Health

Salmonella outbreak appears over; investigation to continue

The cause remains unknown, but jalapeņo peppers are the prime suspects, the CDC said in sounding a cautionary all-clear.

By — Posted Sept. 22, 2008

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The Salmonella outbreak that swept through 43 states plus the District of Columbia this spring and summer appears to be over. But the Centers for Disease Control and Prevention is continuing to watch for any additional cases of the Saintpaul bacteria strain that caused the illnesses.

As of Aug. 25, the CDC had received reports that 1,442 people had been infected -- at least 286 of whom were hospitalized. In addition, the infection may have contributed to two deaths. The outbreak began in late April, and most people were sickened in May and June. It was identified in the CDC's Aug. 29 Morbidity and Mortality Weekly Report as the nation's largest foodborne disease event in the past decade.

Foodborne illnesses are becoming a major public health problem in the United States. In the past few years, Salmonella-laden peanut butter made more than 300 people sick, and spinach contaminated by Escherichia coli caused 206 illnesses, three deaths and more than 100 hospitalizations.

Proper diagnosis of these illnesses are a top concern of doctors and other health care professionals. The AMA, working with other organizations, has developed a primer to increase awareness. Many cases of foodborne ailments are thought to go unrecognized and unreported, MMWR says.

The assessment that the latest Salmonella outbreak had ended was based on several observations, said Robert Tauxe, MD, MPH, deputy director of the CDC's Division of Foodborne, Bacterial and Mycotic Diseases. "The number of reported cases has been dropping since early July and by the beginning of August was down to the number of cases we would expect to see anyway in the absence of a major outbreak," he reported during an Aug. 28 press briefing.

Although no firm conclusions were reached on the particular food that caused the illnesses, jalapeño peppers from a Mexican farm are considered the prime suspect. Serrano peppers and tomatoes also were grown on the same farm and may have played a role, the MMWR says.

Tomatoes may have been an early source of infection, Dr. Tauxe said. "We recognize that since the specific source of the contamination with Salmonella has not been identified, it's important that we remain vigilant."

Nevertheless, the Food and Drug Administration lifted its advice to avoid eating raw jalapeño and Serrano peppers, said David Acheson, MD, the FDA's associate commissioner for foods. "The FDA is taking this action consistent with the CDC's declarations that the Salmonella Saintpaul outbreak appears to be over."

Several lessons were learned from the outbreak that point to the need for improved follow-up action, Dr. Acheson said. He urged Congress to give the FDA the authority to require the food industry to institute more protections, including using electronic tracking, so a source of contamination can be traced more quickly.

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ADDITIONAL INFORMATION

State-by-state breakdown

Number of laboratory-confirmed cases of Salmonella Saintpaul -- as of Aug. 25:

States with zero cases: Alaska, Delaware, Hawaii, Nebraska, North Dakota, South Dakota, Wyoming.

1 to 4 cases: District of Columbia, 1; Florida, 4; Iowa, 2; Kentucky, 2; Louisiana, 3; Maine, 1; Mississippi, 2; Montana, 1; Rhode Island, 3; South Carolina, 2; Utah, 3; Vermont, 2; West Virginia, 1.

5 to 25 cases: Alabama, 8; Arkansas, 21; California, 16; Colorado, 17; Connecticut, 5; Idaho, 6; Indiana, 21; Kansas, 21; Missouri, 20; Nevada, 14; New Hampshire, 6; New Jersey, 16; Ohio, 10; Oregon, 11; Pennsylvania, 15; Tennessee, 10; Washington, 18; Wisconsin, 13.

26 to 75 cases: Arizona, 59; Georgia, 42; Maryland, 39; Massachusetts, 31; Michigan, 28; Minnesota, 31; New York, 41; North Carolina, 28; Oklahoma, 38; Virginia, 31.

76 or more cases: Illinois, 120; New Mexico, 115; Texas, 559.

Note: The total number of reported cases -- 1,442 -- includes five Canadian Salmonella cases involving the Saintpaul strain. Four of the infections appear to have occurred while traveling in the U.S. The travel status of the fifth is unknown.

Source: National Center for Zoonotic, Vector-Borne and Enteric Diseases, Aug. 28

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External links

"Outbreak of Salmonella Serotype Saintpaul Infections Associated with Multiple Raw Produce Items," Morbidity and Mortality Weekly Report, Aug. 29 (link)

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