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Investigation of a Multistate Outbreak of Human Salmonella I 4,[5],12:i:- Infections Linked to Alfalfa Sprouts

December 28, 2010

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Introduction

CDC is collaborating with public health officials in many states and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Salmonella serotype I 4,[5],12:i:- infections. Investigators are using DNA analysis of Salmonella bacteria obtained through diagnostic testing to identify cases of illness that may be part of this outbreak.

From November 1 through December 27, 2010, 94 individuals infected with the outbreak strain of Salmonella serotype I 4,[5],12:i:-, whose illnesses began since November 1, have been reported from 16 states and the District of Columbia.  The number of ill people identified in each state with the outbreak strain is as follows: California (1), Connecticut (1), District of Columbia (1), Georgia (1), Hawaii (1), Iowa (1), Illinois (51), Indiana (9), Massachusetts (1), Missouri (17), New York (1), Pennsylvania (2), South Dakota (1), Tennessee (1), Texas (1), Virginia (1), and Wisconsin (3). Among 91 persons for whom information is available, illness onset dates range from November 1 to December 14, 2010. Case-patients range in age from 1 to 75 years, with a median age of 28. Sixty-one (or 67%) of patients are female. Among persons with available information, 24% reported being hospitalized. No deaths have been reported. Because the pulsed-field gel electrophoresis (PFGE) pattern associated with this particular Salmonella serotype commonly occurs in the United States, some of the cases identified may not be related to this outbreak.

The outbreak can be visually described with a chart showing the number of people who became ill each day. This chart is called an epidemic curve or epi curve. Illnesses that occurred after December 7, 2010, might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 3 weeks. For more information, please see Salmonella Outbreak Investigations: Timeline for Reporting Cases.

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Investigation of the Outbreak

Collaborative investigative efforts of local, state, and federal public health and regulatory agencies have linked this outbreak to consumption of Tiny Greens Organic Farm’s Alfalfa Sprouts and Spicy Sprouts. The sprouts were distributed to Illinois, Indiana, Iowa, and Missouri, and may also have been distributed to other Midwestern states.

Approximately half of the illnesses occurred in Illinois, where many of the ill individuals ate sandwiches containing sprouts at various Jimmy John’s outlets. Jimmy John’s restaurants have voluntarily suspended serving sprouts at their Illinois franchise locations.

This investigation is ongoing. CDC, FDA, and state and local public health partners are continuing surveillance to identify new cases and trace potentially contaminated products. CDC will continue to update the public on the progress of this investigation as information becomes available.

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Clinical Features/Signs and Symptoms

Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts 4 to 7 days, and most persons recover without treatment. However, in some persons, the diarrhea may be so severe that the patient needs to be hospitalized. Salmonella infection may spread from the intestines to the blood stream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics. The elderly, infants, and those with impaired immune systems are more likely to have a severe illness from Salmonella infection.

Advice to Consumers, Retailers and Others

Since 1996, there have been at least 30 reported outbreaks of foodborne illness associated with different types of raw and lightly cooked sprouts. Most of these outbreaks were caused by Salmonella and E coli. Persons who think they might have become ill from eating potentially contaminated products should consult their health care providers.

Below are additional recommendations:

  • Consumers should not eat Tiny Greens brand Alfalfa Sprouts or Spicy Sprouts, and restaurant and food service operators should not serve them. Consumers, retailers and others who have Tiny Greens Alfalfa Sprouts or Spicy Sprouts should dispose of them in a closed plastic bag placed in a sealed trash can. This will prevent people or animals from eating them.
  • Children, the elderly, pregnant women, and persons with weakened immune systems should avoid eating raw sprouts of any kind (including alfalfa, clover, radish, and mung bean sprouts).
  • Cook sprouts thoroughly to reduce the risk of illness. Cooking kills the harmful bacteria.
  • Request that raw sprouts not be added to your food. If you purchase a sandwich or salad at a restaurant or delicatessen, check to make sure that raw sprouts have not been added.
  • To learn more about illnesses associated with sprouts, visit Foodsafety.gov.

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Additional Resources

CDC's Role in Food Safety

As an agency within the U.S. Department of Health and Human Services (HHS), CDC leads federal efforts to gather data on foodborne illnesses, investigate foodborne illnesses and outbreaks, and monitor the effectiveness of prevention and control efforts. CDC is not a food safety regulatory agency but works closely with the food safety regulatory agencies, in particular, with HHS’s Food and Drug Administration (FDA) and the Food Safety and Inspection Service within the U.S. Department of Agriculture. CDC also plays a key role in building state and local health department epidemiology, laboratory, and environmental health capacity to support foodborne disease surveillance and outbreak response. Notably, CDC data can be used to help document the effectiveness of regulatory interventions.

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