Multistate Outbreak of Human Salmonella Montevideo Infections
Posted February 11, 2010
This outbreak appears to be over. However, Salmonella is an important cause of human illness in the United States. More information about Salmonella, and steps people can take to reduce their risk of infection, can be found on the CDC Salmonella Web Page.
Persons Infected with the Outbreak Strain of Salmonella Montevideo, United States, by State
Infections with the Outbreak Strain of Salmonella Montevideo, by Date of Illness Onset
CDC is collaborating with public health officials in many states, the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS), the U.S. Food and Drug Administration (FDA), and the State of Rhode Island to investigate a multistate outbreak of Salmonella serotype Montevideo 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.
As of 9:00 pm EST on February 10, 2010, a total of 225 individuals infected with the outbreak strain of Salmonella Montevideo, which displays either of two closely related PFGE patterns, have been reported from 44 states and District of Columbia since July 1, 2009. The number of ill persons identified in each state with this strain is as follows: AK (1), AL (2), AZ (6), CA (30), CO (4), CT (5), DC (1), DE (2), FL (3), GA (3), IA (1), ID (2), IL (15), IN (3), KS (3), LA (1), MA (13), MD (1), ME (1), MI (4), MN (5), MO (2), MS (1), NC (10), ND (1), NE (1), NH (2), NJ (8), NM (2), NY (18), OH (9), OK (1), OR (9), PA (6), RI (2), SC (1), SD (3), TN (5), TX (7), UT (9), VA (1), WA (17), WI (1), WV (1), and WY (2). Because the main Salmonella Montevideo outbreak PFGE pattern is commonly occurring in the United States, public health investigators may determine that some of the illnesses are not part of this outbreak.
Salmonella Senftenberg, a different serotype of Salmonella, has been found in food samples from retail and a patient household during this outbreak investigation. PulseNet identified 5 persons who had illness caused by Salmonella Senftenberg with matching PFGE patterns between July 1, 2009 and today. Public health officials have interviewed 4 of the 5 ill persons with this strain of Salmonella Senftenberg and determined that one consumed a recalled salami product during the week before their illness began. These five cases are not included in the overall case count reported above.
Among the persons with reported dates available, illnesses began between July 4, 2009 and January 24, 2010. Infected individuals range in age from < 1 year old to 93 years old and the median age is 39 years. Fifty-three percent of patients are male. Among the 166 patients with available information, 43 (26%) were hospitalized. No deaths have been reported.
The outbreak can be visually described with a chart showing the number of persons who became ill each day. This chart is called an epidemic curve or epi curve. Illnesses that occurred after January 20, 2010 might not yet be reported 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. Please see the Salmonella Outbreak Investigations: Timeline for Reporting Cases for more details.
Investigation of the Outbreak
During January 16-21, 2010, CDC and public health officials in multiple states conducted an epidemiologic study by comparing foods eaten by 41 ill and 41 well persons. Preliminary analysis of this study has suggested salami as a possible source of illness. Ill persons (58%) were significantly more likely than well persons (16%) to report eating salami. Additionally, 16 ill persons have been identified who purchased the same type of sliced salami variety pack at different grocery store locations before becoming ill; Two additional ill persons have been identified who purchased a similar type of sliced salami deli tray before becoming ill. These data suggest this product is the source of some of these illnesses. This sliced salami variety pack was recently recalled by Daniele International Inc. CDC and public health officials in multiple states continue to interview ill persons to ask them about the foods they ate during the week before they became ill as well as to collect shopper card information.
On January 23, 2010, FSIS issued a news release that Daniele International Inc. is recalling approximately 1,240,000 pounds of ready-to-eat varieties of Italian sausage products (including salame/salami) in commerce and potentially available to customers in retail locations because they may be contaminated with Salmonella. On February 4, 2010, FSIS updated its January 23, 2010 news release to include two additional salame/salami products, adding approximately 23,754 pounds to the initial recall. These products can have an extended shelf life of up to one year. The manufacturer has voluntarily halted production of salami products.
This initial recall followed isolation of Salmonella in a private laboratory from a retail sample of a salami product produced by Daniele International; this product was different than the sliced salami variety pack purchased at different grocery store locations by the 16 ill persons. FSIS reviewed and affirmed these private laboratory results. The Salmonella strain initially found by the private laboratory was different from the strains causing the outbreak. However, the Washington State Department of Health subsequently tested the bacterial culture provided by the private laboratory (the salami was not provided) and identified two different Salmonella serotypes, the strain found by the private lab and Salmonella Montevideo indistinguishable from the outbreak strain and Salmonella Senftenberg. In addition, the Iowa Department of Public Health and public health officials in Plymouth County, Iowa investigated a patient with Salmonella Montevideo infection indistinguishable from the outbreak strain and discovered an open sliced salami variety pack frozen at the patient's home. The patient had eaten this product before becoming ill. This sliced salami variety pack was the same as that purchased by 16 other ill persons. Using DNA analysis, the University of Iowa Hygienic Laboratory (Iowa's public health laboratory) confirmed that the Salmonella isolated from this leftover salami was indistinguishable from the outbreak strain of Salmonella Montevideo.
On January 31, 2010, FSIS issued a second news release that Daniele International Inc. has expanded its recall to include more ready-to-eat (RTE) varieties of Italian sausage products. Specific products include:
- Packages of “DANIELE HOT SOPRESSATA CALABRESE,” produced on 11/7/09, 12/16/09 and 12/18/09.
- Packages of “DANIELE SOPRESSATA CALABRESE,” produced on 12/16/09 and 12/18/09.
- Packages of “BOAR’S HEAD BRAND HOT SOPRESSATA CALABRESE,” produced on 11/28/09, 12/9/09 and 12/14/09.
These products were distributed to retail establishments nationwide.
The recall was being expanded as a result of a confirmed finding of Salmonella in an unopened salami product reported by the Illinois Department of Public Health. The product was sampled during the course of an ongoing investigation of a multistate outbreak of Salmonella serotype Montevideo illnesses. The product tested was not included in the previous recall (FSIS Recall 006-2010) issued January 23, 2010, but is similar to products bought by customers who later became sick and were identified as part of the Montevideo investigation. The company believes that black pepper is a possible source of Salmonella contamination.
On February 4, 2010, FSIS announced that Daniele International Inc. added two more products to its list of recalled products. Specific products include:
- 3-ounce packages of “DANIELE NATURALE SALAME COATED WITH COARSE BLACK PEPPER.”
- Approximately 6-pound packages of “DANIELE SALAME GRANDE COATED WITH PORK FAT & PEPPER.”
Further testing is ongoing at a state health partner laboratory, and might determine if the product tested in Illinois contained the Salmonella Montevideo strain associated with the multistate outbreak.
Daniele International Inc. has recalled ready-to-eat varieties of Italian sausage products, including salami, which are regulated by the USDA. Some of the products contain black pepper, which is regulated by the FDA.
Recent test results provided by the Rhode Island Department of Health revealed that an opened container of black pepper used in the manufacturing of at least some of the recalled products was positive for Salmonella Montevideo and that the DNA fingerprint matched the outbreak strain: http://www.ri.gov/press/view/10647.
The FDA is investigating the supply chain of the black pepper used in the manufacturing of the recalled meat products. The Agency has collected and is currently analyzing black pepper samples. To date, all the samples collected and analyzed by the FDA have tested negative for Salmonella, however, sample collection and analysis continues.
CDC and its public health partners are continuing the epidemiologic investigation to verify that the outbreak is controlled. CDC, USDA-FSIS, and FDA continue to work closely to identify the specific products or ingredients that became contaminated and how the contamination occurred and to identify any other food vehicles that may be involved.
Unique Features of this Outbreak Investigation
- There are over 2,500 serotypes of Salmonella. Serotype Montevideo is in the top 10 most common Salmonella serotypes. Because the outbreak strain of Salmonella Montevideo is the most common pattern for serotype Montevideo based on DNA analysis, detecting an outbreak is challenging. CDC developed and tested a new statistical method for figuring out whether the cases reported to the PulseNet database were above what was expected based on historical trends.
- Shopper card information was successfully used for the first time to determine specific brands of a product suspected to cause illness. Additionally, a case-control study was conducted which suggested that the individuals who became ill ate salami/salame products a week prior to becoming ill.
- The recalled product contains ingredients regulated by two different federal agencies, USDA and FDA, both of which are fully engaged in this investigation. USDA regulates the meat used in the salami/salame and FDA regulates the black pepper.
Clinical Features/Signs and Symptoms
Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12–72 hours after infection. Infection is usually diagnosed by culture of a stool sample. The illness usually lasts from 4 to 7 days. Although most people recover without treatment, severe infections may occur. Infants, elderly persons, and those with weakened immune systems are more likely than others to develop severe illness. When severe infection occurs, Salmonella may spread from the intestines to the bloodstream and then to other body sites and can cause death unless the person is treated promptly with antibiotics.
More general information about Salmonella can be found here under Salmonella FAQs.
Advice to Consumers
- Recalled products may still be in grocery stores and in consumers' homes, including in the freezer. Recalled products should not be consumed. Consumers are advised to review the list of recalled products and labels for the initial January 23, 2010 recall and the February 4, 2010 addition of two products for the expanded recall announced on January 31, 2010.
- Consumer with questions regarding the recall should contact the Daniele International, Inc. Hotline at (888) 345-4160 and its PR contact, Levick Strategic Communications at (202) 973-1335.
- If you have a recalled product, do not eat it; return it to the place of purchase or dispose of it in a closed plastic bag and placed in a sealed trash can to prevent people or animals, including wild animals, from eating it.
- No illness has been linked to salami products produced by other companies.
- Consumers with food safety questions can "Ask Karen," the FSIS virtual representative available 24 hours a day at AskKaren.gov.
- The toll-free USDA Meat and Poultry Hotline 1-888-MPHotline (1-888-674-6854) is available in English and Spanish and can be reached from 10 a.m. to 4 p.m. EST Monday through Friday. Recorded food safety messages are available 24 hours a day.
- Consumers without Internet access can also call 1-800-CDC-INFO (1-800-232-4636), 24 hours a day, 7 days a week, for product recall information from the USDA-FSIS website and for other information on salmonellosis.
- Persons who think they might have become ill from eating a recalled product should consult their health care providers. Infants, elderly persons, and persons with impaired immune systems are more likely than others to develop severe illness.
- Press release from Rhode Island Department of Health
- Potentially Tainted Italian Sausage Recalled, Products from Rhode Island-based Firm May be Contaminated with Salmonella - Los Angeles County Department of Public Health
- Hygienic Laboratory First to Confirm Salmonella in Nationwide Outbreak - University of Iowa
- Salmonella Outbreak Prompts Salami Recall, Oregon Public Health Officials are Tracking Cases Throughout the State [PDF - 3 pages] - Oregon Department of Human Services
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 U.S. Food and Drug Administration (FDA) and the Food Safety and Inspection Service within the United States Department of Agriculture (USDA). 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.
Previous Updates on this Outbreak
- February 9, 2010
- February 5, 2010
- February 3, 2010
- February 1, 2010
- January 29, 2010
- January 26, 2010
- January 25, 2010
- January 23, 2010
- January 22, 2010