with Lot code 469566.

The Raw Macadamia Nuts were distributed nationwide in retail stores and through mail orders.

No illnesses have been reported to date in connection with this problem.

Random third-party testing found presence of Salmonella in the one-pound package of Jansal Valley Raw Macadamia Nuts.

pork-chopsWashington State health officials are working with state and local partners to investigate several cases and clusters of Salmonella infections that appear to be linked to eating pork. The ongoing investigation of at least 56 cases in eight counties around the state includes food served at a variety of events.

Disease investigators continue to explore several sources from farm to table, and are focused on an apparent link to pork consumption or contamination from raw pork. Salmonellosis, the illness caused by infection with Salmonella, can cause severe and even bloody diarrhea, fever, chills, abdominal discomfort, and vomiting. Serious bloodstream infections may also occur.

As of July 23, the 56 cases include residents of King (44), Snohomish (4), Mason (2), Thurston (2), Pierce (1), Grays Harbor (1), Yakima (1), and Clark (1) counties. Five of the cases were hospitalized; no deaths have been reported. All were infected with the same strain of Salmonella bacteria. The disease investigation shows a potential exposure source for several cases was whole roasted pigs, cooked and served at private events. The source of contamination remains under investigation by state and local health officials and federal partners.

The outbreaks are a reminder of the importance of proper food care, handling, preparation, and cooking to prevent illness. State health officials recommend these food safety strategies broadly, and specifically advise against eating raw or undercooked pork.

Following food safety guidance can help prevent food-borne illness. Health officials warn consumers who handle and/or eat pork to cook the meat to a safe internal temperature, using a meat thermometer; whole cuts of pork should be cooked to 145 degrees. Meat thermometers should be placed in the thickest part of the meat, avoiding bone, fat, and cartilage.

All meats and fish should be cooked to a safe internal temperature, using a food thermometer; guidance can be found on the Department of Health website. Other food safety tips include washing hands thoroughly with soap and water before and after preparing food, especially raw meats. To avoid cross-contamination, don’t place cooked food on a plate that previously held raw meat of any kind.

It’s also important to sanitize cutting boards, knives, and countertops that come into contact with raw meat by using a solution of bleach water (1 teaspoon bleach per gallon of water) or antibacterial cleaner.

Food Safety News reports that Massachusetts state and local health department officials are investigating 19 Salmonella cases linked to a restaurant in Holyoke,  Brian Fitzgerald, Holyoke’s health director, told a local TV station that officials were trying to figure out why people were apparently sickened after eating at the Delaney House in Holyoke between Nov. 11 and 15, 2014.

Investigative reports from the Massachusetts Department of Public Health indicate that 19 confirmed Salmonella cases and additional potential cases were traced back to 10 different events held at the Delaney House.

The restaurant has not been shut down, although the state asked local health officials to order the management to comply with several alleged food code violations.

Five food handlers and one non-food handling employee at the restaurant also tested positive for Salmonella. Some of the infected food handlers reportedly worked at events outside of the Delaney House, including the Log Cabin, a take-out restaurant, and various catered events.

Lundberg Family Farms announced that it is voluntarily recalling specific bags of Brown Rice Flour because they have the potential to be contaminated with Salmonella, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems if consumed raw. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain.

The recalled Eco-Farmed Brown Rice Flour (UPC# 0 73416 00550 1) and Organic Brown Rice Flour (UPC # 073416 00500 6) were distributed in retail store bulk bins, and 25lb bulk bags, between November 4th and November 12th, 2014 in the following states: CA, HI, MA, AZ, NV, and through mail order.

The affected 25lb bulk bags contain the following lot numbers 141027, 141028, 141029, 141030 located on the bottom seam of the bag.

No serious illnesses have been reported to date from the consumption of the product. The potential for contamination was identified after routine testing and immediate corrective action has been taken. Distributors and retailers have been notified and requested to discard the affected products in stock. The company notified the U.S. Food and Drug Administration, and is cooperating fully with the agency.

Friday the CDC updated its ongoing reporting of a Salmonella outbreak linked to baby chickens and ducks.  Now a total of 300 persons infected with the outbreak strains of Salmonella Infantis,Salmonella Newport, or SalmonellaHadar have been reported from 42 states and Puerto Rico. The number of ill persons identified in each state is as follows:  Alabama (8), Arizona (2), Arkansas (3), California (3), Colorado (5), Connecticut (1), Florida (1), Georgia (16), Idaho (4), Illinois (5), Iowa (3), Indiana (4), Kansas (1), Kentucky (11), Maine (9), Maryland (3), Massachusetts (1), Michigan (1), Minnesota (1), Mississippi (2), Missouri (1), Montana (3), Nebraska (3), New Hampshire (3), New Jersey (2), New Mexico (2), New York (30), North Carolina (28), Ohio (24), Oregon (1), Pennsylvania (29), Puerto Rico (1), South Carolina (6), South Dakota (3), Tennessee (17), Texas (2), Utah (1), Vermont (7), Virginia (25), Washington (8), West Virginia (18) Wisconsin (1), and Wyoming (1).

31% of ill persons have been hospitalized, and no deaths have been reported.

Epidemiologic, laboratory, and traceback findings have linked this outbreak of humanSalmonella infections to contact with chicks, ducklings, and other live poultry from Mt. Healthy Hatcheries in Ohio.  80% of ill people reported contact with live poultry in the week before their illness began.

Findings of multiple traceback investigations of live baby poultry from homes of ill persons have identified Mt. Healthy Hatcheries in Ohio as the source of chicks and ducklings. This is the same mail-order hatchery that has been associated with multiple outbreaks of Salmonella infections linked to live poultry in past years, including in 2012 and 2013.

Greg Pratt of the Chicago Tribune reports that public health officials are investigating a Salmonella outbreak linked to the Jewel Osco store in Tinley Park after nine people recently became ill.  Amy Poore, spokeswoman for the Cook County Department of Public Health, said the county is investigating after some food items were linked back to the Jewel at 171st Street and Harlem Avenue.

Jewel officials temporarily closed the store’s service deli Wednesday.

The CDC reports a total of 12 persons infected with the outbreak strain of Salmonella Newport have been reported from 7 states: Arizona (1), California (2), Connecticut (1), Massachusetts (1), New York (4), Utah (1), and Wisconsin (2).

Collaborative investigation efforts of state, local, and federal public health and regulatory agencies indicate that organic sprouted chia powder distributed by Navitas Naturals of Novato, California is the likely source of this outbreak. Chia powder is made from ground dried chia seeds.  The FDA announced a recall.  The affected products were distributed nationally and include:

  • Navitas Naturals Organic Sprouted Chia Powder, 8oz, UPC 858847000369 with best buy dates from 04/30/2015 through 09/05/2015
  • Navitas Naturals Omega Blend Sprouted Smoothie Mix, 8oz, UPC 858847000314 with best buy dates from 07/29/2015 through 09/19/2015
  • Williams-Sonoma Omega 3 Smoothie Mixer, 8 oz, SKU 506436 with best buy dates from 09/12/2015 through 10/02/2015

The Department of Agriculture’s Food Safety and Inspection Service requests comments on changes to its Salmonella and E. coli testing procedures for raw beef products, the agency announced.

The modified testing will be used to conduct a risk assessment and to develop new standards for Salmonella in beef. The FSIS’s action comes after a December 2011, multi-state outbreak of the disease linked to a multi-drug resistant strain that caused 19 people in the northeast U.S. to get sick. In June 2012, the agency was notified of 50 cases of Salmonella enteriditis across nine states. All were connected to ground beef consumption, according to the agency’s action.

The FSIS previously used two different testing procedures for raw beef, but has announced its intention to combine them into one. Now, the Salmonella sampling set procedures for ground beef products will be discontinued, “except in establishments with results that exceeded the standard for Salmonella in that establishment’s most recently completed sample set,” according to the FSIS’s action.

The FSIS’s previous inspection program involved the collection of random samples of raw beef that were sent to laboratories for analysis over a defined number of sequential days of production to complete a sample set, according to the agency.

The agency, however, is enhancing its procedures by combining Salmonella testing procedures with those for Shiga toxin-producing Escherichia coli (STEC).

“Therefore, FSIS will begin analyzing for Salmonella all samples of raw ground beef, beef manufacturing trimmings, bench trim, and other raw ground beef components that its personnel collect for STEC testing, including raw ground beef products FSIS samples at retail stores and ground beef, trim, and other raw ground beef components FSIS samples at import establishments,” the action notes.

As a result, the agency will need to take a larger sample of the raw ground beef, collecting 325 grams instead of only 25 grams, which increases the likelihood of detecting positive samples. The new procedures will be more effective compared to carcass testing, the agency said.

In addition, the agency will save money, it said. “The changes that FSIS is announcing to its Salmonella sampling procedures will permit FSIS to analyze more samples at the same time for lower agency costs than the present method,” the FSIS said in its action.

The new procedures will be conducted for three months and then used to conduct a risk assessment enroute to developing a revised Salmonella performance standard.

“FSIS is considering moving Salmonella sampling from a set-based approach to a continuous sampling and ‘moving window’ approach for all classes of products subject to FSIS sampling and testing for Salmonella,” the agency said. “This approach will allow FSIS more flexibility in scheduling and collecting samples.”

The agency is also considering extending Salmonella testing to pork trim, pork parts, ground pork, chicken parts and lamb carcasses, but would start by sampling to assess the prevalence of the disease in those products.

Salmonella bacteria are among the most frequently reported causes of foodborne illnesses, according to the agency.

Comments are due by Sept. 27, and there will be no comment extensions.

Interim Report

Linh Nguyen, PhD, MPH, Epidemiologist

April 30, 2013

BACKGROUND

On April 26, 2013, the Southern Nevada Health District (SNHD), Office of Epidemiology (OOE) received reports of gastrointestinal illness from eight independent groups of patrons of Firefly on Paradise or the adjacent affiliated restaurant Dragonfly on Paradise (Firefly) located at 3900 Paradise Road, Las Vegas, NV 89109. All patrons from these groups ate at the restaurant during April 21-24, 2013. Ill patrons reported symptoms of diarrhea and/or vomiting after they consumed food from Firefly restaurant, and many sought medical care for their illness. In response to these illness reports, the SNHD initiated an investigation.

On April 26, 2013, the SNHD performed an investigative inspection and closed Firefly andDragonfly restaurants to minimize ongoing risk of illness. The SNHD OOE, Environmental Health (EH) and Southern Nevada Public Health Laboratory (SNPHL) have been collaborating on the investigation and response to this outbreak. The Nevada State Health Division was also apprised of the outbreak investigation.

METHODS

Epidemiology: OOE staff performed telephone interviews with ill patrons to obtain more information regarding symptoms, food history, and illnesses among restaurant patrons. The SNHD foodborne illness complaint database was searched to identify other complaints against the restaurant in the 30 days prior to these complaints.

On April 26, 2013, OOE and EH staff visited the restaurant. OOE staff interviewed restaurant management and other employees regarding their illnesses in the past two weeks, their current illness status, their knowledge of other recent illnesses in restaurant staff and patrons, whether the restaurant had a sick employee policy, and if there were other customer complaints of illness.

A case is defined as illness in a person who consumed food served by Firefly restaurant during April 21-26, 2013 and experienced diarrhea (defined as ≥ 3 bouts of loose stools) and/or ≥ 1 episodes of vomiting during a 72-hour period after eating.In order to perform a case-control study and do additional case-finding, OOE staff identified additional restaurant patrons who dined at Firefly during April 21-24, 2013 via contact information from OpenTable, an online restaurant reservation system.

Environmental Health: EH staff performed inspections of Firefly and Dragonfly restaurants on April 26, 2013 and an ongoing risk assessment for foodborne illness.

Laboratory: Ill restaurant guests and staff were requested to provide stool specimens for bacterial culture (Salmonella, Shigella, Campylobacter, Escherichia coli O157, Yersinia, and Vibrio), Shiga toxin-producing E. coli (STEC) testing, and norovirus RT-PCR testing.

Food specimens were collected for submission to the Nevada State Public Health Laboratory for pathogen testing.

RESULTS

Epidemiology: The epidemiologic curve to date is presented in the figure below, and shows the total of 86 identified ill persons who ate at Firefly during April 21-26, 2013.

A total of 40 employees worked the dinner shift at Firefly on April 26, 2013. Of these, 33 were interviewed including three employees who were identified as having been recently ill with gastrointestinal symptoms; these workers were asked to submit stool specimens.

The restaurant has a sick employee policy and employees may call-in sick when necessary.  There was one customer complaint of illness to the restaurant. Thirty-three patron phone numbers were obtained from the OpenTable online reservations.

Environmental Health: Firefly restaurant uses two adjacent permitted kitchens, Firefly on Paradise (SNHD Permit Number PR0013375) and Dragonfly on Paradise (SNHD Permit Number PR0015008), to prepare food for their customers. The inspection found that numerous conditions existed that could contribute to an outbreak of a foodborne disease and included:

Inadequate holding of food, inadequate cooling, improper handwashing, employee bare hand contact with ready to eat food, improper food storage practices, improper cleaning practices, and improper thawing of food.

The results of the inspection were 44 demerits for Firefly and 47 demerits for Dragonfly on Paradise. Both facilities were closed by SNHD for excessive demerits and for being associated with a large cluster of reports of illness (SNHD Regulations Governing the Sanitation of Food Establishments 8-304.11).

Thirty samples of various foods were collected during the inspection and submitted to the SNPHL for possible testing to determine which food item(s) could have been the source of the illness.

Inspections were also conducted on April 29, 2013 of the two other Firefly restaurant outlets located in Clark County. Firefly Westside located at 9560 W. Sahara, Las Vegas received 30 demerits, and Firefly on Eastern located at 11261 S. Eastern received 6 demerits.

Laboratory: Of the 14 stool specimens collected from ill restaurant patrons, seven were positive for Salmonella species, one was negative for Salmonella, and results of six samples are pending.

The SNPHL submitted eight food items collected from Firefly restaurant to the Nevada State Public Health Laboratory for analyses.

CONCLUSIONS

At least 86 patrons and 3 employees who consumed food and/or drinks at Firefly during April 21-25, 2013 may have contracted Salmonella infection.

FUTURE ACTIONS

1.  Firefly should rectify faulty food storage equipment and practices to ensure that food will be maintained at proper temperatures.

2.  The SNHD OOE staff will continue to collect information about customers who ate at Firefly during April 21-26, 2013 to establish illness occurrences among restaurant  patrons, and to conduct a case-control study to identify specific food item(s), if any, were associated with illness.

3.  The SNHD EH staff will continue to review Firefly’s food preparation methods to identify possible lapses in food safety procedures, and to require restaurant management to provide and implement a comprehensive food safety plan.

4.  The SNHD OOE staff will continue to monitor the foodborne illness database for additional complaints of illness to determine whether the outbreak is limited to this establishment or has spread to the general community.

5.  The SNPHL will perform pulsed field gel electrophoresis on the submitted specimens that were positive for Salmonella to determine if illnesses among patrons from the different groups were linked.

RECOMMENDATIONS

1.  Food-service workers who test positive for Salmonella must be excluded or restricted from work per the FDA Food Code, and will require approval from the SNHD to return to work.

2.  Restaurant employees should also be cautioned about how Salmonella is transmitted and be made aware of the heightened importance of hand hygiene through washing with soap and water. Information about salmonellosis can be found at the SNHD website http://www.southernnevadahealthdistrict.org/health-topics/salmonellosis.php

3.  Food service workers should also be educated to the ways to clean and sanitize food preparation surfaces. Types of acceptable sanitizer solutions for use in a food establishment are located at the SNHD website http://www.southernnevadahealthdistrict.org/ferl/sanitizer-fact-sheet.php

4.  The restaurants are advised to cook all potentially hazardous foods thoroughly. Menu items intended not to be cooked to the recommended temperatures should be noted on menus, with an appropriate warning to consumers about the potential health hazards of eating undercooked foods.

5.  All suspected cases of Salmonella infection related to this outbreak should be reported  to the health authority. Illness clusters (e.g. restaurants, schools, hotels) are reportable.