Investigation Details

Posted May 7, 2021

May 7, 2021

Epidemiologic, laboratory, and traceback data show that Jule’s cashew brie was contaminated with Salmonella and has made people sick.

Since the last update on April 23, 2021, Salmonella Urbana was found in Jule’s cashew brie and has been added to this outbreak investigation. Two people were infected with this outbreak strain.

Epidemiologic Data

As of May 7, 2021, seven people infected with the outbreak strains of Salmonella Duisburg and Salmonella Urbana have been reported from three states (see map). Illnesses started on dates ranging from January 31, 2021, to April 8, 2021 (see timeline).

Sick people range in age from 23 to 72 years, with a median age of 26, and 57% are female. Three people have been hospitalized, and no deaths have been reported.

The true number of sick people in an outbreak is likely much higher than the number reported, and the outbreak may not be limited to the states with known illnesses. This is because many people recover without medical care and are not tested for Salmonella. In addition, recent illnesses may not yet be reported as it usually takes 2 to 4 weeks to determine if a sick person is part of an outbreak.

State and local public health officials interviewed people about the foods they ate in the week before they got sick. Of the six people interviewed, four (67%) reported eating Jule’s cashew brie – the only common product identified.

Laboratory Data

Officials from California and Tennessee collected samples of Jule’s cashew brie for testing. Whole genome sequencing (WGS) results showed Jule’s truffle cashew brie collected in both states were contaminated with the outbreak strain of Salmonella Urbana. In addition, the other varieties of Jule’s cashew brie were contaminated with other strains of Salmonella. At this time, we have not identified any sick people who were infected with these other strains.

FDA also collected food samples from Jule’s Foods production facility. WGS results showed that raw cashews from the same lot used to make the recalled brie were contaminated with the outbreak strain of Salmonella Urbana.

WGS predicted that bacteria from four people’s samples are resistant to fosfomycin; bacteria from one person’s sample and one food sample have no resistance. Standard antibiotic susceptibility testing by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory is currently underway. Most people with Salmonella illness recover without antibiotics. However, if antibiotics are needed, this resistance is unlikely to affect the choice of antibiotic used to treat most people.

Public Health Actions

FDA is working with the supplier of the raw cashews to ensure that all potentially contaminated products have been withdrawn from the market. The supplier has told their customers not to use any of the cashews. The supplier reported that they do not sell cashews directly to consumers.

FDA is continuing to work with the cashew supplier to determine if additional products may be contaminated.

Previous Updates

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are collecting different types of data to investigate a multistate outbreak of Salmonella Duisburg infections.

Epidemiologic and traceback data show that Jule’s cashew brie may be contaminated with Salmonella and may be making people sick.

Epidemiologic and Traceback Data

As of April 21, 2021, five people infected with the outbreak strain of Salmonella Duisburg have been reported from three states (see map). Illnesses started on dates ranging from February 1, 2021 to February 27, 2021 (see timeline).

Sick people range in age from 23 to 70 years, with a median age of 26, and 80% are female. Of five people with information available, two have been hospitalized. No deaths have been reported.

The true number of sick people in an outbreak is likely much higher than the number reported, and the outbreak may not be limited to the states with known illnesses. This is because many people recover without medical care and are not tested for Salmonella. In addition, recent illnesses may not yet be reported as it usually takes 2 to 4 weeks to determine if a sick person is part of an outbreak.

State and local public health officials interviewed people about the foods they ate in the week before they got sick. Of the five people interviewed, three (60%) reported eating Jule’s truffle cashew brie – the only common product identified. Two of these people reported eating the cashew truffle brie at the same restaurant on different days.

Laboratory Data

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. CDC PulseNet manages a national database of DNA fingerprints of bacteria that cause foodborne illnesses. DNA fingerprinting is performed on bacteria using a method called whole genome sequencing (WGS). WGS showed that bacteria from sick people’s samples are closely related genetically. This means that people in this outbreak likely got sick from the same food.

Officials from California and Tennessee collected samples of Jule’s cashew brie for testing. On April 22, testing results showed that the samples of all varieties of Jule’s cashew brie collected in California were contaminated with Salmonella. WGS is currently being conducted to see if the Salmonella bacteria in these samples are the same bacteria making people sick in this outbreak. Test results of the samples collected in Tennessee are pending.

WGS predicted that bacteria from four people’s samples are resistant to fosfomycin. Standard antibiotic susceptibility testing by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory is currently underway. Most people with Salmonella illness recover without antibiotics. However, if antibiotics are needed, this resistance may affect the choice of antibiotic used for treatment.

Public Health Actions

On April 22, Jule’s Foods recalled all their products, including their cashew brie (see recall noticeexternal icon). CDC advises everyone not to eat, sell, or serve the recalled products. Jule’s Foods has stopped producing and distributing all of their products.

FDA investigators and California Department of Public Health state inspectors are conducting an inspection at the Jule’s Foods production facility. They are also collecting additional product and environmental samples for testing.