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Multistate Outbreak of Salmonella Saintpaul Infections Linked to Raw Produce

Posted July 7, 2008

Click here to go to the Final Update

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.

 

Cases infected with the outbreak strain of Salmonella Saintpaul, United States, by state
Incidence of cases of infection 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 several states among persons who ate at restaurants. These clusters led us to broaden the investigation to be sure that it encompasses food items that are commonly consumed with tomatoes. Fresh tomatoes, fresh hot chili peppers such as jalapeños, and fresh cilantro are the lead hypotheses. However, at this point in the investigation, we can neither directly implicate one of these ingredients as the single source, nor discard any as a possible source.

Since April, 971 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in 40 states, the District of Columbia, and Canada. These were identified because clinical laboratories in all states send Salmonella strains from ill persons to their State public health laboratory for characterization. No new states report ill persons. The number of ill persons identified in each state is as follows: Alabama (2 persons), Arkansas (10), Arizona (45), California (8), Colorado (12), Connecticut (4), Florida (2), Georgia (24), Idaho (4), Illinois (93), Indiana (14), Iowa (2), Kansas (17), Kentucky (1), Louisiana (1), Maine (1), Maryland (29), Massachusetts (22), Michigan (7), Minnesota (8), Missouri (12), New Hampshire (4), Nevada (11), New Jersey (9), New Mexico (98), New York (28), North Carolina (10), Ohio (7), Oklahoma (23), Oregon (10), Pennsylvania (8), Rhode Island (3), South Carolina (1), Tennessee (8), Texas (381), Utah (2), Virginia (29), Vermont (2), Washington (4), Wisconsin (10), and the District of Columbia (1). Four ill persons are reported from Canada; three appear to have been infected while traveling in the United States, and one illness remains under investigation.

Among the 693 persons with information available, illnesses began between April 10 and June 26, 2008, including 258 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 80 or more years old. At least 189 persons were hospitalized. One death in a man in Texas in his eighties has been associated with this outbreak. In addition, 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 6 persons infected with this strain of Salmonella Saintpaul were identified in the country during April through June of 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.

Health officials have worked continuously since late May to investigate this outbreak. CDC has sent 17 people to the field to work with other public health officials. The investigation is complex and difficult. One difficult aspect is that people often have difficulty remembering exactly what foods they ate, and remembering specific ingredients is even more difficult. Although laboratory testing of foods might help, perishable foods that were consumed by ill persons are often not available to test.

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 follow the general food safety guidelines below:

  • 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.

FDA information on this investigation.

More information about Salmonella and this investigation can be found at:

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