Conagra Brands is collaborating with health officials in connection with a positive finding of Salmonella in a retail sample of Duncan Hines Classic White cake mix that may be linked to a Salmonella outbreak that is currently being investigated by CDC and FDA. While it has not been definitively concluded that this product is linked to the outbreak and the investigation is still ongoing, Conagra has decided to voluntarily recall the specific Duncan Hines variety identified (Classic White) and three other varieties (Classic Butter Golden, Signature Confetti and Classic Yellow) made during the same time period out of an abundance of caution.

Five occurrences of illnesses due to Salmonella are being researched by CDC and FDA as part of this investigation. Salmonella is an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.

Several of the individuals reported consuming a cake mix at some point prior to becoming ill, and some may have also consumed these products raw and not baked. Consumers are reminded not to consume any raw batter. Cake mixes and batter can be made with ingredients such as eggs or flour which can carry risks of bacteria that are rendered harmless by baking, frying or boiling. Consumers are reminded to wash their hands, work surfaces, and utensils thoroughly after contact with raw batter products, to follow baking instructions, and to never eat raw batter.

The products covered by this recall were distributed for retail sale in the U.S. and limited international exports; the specific product information is listed below.

The Public Health Agency of Canada is collaborating with provincial and territorial public health partners, the Canadian Food Inspection Agency and Health Canada to investigate outbreaks of Salmonella infections across Canada linked to raw chicken, including frozen raw breaded chicken products.

As of November 2, 2018, there have been 474 laboratory-confirmed cases of Salmonella illness investigated as part of the illness outbreaks across the country: British Columbia (38), Alberta (70), Saskatchewan (17), Manitoba (22), Ontario (166), Quebec (107), New Brunswick (25), Nova Scotia (12), Prince Edward Island (2), Newfoundland and Labrador (11), Northwest Territories (1), Yukon (1), and Nunavut (2). There have been 90 individuals hospitalized as part of these outbreaks. Three individuals have died; however, Salmonella was not the cause of death for two of those individuals, and it was not determined whether Salmonella contributed to the cause of death for the third individual. Infections have occurred in Canadians of all ages and genders.

All active and future Salmonella outbreak investigations linked to raw chicken, including frozen raw breaded chicken products, and related food recall warnings will be listed in the next section of the public health notice to remind Canadians of the ongoing risk associated with these types of food products.

And, do not forget the 6 sick in Washington.

The Public Health Agency of Canada is collaborating with provincial public health partners, the Canadian Food Inspection Agency and Health Canada to investigate an outbreak of Salmonella infections involving five provinces: British Columbia, Alberta, Saskatchewan, Manitoba, and Quebec. The illness reported in Quebec was related to travel to British Columbia.

Based on the investigation findings to date, exposure to long English cucumbers has been identified as the likely source of the outbreak. Many of the individuals who became sick reported eating long English cucumbers before their illness. However, more information is needed to determine the possible causes of contamination. The outbreak appears to be ongoing, as illnesses continue to be reported.

The Public Health Agency of Canada is issuing this updated public health notice to inform residents in western Canada of the investigation findings to date and to share important safe food handling practices to help prevent further Salmonella infections. At this time, there is no evidence to suggest that residents in eastern Canada are affected by this outbreak.

As of November 2, 2018, there have been 50 laboratory-confirmed cases of Salmonella Infantis illness investigated in the following provinces: British Columbia (42), Alberta (5), Saskatchewan (1), Manitoba (1), and Quebec (1). The individual from Quebec reported traveling to British Columbia before becoming ill. Individuals became sick between mid-June and early-October 2018. Ten individuals have been hospitalized. No deaths have been reported. Individuals who became ill are between 1 and 92 years of age. The majority of cases (58%) are female.

The Canadian Food Inspection Agency continues to collaborate with the overall outbreak investigation. If contaminated food products are identified, they will take the necessary steps to protect the public, including recalling the product as required. Currently there are no Food Recall Warnings associated with this outbreak.

On October 19, 2018, Washington State health officials announced a Salmonella outbreak linked to English cucumbers sold at Costco. The outbreak investigation identified 6 confirmed cases of Salmonella infections in the state of Washington. The last reported illness happened on September 15, 2018. Counties affected include:

King
Pierce
Snohomish
Thurston
Yakima

JBS Tolleson, Inc., a Tolleson, Ariz. establishment, is recalling approximately 6,937,195 pounds of various raw, non-intact beef products that may be contaminated with Salmonella Newport, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The raw, non-intact beef items, including ground beef, were packaged on various dates from July 26, 2018 to Sept. 7, 2018. The following products are subject to recall: [Products List (PDF) (or XLSX) | Product Labels (PDF only) | Distribution List (PDF)]

The products subject to recall bear establishment number “EST. 267” inside the USDA mark of inspection. These items were shipped to retail locations and institutions nationwide.

On September 5, 2018, FSIS was notified of an investigation of Salmonella Newport illnesses with reported consumption of several different FSIS-regulated products by case-patients. The first store receipt potentially linking the purchase of FSIS-regulated product to a case-patient was received on September 19, 2018; FSIS was then able to begin traceback of ground beef products. To date, eight case-patients have provided receipts or shopper card numbers, which have enabled product traceback investigations.  FSIS, the Centers for Disease Control and Prevention (CDC), and state public health and agriculture partners have now determined that raw ground beef was the probable source of the reported illnesses. Traceback has identified JBS as the common supplier of the ground beef products. The epidemiological investigation has identified 57 case-patients from 16 states with illness onset dates ranging from August 5 to September 6, 2018. FSIS will continue to work with public health partners and will provide updated information should it become available.

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.

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

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.