Multistate Outbreak of Salmonella Saintpaul Infections Linked to Raw Produce
Posted July 1, 2008
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 Saintpaul, United States, by state
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 initial epidemiologic investigation comparing foods eaten by ill and well persons identified consumption of raw tomatoes as strongly linked to illness. Recently, many clusters of illnesses have been identified in Texas and other states among persons who ate at restaurants. These clusters have led us to broaden the investigation to be sure that it encompasses food items that are commonly consumed with tomatoes.
Since April, 869 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in 36 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 number of ill persons identified in each state is as follows: Arkansas (10 persons), Arizona (41), California (10), Colorado (11), Connecticut (4), Florida (1), Georgia (20), Idaho (3), Illinois (91), Indiana (11), Kansas (14), Kentucky (1), Maine (1), Maryland (29), Massachusetts (21), Michigan (6), Minnesota (2), Missouri (12), New Hampshire (3), Nevada (11), New Jersey (6), New Mexico (90), New York (26), North Carolina (5), Ohio (7), Oklahoma (23), Oregon (10), Pennsylvania (8), Rhode Island (3), Tennessee (6), Texas (346), Utah (2), Virginia (22), Vermont (2), Washington (4), Wisconsin (6), and the District of Columbia (1).
Among the 588 persons with information available, illnesses began between April 10 and June 20, 2008, including 179 who became ill on June 1 or later. Many steps must occur between a person becoming ill and the determination that the illness was caused by the outbreak strain of Salmonella; these steps take an average of 2-3 weeks. Therefore, an illness reported today may have begun 2-3 weeks ago. Patients range in age from <1 to 99 years; 48% are female. The rate of illness is highest among persons 20 to 29 years old; the rate of illness is lowest in children 10 to 19 years old and in persons greater than 80 years old. At least 107 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 food is distributed throughout much of the country. Because many persons with Salmonella illness do not have a stool specimen tested, it is likely that 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
- New Jersey Department of Health and Human Services: NJ Reports Four Salmonella Cases Linked to Multi-State Outbreak
- Utah Department of Health: Health News
- Information on the safe handling of produce [PDF - 2 pages]