As of October 15, 2018, 92 people infected with the outbreak strain of Salmonella Infantis have been reported from 29 states. A list of the states and the number of cases in each can be found on the Map of Reported Cases page.

Alabama 1, California 1, Connecticut 1, Delaware 2, Florida 2, Georgia 2, Hawaii 1, Illinois 5, Indiana 1, Kentucky 1, Louisiana 2, Maine 1, Maryland 2, Massachusetts 9, Michigan 3, Minnesota 3, Missouri 3, North Carolina 4, Nebraska 1, New Jersey 9, New York 10, Ohio 7, Pennsylvania 11, Rhode Island 2, South Carolina 1, Tennessee 1, Texas 2, Virginia 2, Washington 2.

Illnesses started from January 19, 2018, to September 9, 2018. Ill people range in age from less than 1 year to 105, with a median age of 36. Sixty-nine percent of ill people are female. Of 62 people with information available, 21 (34%) have been hospitalized. No deaths have been reported.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Of 54 people interviewed, 48 (89%) people interviewed reported preparing or eating chicken products that were purchased raw, including ground chicken, chicken pieces, and whole chicken. Ill people reported buying many different brands of raw chicken products from multiple stores. Also, one person got sick after pets in their home ate raw ground chicken pet food. Another ill person lived with someone who works in a facility that raises or processes chickens.

The outbreak strain of Salmonella Infantis has been identified in samples from raw chicken pet food, from raw chicken products from 58 slaughter and/or processing establishments, and from live chickens.  Samples collected at slaughter and processing establishments were collected as part of FSIS’s routine testing under the Salmonellaperformance standards. Furthermore, WGS showed that the Salmonella from these samples is closely related genetically to the Salmonella from ill people.  This result provides more evidence that people in this outbreak got sick from handling or eating raw or undercooked chicken.

WGS analysis of isolates from 43 ill people and 68 food or environmental samples predicted resistance to some or all of the following antibiotics: ampicillin, ceftriaxone, chloramphenicol, ciprofloxacin, fosfomycin, gentamicin, hygromycin, kanamycin, nalidixic acid, streptomycin, sulfamethoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Two non-clinical isolates had no predicted resistance. Testing of five isolates using standard antibiotic susceptibility testing by CDC’s National Antimicrobial Resistance Monitoring System (NARMS)laboratory confirmed these results (fosfomycin, hygromycin, and kanamycin were not tested by this method). These antibiotic-resistant infections may be difficult to treat with commonly recommended antibiotics, and may require a different antibiotic choice. Advice to clinicians is available.

Available data indicate that this strain of Salmonella Infantis may be present in live chickens and in raw chicken products. A single, common supplier of raw chicken products or of live chickens has not been identified.

A total of 38 people infected with the outbreak strain of Salmonella Enteritidis have been reported from seven states – Montana, Colorado, Iowa, Ohio, Kentucky, Tennessee and Alabama.

Illnesses started on dates ranging from June 17, 2018, to August 16, 2018.

Ten people have been hospitalized. No deaths have been reported.

The outbreak strain of Salmonella Enteritidis was identified in environmental samples and in eggs collected from Gravel Ridge Farms.

On September 8, 2018, Gravel Ridge Farms recalled cage-free large eggs because they might be contaminated with Salmonella.

On September 8, 2018, Gravel Ridge Farms recalled cage-free large eggs because they might be contaminated with Salmonella.

Do not eat, sell, or serve recalled Gravel Ridge Farms cage-free large eggs.

Gravel Ridge Farms recalled packages of a dozen and 2.5 dozen eggs in cardboard containers with UPC code 7-06970-38444-6.

Recalled eggs have “best if used by” dates of July 25, 2018 through October 3, 2018.

Recalled eggs were sold in grocery stores and to restaurants in Alabama, Georgia, and Tennessee. For a full list of locations where recalled eggs were sold, visit the FDA website.

Summary

Public Health is investigating an outbreak of salmonellosis associated with food prepared in the service deli at the Costco Wholesale Warehouse in Issaquah. The service deli prepares and sells ready-to-eat foods, including rotisserie chicken, pork ribs, sandwiches, wraps, macaroni and cheese, poke, cilantro lime shrimp, and shrimp cocktail.

At this time, the source of the illnesses has not been identified. Everyone who reported illness has recovered.

Illnesses

Since August 28, 2017, we have learned of seven King County residents who tested positive for Salmonella I,4,[5], 12:i:- infections. DNA fingerprinting was performed on the Salmonella bacteria from the seven people who got sick and was identical for all cases, suggesting a common source of infection. Illness onsets occurred sporadically during August 28, 2017–July 13, 2018, and a common epidemiological link among all cases was not established until August 2018; no single food item prepared by the service deli has been identified as the source of the illnesses.

All seven people who got sick shopped at the Costco Wholesale Warehouse in Issaquah; five bought ready-to-eat food from the service deli, food purchase history cannot be verified for one person, and one was an employee at the Costco service deli. There is no evidence to indicate that the service deli employee is the source of the outbreak.

In September, an eighth person with Salmonella I,4,[5], 12:i:- infection was reported. However, this infection was caused by a Salmonella strain with a different DNA fingerprint that does not appear to be closely related to the other seven people who got sick, suggesting that this case is not related to the outbreak.

Public Health actions

As part of the Public Health investigation, Environmental Health investigators visited Costco Wholesale Warehouse in Issaquah on August 7, 2018. Investigators identified potential risk factors for cross contamination and spread of bacteria, including inconsistent handwashing practices and improper cleaning and sanitizing of surfaces that touch foods. Corrective actions were addressed with Costco Issaquah management, including food handling procedure changes, retraining employees on food safety practices, and documenting appropriate cleaning and sanitizing practices.

Investigators re-visited the service deli on August 30, 2018, to ensure corrective actions had been addressed. Investigators again identified concerns for inconsistent handwashing practices and improper cleaning and sanitizing of surfaces that touch foods. Corrective actions were addressed with Costco Issaquah management.

On September 19, 2018, Environmental Health investigators asked Costco Issaquah’s service deli to temporarily stop preparing ready-to-eat foods that would not be cooked further by the customer in order to reevaluate food handling practices and procedures. On September 20, 2018, investigators visited the facility and identified further areas for improvement to limit cross contamination. The facility was instructed to provide additional food handling training to service deli employees to minimize the risk of cross contamination, such as hand washing and sanitation of surfaces where foods are prepared and stored. In addition, completion of a deep cleaning and disinfection of the service deli was required before resuming preparing and selling of ready-to-eat foods.

The investigators re-visited the service deli on September 21, 2018, to confirm the facility had completed a thorough cleaning and disinfection and that a plan for further training and procedure changes had been initiated. Costco Issaquah provided sufficient evidence of a thorough disinfection and corrective actions so the service deli was allowed to resume their normal food preparation operations. Another follow-up visit will occur within 14 days to ensure all corrective actions have been completed.

Environmental testing

Raw poultry and environmental samples collected in the service deli on August 7, 2018, tested negative for SalmonellaI,4,[5], 12:i:- at the Washington State Public Health Laboratory.

As of September 25, 2018, 135 people infected with the outbreak strain of Salmonella Mbandaka were reported from 36 states. A list of the states and the number of cases in each state can be found on the Case Count Map page.

Illnesses started on dates from March 3, 2018, to August 29, 2018. Ill people ranged in age from less than one year to 95, with a median age of 57. Sixty-nine percent of ill people were female. Out of 101 people with information available, 34 (34%) were hospitalized. No deaths were reported.

WGS analysis did not predict antibiotic resistance in bacteria isolated from 91 ill people and 8 food and environmental samples. Testing of five clinical isolates using standard antibiotic susceptibility testing methods by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory also did not show antibiotic resistance.

Epidemiologic and laboratory evidence indicated that Kellogg’s Honey Smacks cereal was the likely source of this multistate outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Sixty-three (75%) of 84 people interviewed reported eating Kellogg’s Honey Smacks cereal. Ill people in this outbreak reported this cereal more often than any other cereals or food items.

Health officials in several states collected Kellogg’s Honey Smacks cereal from retail locations and ill people’s homes for testing. Laboratory testing identified the outbreak strain of Salmonella Mbandaka in a sample of unopened Kellogg’s Honey Smacks cereal collected from a retail location in California. Laboratory testing also identified the outbreak strain in samples of leftover Kellogg’s Honey Smacks cereal collected from the homes of ill people in Montana, New York, and Utah. WGS showed that Salmonella bacteria isolated from sick people and the cereal were closely related genetically. This result provides more evidence that people in this outbreak got sick from eating Kellogg’s Honey Smacks.

On June 14, 2018, the Kellogg Company recalled all Honey Smacks cereal that were on the market within the cereal’s one-year shelf-life.

Today the CDC reported that it, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Salmonella Enteritidis infections.

As of September 7, 2018, 14 people infected with the outbreak strain of Salmonella Enteritidis have been reported from Alabama and Tennessee.

Illnesses started on dates ranging from July 10, 2018 to August 7, 2018 Ill people range in age from 1 year to 94, with a median age of 31. Fifty percent are female. Of 9 people with information available, 2 (22%) have been hospitalized. No deaths have been reported.

Epidemiologic and traceback evidence indicates that shell eggs from Gravel Ridge Farms in Cullman, Alabama are a likely source of the outbreak.

On September 8, 2018, Gravel Ridge Farms recalled cage-free large eggs because they might be contaminated with Salmonella Enteritidis bacteria. Recalled eggs were sold in grocery stores and to restaurants in Alabama, Georgia, and Tennessee. The FDA website has a list of the grocery stores where recalled eggs were sold. Consumers who have any Gravel Ridge Farms cage-free large eggs in their homes should not eat them. Return them to the store for a refund or throw them away. Restaurants and retailers should not serve or sell recalled Gravel Ridge Farms cage-free large eggs.

As of July 12, 2018, 100 people infected with the outbreak strain of Salmonella Mbandaka have been reported from 33 states.

Illnesses started on dates from March 3, 2018, to July 2, 2018. Ill people range in age from less than one year to 95, with a median age of 57. Of ill people, 68% are female. Out of 77 people with information available, 30 (39%) have been hospitalized. No deaths have been reported.

Illnesses that occurred after June 19, 2018, might not yet be reported due to the time it takes between when a person becomes ill and when their illness is reported. This takes an average of 2 to 4 weeks.

State and local health officials continue to interview ill people and ask questions about the foods they ate and other exposures in the week before they became ill. Fifty-five (85%) of 65 people interviewed reported eating cold cereal. In interviews, 43 people specifically reported eating Kellogg’s Honey Smacks cereal. Ill people in this outbreak reported this cereal more often than any other cereals or food items.

Health officials in several states collected Kellogg’s Honey Smacks cereal from retail locations and ill people’s homes for testing. Laboratory testing identified the outbreak strain of Salmonella Mbandaka in a sample of unopened Kellogg’s Honey Smacks cereal collected from a retail location in California. Laboratory testing also identified the outbreak strain in samples of leftover Kellogg’s Honey Smacks cereal collected from the homes of ill people in Montana, New York, and Utah.

The Kellogg Company recalled all Honey Smacks products that were on the market within the cereal’s one-year shelf-life. However, Honey Smacks products with earlier dates could also potentially be contaminated. Do not eat Kellogg’s Honey Smacks cereal of any size package or with any “best if used by” date.

As of June 14, 2018, 73 people infected with the outbreak strain of Salmonella Mbandaka have been reported from 31 states. A list of the states and the number of cases in each can be found on the Case Count Map page.

Illnesses started on dates from March 3, 2018, to May 28, 2018. Ill people range in age from less than one year to 87, with a median age of 58. Sixty-five percent are female. Out of 55 people with information available, 24 (44%) have been hospitalized. No deaths have been reported.

Epidemiologic evidence indicates that Kellogg’s Honey Smacks cereal is a likely source of this multistate outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Thirty (77%) of 39 people interviewed reported eating cold cereal. In interviews, 14 people specifically reported eating Kellogg’s Honey Smacks cereal. Ill people in this outbreak reported this cereal more often than any other cereals or food items.

On June 14, 2018, the Kellogg Company recalled 15.3 oz. and 23 oz. packages of Kellogg’s Honey Smacks cereal.

Recalled Kellogg’s Honey Smacks cereal have a “best if used by” date from June 14, 2018 through June 14, 2019. The “best if used by” date is on the box top.

The recalled 15.3 oz. Kellogg’s Honey Smacks cereal has a UPC code of 38000 39103. The recalled 23.0 oz. Kellogg’s Honey Smacks cereal has a UPC code of 38000 14810. The UPC code is on the bottom of the box.

The FDA, CDC, along with state and local officials are investigating a multi-state outbreak of Salmonella Adelaide infections. CDC reports that fruit salad mixes that include pre-cut melons are a likely source of this outbreak.

FDA advises consumers not to eat recalled fresh cut watermelon, honeydew melon, cantaloupe, and fresh-cut fruit medley products containing any of these melons produced at the Caito Foods facility in Indianapolis, Indiana. Products produced at this facility have been distributed in Georgia, Illinois, Indiana, Iowa, Kentucky, Michigan, Missouri, North Carolina, Ohio, Pennsylvania, West Virginia, and Wisconsin. The products were packaged in clear, plastic clamshell containers and distributed to Costco, Jay C, Kroger, Payless, Owen’s, Sprouts, Trader Joe’s, Walgreens, Walmart, and Whole Foods/Amazon. Caito Foods, LLC has voluntarily recalled fruit salad mixes that contain pre-cut melons to prevent further distribution of potentially contaminated products.

The CDC reports that 60 people in five Midwestern states have become ill. Among 47 people with information available, thirty-one cases (66%) have been hospitalized.

The 60 illnesses occurred within the period of April 30, 2018 to May 28, 2018.

The FDA is working with CDC, along with state partners in Illinois, Indiana, Michigan, Missouri, Iowa, and Ohio to trace back the pre-cut melons to identify the source to determine the full distribution of pre-cut melons, and to learn more about the potential route of contamination.

As this is an ongoing investigation, the FDA will update this page as more information becomes available, such as product information, epidemiological results, and recalls.

Additional distribution information has been added that identifies retail locations that received potentially contaminated product. The FDA is advising consumers to discard any recalled products purchased at the listed locations. The FDA is sharing this information with consumers as soon as possible and additional distribution information may be added as it becomes available. It is possible that some stores may be mentioned more than once because they received more than one shipment or more than one product. Consumers may wish to ask a firm directly if the recalled product was available for sale.

Consumers who have symptoms of Salmonellainfection should contact their health care provider to report their symptoms and receive care. Most people infected with Salmonella develop diarrhea, fever, and abdominal cramps. Most infections usually lasts 4 to 7 days and most people recover without treatment, however some people develop diarrhea so severe that they need to be hospitalized.

The FDA, CDC, along with state and local officials are investigating a multi-state outbreak of Salmonella Adelaide infections. Epidemiologic and preliminary traceback evidence indicates that pre-cut melon distributed by Caito Foods, LLC is a likely source of this outbreak. Caito Foods, LLC has voluntarily recalled their products, to prevent further distribution of potentially contaminated products. The recalled products were packaged in clear, plastic clamshell containers and distributed in Georgia, Illinois, Indiana, Kentucky, Michigan, Missouri, North Carolina, Ohio, Iowa, Pennsylvania, West Virginia and Wisconsin. The FDA is currently working with state partners to trace back the pre-cut melons to identify the source of the pathogen, to determine the full distribution of the pre-cut melons, and to learn more about how the contamination occurred.

There are 60 people ill with this strain of Salmonellain five states: IL (6), IN (11), MI (32), MO (10), OH (1). The ages of the ill people range from less than one year to 97 (median 67 years) and 65% of cases are female. Reported illness onset dates range from 4/30/18 – 5/28/18. Among 47 with available information, 31 (66%) have been hospitalized. No deaths have been reported.

The Centers for Disease Control and Prevention (CDC) is reporting 60 cases from five states: Illinois, Indiana, Michigan, Missouri, and Ohio. The CDC investigation indicates pre-cut melons, including fruit salads, are a likely source of this multistate outbreak.

“The Illinois Department of Public Health is urging people not to eat pre-cut melon purchased from any Walmart store in Illinois, or any of the other affected states, at this time,” said IDPH Director Nirav D. Shah, M.D., J.D. “If you have recently purchased pre-cut melon from Walmart, throw it out. If you have recently eaten pre-cut melon from a Walmart store and experience diarrhea, fever, and cramps, contact your health care provider.”

Illinois cases range in age from 23 to 87 years and have been reported in all regions of the state. Therefore, it is recommended that people not eat pre-cut melon from Walmart stores anywhere in Illinois. As the investigation continues, additional grocery stores may be added.

Most people affected by Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after eating food contaminated by the bacteria. The illness usually lasts 4 to 7 days, and most people recover without treatment. However, diarrhea for some people may be so severe that they need to be hospitalized. The CDC has indicated there have been more hospitalizations with this outbreak than what is typically seen. The elderly, infants, and those with compromised immune systems are more likely to have a severe illness.

The U.S. Food and Drug Administration is working to identify the source of Salmonella and there may be recalls as more information is learned. Walmart stores in Illinois have removed pre-cut melons linked to this outbreak from their shelves.

So far only pre-cut melons have been linked, but it’s important to remember food safety measures if you buy whole melons. Make sure to wash the melons before you start cutting. Also make sure you’ve washed your hands and all utensils¾knives and cutting boards, and don’t let fresh fruits and vegetables come into contact with raw meat.