Posted June 20, 2008
Multistate Outbreak of Salmonella Saintpaul Infections Linked to Raw Produce
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.
States with persons with the outbreak strain of Salmonella Saintpaul, by state of residence
CDC is collaborating with public health officials in many states, the Indian Health Service, and the U.S. Food and Drug Administration (FDA) to investigate an ongoing multi-state outbreak of human Salmonella serotype Saintpaul infections. An epidemiologic investigation comparing foods eaten by ill and well persons has identified consumption of raw tomatoes as the likely source of the illnesses. The specific type and source of tomatoes is under investigation; however, the data suggest that illnesses are linked to consumption of raw red plum, red Roma, or round red tomatoes, or any combination of these types of tomatoes, and to products containing these raw tomatoes.
Since April, 552 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in 32 states and the District of Columbia. These were identified because clinical laboratories in all states send Salmonella strains from ill persons to their State public health laboratory for characterization. The marked increase in reported ill persons since the last update is not thought to be due to a large number of new infections. The number of reported ill persons increased mainly because some states improved surveillance for Salmonella in response to this outbreak and because laboratory identification of many previously submitted strains was completed. In particular, the number of ill persons reported from Texas markedly increased, and two new states, New Jersey and Rhode Island, reported ill persons. The number of ill persons identified in each state is as follows: Arkansas (3 persons), Arizona (29), California (8), Colorado (4), Connecticut (4), Florida (1), Georgia (11), Idaho (3), Illinois (34), Indiana (8), Kansas (9), Kentucky (1), Maryland (18), Michigan (4), Missouri (10), New Hampshire (1), New Jersey (1), New Mexico (73), New York (10), North Carolina (1), Ohio (3), Oklahoma (5), Oregon (5), Pennsylvania (5), Rhode Island (2), Tennessee (4), Texas (265), Utah (2), Virginia (20), Vermont (1), Washington (1), Wisconsin (5), and the District of Columbia (1). Among the 281 persons with information available, illnesses began between April 10 and June 10, 2008. Patients range in age from <1 to 88 years; 49% are female. At least 53 persons were hospitalized. No deaths have been officially attributed to this outbreak. However, a man in his sixties who died in Texas from cancer had an infection with the outbreak strain of Salmonella Saintpaul at the time of his death. The infection may have contributed to his death.
Only 3 persons infected with this strain of Salmonella Saintpaul were identified in the country during the same period in 2007. The previous rarity of this strain and the distribution of illnesses in all U.S. regions suggest that the implicated tomatoes are distributed throughout much of the country. Because of inherent delays in reporting and because many persons with Salmonella illness do not have a stool specimen tested, it is likely many more illnesses have occurred than those reported. Some of these unreported illnesses may be in states that are not on today’s map.
Clinical features of Salmonella Infection
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 4-7 days. Although most people recover without treatment, severe infections may occur. Infants, elderly persons, and those with impaired 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. In these severe cases, antibiotic treatment may be necessary.
Advice to consumers
At this time, FDA is advising U.S. consumers to limit their tomato consumption to specific types and specific sources. These include cherry tomatoes; grape tomatoes; tomatoes sold with the vine still attached; tomatoes grown at home; and red plum, red Roma, and round red tomatoes from specific sources listed. Consumers should be aware that raw tomatoes are often used in the preparation of fresh salsa, guacamole, and pico de gallo, are part of fillings for tortillas, and are used in many other dishes.
Consumers everywhere are advised to:
- Refrigerate within 2 hours or discard cut, peeled, or cooked produce items, including tomatoes and peppers.
- Avoid purchasing bruised or damaged tomatoes, peppers, and other produce items, and discard any that appear spoiled.
- Thoroughly wash all tomatoes, peppers, and other produce items under running water.
- Keep produce items that will be consumed raw separate from raw meats, raw seafood, and raw produce items.
- Wash cutting boards, dishes, utensils, and counter tops with hot water and soap when switching between types of food products.
FDA recommends that U.S. retail outlets, restaurants, and food service operators offer only fresh and fresh cut red plum, red Roma, and round red tomatoes and food products made from these tomatoes from specific sources listed. Cherry tomatoes, grape tomatoes, and tomatoes sold with the vine still attached from any source may be offered.
More information about Salmonella and this investigation can be found at:
- Salmonella in tomatoes FAQ
- Timeline for Reporting of Cases
- New Mexico Department of Health [PDF – 191 KB]
- Kansas Identifies 3 Cases Linked to Multi-State Salmonella Outbreak
- Kentucky Cabinet for Health and Family Services Press Release
- Indiana State Department of Health Media Update on Salmonella Outbreak
- Utah Department of Health: Health News
- Information on the safe handling of produce [PDF - 2 pages]