A bit(e) of history of Antibiotic-Resistant Salmonella Outbreaks.

122011-map-tn.jpgHannaford, a Scarborough, Maine-based grocery chain, last week recalled an undetermined amount of fresh ground beef products that may be contaminated with a strain of Salmonella Typhimurium.

This recall was initiated due to concerns about illnesses caused by an outbreak of salmonellosis that may be associated with use and consumption of fresh in-store ground beef prepared in and purchased at Hannaford stores. The PFGE pattern associated with this outbreak is reported rarely in the U.S. The Centers for Disease Control and Prevention (CDC) have reported 16 ill persons with an indistinguishable PFGE pattern, and 11 of those individuals reported consuming ground beef. Seven individuals were hospitalized and no deaths have been reported. Ten of the 14 case-patients reported purchasing ground beef at Hannaford stores in Maine, New York, New Hampshire and Vermont between Oct. 12 and Nov. 20.

The outbreak strain of Salmonella Typhimurium has initially tested resistant to multiple commonly prescribed antibiotics, including drug classes such as beta-lactams, aminoglycosides, and cephalosporins.

Here is a decade of history of Antibiotic-Resistant Salmonella Outbreaks:

Emmpak/Cargill Ground Beef 2002 – 47 Ill:  In early 2002, isolates of Salmonella Newport in New York State were found to be resistant to more than nine antibiotics and had a decreased susceptibility to the antibiotic, ceftriaxone. Since 1996, an increasing number of Salmonella Newport isolates had been found to be resistant to antibiotics. This particular strain of Salmonella Newport was referred to as SN-MDR-AmpC. Subsequent to the discovery of cases in New York, four additional states discovered cases sharing the same strain of SN-MDR-AmpC.

When the cases were investigated, it was found that consumption of undercooked ground beef was the only food that was significantly associated with a risk of infection. The risk of infection when undercooked ground beef eaten was over 50 times greater than when well-cooked meat was eaten.

A sample of ground beef provided by a case-patient was analyzed and was found to be contaminated with SN-MDR-AmpC. Traceback of the meat implicated Emmpak Foods Inc., a subsidiary of Cargill, Inc. Most patients had eaten lean, or extra-lean, ground beef.

This outbreak was the first to implicate ground beef as a source of SN-MDR-AmpC. It illustrated the spread of antibiotic resistance from animal products to humans.

Northeastern States Ground Beef 2003 – 58 Ill:  A cluster of Salmonella Typhimurium DT104 cases was found in the northeastern United States in late 2003. The strain was resistant to several antibiotics and was referred to as R-type ACSSuT. Illness was associated with consuming grocery store bought ground beef that was prepared at home as hamburgers.

Product traceback linked the cases to a single, large ground beef manufacturer that had previously been implicated in a multistate outbreak of a highly antibiotic resistant strain of Salmonella Newport in 2002. The meat processor produced much of the ground beef from culled cows.

On January 29, 2004, the USDA issued a reminder to consumers to cook beef thoroughly, but no product recall was issued. Related cases were found through April 2004. Cases were more likely than controls to have pre-existing medical problems.

Safeway Ground Beef 2007 – 43 Ill:  Safeway markets in Arizona, California, Hawaii, Nevada, and New Mexico sold contaminated ground beef. A rare, drug resistant, strain of Salmonella Newport was isolated from the ill.

No recall was issued as the Food Safety and Inspection Service could not identify the specific “establishments, lots and products” that received the ground beef.

An alert was issued on December 21, 2007 that advised Safeway customers to refrain from eating ground beef that had been purchased between September 19 and November 5.

Beef Packers, Inc., Cargill, Ground Beef 2009 – 2 Ill:  In December, Beef Packers, Inc., owned by Cargill, recalled over 20,000 pounds of ground beef contaminated with a drug-resistant strain of Salmonella Newport.

The company issued an earlier recall in August 2009, due to contamination of ground beef with the same strain of Salmonella Newport. This contaminated ground beef was produced in September and was distributed to Safeway grocery stores in Arizona and New Mexico.

The Arizona Department of Health linked two illnesses to the ground beef.

Beef Packers, Inc., Cargill, Ground Beef 2009 – 40 Ill:  A Beef Packers, Inc. plant in California, owned by Cargill, distributed approximately 830,000 pounds of ground beef that was likely contaminated with Salmonella Newport. The beef was shipped to distribution centers in Arizona, California, Colorado, and Utah where it was repackaged into consumer-sized packages and sold under different retail brand names.

The contaminated beef contained a strain of Salmonella resistant to several commonly used antibiotics (called MDR-AmpC resistance). At least 40 people in nine states fell ill; at least 21 of the people lived in Colorado and five lived in California. Most people became ill during late June and early July, 2009.

Most of the ill in Colorado had purchased the ground beef at Safeway grocery stores. Ground beef was likely sold through other retail outlets as well.

Cargill is a privately held, multinational corporation whose business activities include production of crop nutrients, grain, livestock feed, agricultural commodities, and ingredients for processed foods.

King Soopers, Inc., Ground Beef 2009 – 14 Ill:  King Soopers, Inc., a supermarket chain, recalled approximately 466,236 pounds of ground beef that was linked to an outbreak of Salmonella Typhimurium DT 104 in the state of Colorado.

The beef had been distributed in the states of Colorado, Kansas, Missouri, Nebraska, New Mexico, Utah, and Wyoming. The recall involved tray packs and chubs. The ground beef was produced on various dates ranging from May 23 to June 13, 2009. The Salmonella was resistant to many the antibiotics.

Jenny-O-Turkey Burgers 2010 – 12 Ill:  Jennie-O-Turkey Store, All Natural Lean White Meat Turkey Burgers were recalled on April 1, 2011, after an outbreak of Salmonella Hadar had been linked with the consumption of this product.

The turkey burgers were sold exclusively in 4-pound cartons through Sam’s Club stores.

Consumer turkey burger samples in two states were confirmed to be contaminated with the outbreak strain of Salmonella Hadar.

The Salmonella Hadar is known to be resistant to several antibiotic drugs, including ampicillin, amoxicillin/clavulanate, cephalothin, and tetracycline. The Jenny-O Turkey Store is part of the Hormel Foods Company.

Cargill Meat Solutions Ground Turkey 2011 – 136 Ill:  The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) issued a public health alert on July 29, 2011, due to concerns about illnesses caused by Salmonella Heidelberg associated with the use and the consumption of ground turkey. The alert was initiated after continuous medical reports; ongoing investigations and testing conducted by various departments of health across the nation determined an association between consumption of ground turkey products and illness.

On August 3, Cargill Meat Solutions issued a recall of ground turkey products. On August 4, the Centers for Disease Control published its first outbreak summary.

The Salmonella Heidelberg was multi-drug resistant, resistant to ampicillin, streptomycin, tetracycline, and gentamycin.

The CDC began its investigation on May 23, after recognizing an “unusual clustering” of Salmonella Heidelberg cases. About the same time, routine surveillance by a federal food monitoring system found the same strain of Salmonella Heidelberg in ground turkey in stores.

On July 29, the initial outbreak strain and a second, closely related, strain of Salmonella Heidelberg was isolated from a sample of leftover unlabeled frozen ground turkey from the home of an outbreak case in Ohio. Since February 27, 2011, a total of 23 ill persons were reported to PulseNet with this second, closely related, strain. Eighty-four ill persons were infected with the initial strain.

The consumer product sample originated from the Cargill Meat Solutions Corporation establishment in Springdale, Arkansas.

On September 11, Cargill Meat Solutions recalled an additional, approximately 185,000 pounds, of ground turkey contaminated with an identical strain of Salmonella Heidelberg that had led to the earlier recall on August 3.

As of September 27, 2011 no illnesses had been linked to the additionally recalled ground turkey products.

Schreiber Processing Company, MealMart Brand, Kosher Broiled Chicken Livers 2011 – 179 Ill:  An outbreak of Salmonella Heidelberg was associated with eating broiled chicken liver or chopped chicken liver produced by the Schreiber Processing Company under the MealMart brand. As of November 16, 99 cases were identified in New York, 61 cases in New Jersey, 10 cases in Pennsylvania, 6 cases in Maryland, 2 cases in Ohio, and 1 case in Minnesota. Consumers believed that the product was fully cooked, however it was not. The product should have been heated before eating. The outbreak strain of Salmonella was found in samples of kosher broiled chicken livers and in samples of chopped chicken liver made from the same broiled chicken liver. In stores, “broiled chicken livers” are often re-packaged and sold in smaller quantities or are used to prepare chopped liver sold at deli-style establishments.