Salmonella

Multistate Outbreak of Salmonella Typhimurium Infections Linked to Peanut Butter, 2008–2009

Posted January 12, 2009

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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.

As of Monday, January 12, 2009, 410 persons infected with the outbreak strains of Salmonella Typhimurium have been reported from 43 states. The number of ill persons identified in each state is as follows: Alabama (1), Arizona (8), Arkansas (3), California (55), Colorado (9), Connecticut (6), Georgia (5), Hawaii (1), Idaho (10), Illinois (5), Indiana (4), Iowa (1), Kansas (2), Kentucky (3), Maine (4), Maryland (7), Massachu setts (40), Michigan (20), Minnesota (30), Missouri (8), Mississippi (1), Nebraska (1), New Hampshire (10), New Jersey (13), New York (12), Nevada (6), North Carolina (1), North Dakota (10), Ohio (53), Oklahoma (2), Oregon (5), Pennsylvania (12), Rhode Island (4), South Dakota (2), Tennessee (9), Texas (5), Utah (3), Vermont (4), Virginia (17), Washington (11), West Virginia (2), Wisconsin (3), and Wyoming (2). Among the 388 persons with dates available, illnesses began between September 3 and December 31, 2008, with most illnesses beginning after October 1, 2008. Patients range in age from < 1 to 98 years; 48% are female. Among persons with available information, 18% were hospitalized and the infection may have contributed to three deaths.

Outbreak Investigation

Preliminary analysis of an epidemiologic study conducted by CDC and public health officials in multiple states comparing foods eaten by ill and well persons has suggested peanut butter as a likely source. To date, no association has been found with common brand names of peanut butter sold in grocery stores.

An epidemiologic investigation by the Minnesota Department of Health suggested King Nut creamy peanut butter as a likely source of Salmonella infections among many ill persons in Minnesota. The Minnesota Department of Agriculture Laboratory isolated the outbreak strains of Salmonella Typhimurium from an open 5-pound container of King Nut brand creamy peanut butter. The product is distributed in Minnesota to establishments such as long-term care facilities, hospitals, schools, universities, restaurants, delis, cafeterias, and bakeries. It is not sold directly to consumers and is not known to be distributed for retail sale in grocery stores.

Clusters of infections in several states have been reported in schools and other institutions, such as long-term care facilities and hospitals, and King Nut is the only brand of peanut butter used in those facilities for which we have information.

CDC and other public health officials are continuing to conduct surveillance for cases of infection with the outbreak strains, and to gather and analyze data or exposures that may be associated with illness.

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Advice to Consumers

To date, common brands of peanut butter sold in grocery stores do not appear to be associated with the outbreak. Persons who think they may have become ill from eating peanut butter are advised to consult their health care providers.

On January 10, 2009, King Nut Companies, a distributor of peanut butter manufactured by Peanut Corporation of America, issued a voluntary recall of peanut butter distributed under the King Nut label. In addition, King Nut Companies also issued a voluntary recall of Parnell’s Pride peanut butter distributed by King Nut, which is produced by the same manufacturer. The recalled products have lot codes beginning with “8”. No other King Nut products are included in this voluntary recall.

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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 4 to 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 unless the person is treated promptly with antibiotics.

General information about Salmonella.

More information on this investigation can be found below.

The next web posting is expected on Monday, January 14, 2009.