Salmonella Bareilly Infects 90 People

At least 90 people in 19 US states and the District of Columbia have been infected with a single outbreak strain of Salmonella Bareilly, according to media reports.

Food Safety News, msnbc.com and other media outlets have reported that FDA and CDC are jointly investigating this new Salmonella outbreak, which may be associated with the consumption of spicy tuna sushi rolls.

The news leaked today via a memo that was inadvertently circulated throughout FDA, spokesperson Curtis Allen told JoNel Aleccia of msnbc.com.

When contacted by eFoodAlert for confirmation, CDC spokesperson Lola Russell replied, “We haven’t confirmed any of the details of this outbreak as of yet – it is still under investigation and a food vehicle has not been identified.”

A survey of state health agencies, combined with the information contained in the original FDA memo, has yielded the following information as of April 3, 2012:

Confirmed cases have been reported by Texas, the District of Columbia, Maryland, Rhode Island, Connecticut, Wisconsin, Missouri, New York State and Louisiana. The remaining eleven states have not yet been identified.
No confirmed cases have been reported, and no suspect cases are currently under investigation, in Alaska, Arizona, Hawaii, Idaho, Iowa, Maine, Minnesota, Nevada, Oklahoma, or Utah.
Restaurant-associated illness clusters were identified in Texas, Wisconsin, Maryland and Connecticut. Illness clusters of this nature are often instrumental in determining the source of an outbreak strain.
New York State has confirmed 17 cases of Salmonella Bareilly, excluding cases that may have been detected in New York City, which is served by its own Department of Health. One of the 17 New York State cases was hospitalized; the victim has since been discharged and is recovering. No additional cases are under investigation by the state’s Department of Health.
Louisiana has reported two confirmed cases – one male and one female – both of whom were hospitalized and are described as “doing well.” No additional cases are under investigation in Louisiana at this time.
The first outbreak case-patient became ill on February 3, 2012, according to information provided by Meghan Speakes of Louisiana’s Department of Health. Both Louisiana victims fell ill in mid February. The earliest case reported to New York State (outside of NYC) became ill on March 1st.
New York State spokesman Peter Constantakes declined to comment on the possible association between the outbreak and the consumption of tuna roll sushi, preferring to defer to CDC, which is the lead investigating agency for the outbreak. Louisiana spokesperson Speakes confirmed that one of the two Louisiana victims reported having eaten spicy roll sushi; there was no food history available from the other victim.

While early media reports have pointed an accusing finger at spicy tuna roll sushi, it is too early to conclude that this is the definitive source of the outbreak. Even if the sushi proves to be a common element, FDA will need to carry out a trace-back investigation to determine – if possible – which component of the sushi roll may have been contaminated.

Jimmy John’s Sprout Toll Now 14, And Rising

CDC reported today that the number of victims confirmed to be infected with E. coli O26 after consuming raw clover sprouts at Jimmy John’s restaurants has risen to 14 people in 6 states.

Michigan was the latest state to be added to the outbreak map, with two confirmed cases reported in early February. The Michigan Department of Community Health reports that an additional five cases are under investigation. All seven people consumed raw sprouts at sandwich shops in mid and southeast Michigan.

The Michigan confirmed and suspected victims range in age from 19 to 50 years old. Two of the seven were hospitalized. While the Michigan public health alert makes it clear that these cases of E. coli O26 are part of the 6-state Jimmy John’s outbreak, the department is warning Michigonians to avoid the consumption of raw clover sprouts, regardless of the source or venue, until more information about the source of the contamination is available. The Michigan Department of Agriculture is investigating.

As of today’s report, outbreak illnesses are confirmed in Iowa (5), Missouri (3), Kansas (2), Michigan (2), Arkansas (1) and Wisconsin (1). Outbreak victims range from 9 to 49 years old. All of the 14 confirmed victims are female. Illness onset dates range from December 25, 2011 to February 7, 2012. The onset dates for the seven Michigan cases (2 confirmed + 5 under investigation) range from February 6th to 12th.

E. coli O26 is a Shiga-toxin producing E. coli, and causes illness similar to that caused by infections with E. coli O157:H7. The most common symptoms are acute diarrhea (often bloody), and abdominal cramps. While young children and the elderly are susceptible to developing hemolytic uremic syndrome (HUS) as a result of an infection with a shiga-toxin producing E. coli, there have not yet been any reports of HUS in this outbreak.

FDA has been conducting a traceback investigation, and reported the following updated information today:

The traceback investigation involving iceberg lettuce found no common source to link that commodity to the ongoing outbreak.
FDA has determined that the common seed lot identified (lot SCCTSX) was distributed nationwide.
On February 10, the seed supplier of the common seed lot identified agreed to notify its customers to remove the lot in question from distribution. On February 13, the supplier informed FDA that notification of all customers was complete and that instructions had been given to return any of the seed lot in question to the supplier.
FDA continues to monitor the removal of the seed lot in question from the supply chain.
Sprouts have a short shelf life (2-3 weeks). It is unlikely that sprouts produced from the seed lot in question are currently in the marketplace.

Jimmy Johns announced on February 17th that it has permanently removed raw clover sprouts from its menu.

Taco Bell Named In Multi-State Salmonella Outbreak

On January 19th, the US CDC reported a multi-state outbreak of 68 confirmed cases of Salmonella enteritidis gastroenteritis associated with eating food from “Restaurant A,” which the Investigation Announcement described as a Mexican-style fast food restaurant chain. Forty-three of the confirmed cases were reported by Texas, and 16 by Oklahoma. Outbreak illnesses also were reported by Kansas (2), Iowa (1), Michigan (1), Missouri (1), Nebraska (1), New Mexico (1), Ohio (1), and Tennessee (1).

Ever since the Investigation Announcement was released, CDC has ignored, dodged, and declined to answer repeated requests from the media – including an Open Letter published on eFoodAlert – to identify Restaurant A. In a recent interview with JoNel Aleccia of MSNBC, Dr. Robert Tauxe, CDC’s deputy director of the Division of Foodborne, Waterborne and Environmental Diseases, explained the agency’s policy.

“The longstanding policy,” Tauxe told Aleccia, “is we publicly identify a company only when people can use that information to take specific action to protect their health. On the other hand,” he added, “if there’s not an important public health reason to use the name publicly, CDC doesn’t use the name publicly.”

Fortunately, the state of Oklahoma takes a broader view than CDC of the public’s right to know the identity of Restaurant A.

I have just learned, courtesy of the Oklahoma State Department of Health Acute Disease Service, that “Restaurant A” is Taco Bell. Following is the summary I was given of Oklahoma’s participation in the outbreak investigation.

Oklahoma State Department of Health
Acute Disease Service

Summary of Supplemental Questionnaire Responses Specific to
Taco Bell Exposure of Oklahoma Outbreak-associated Cases
Multistate Salmonella Enteritidis Outbreak Investigation
November 2011 – January 2012

Summary Demographic information

16 cases in 5 Oklahoma counties
- Cleveland (10), Bryan (2), Lincoln (2), Pottawatomie (1), and Greer (1)
Onset date range: 10/21/2011 – 11/18/2011
- 1 onset date unknown but believes around Thanksgiving
Hospitalizations: 4
Gender distribution: 10 (63%) females and 6 (37%) males
Age range: 5 to 78 years (median 23 years)

Taco Bell exposure summary of Oklahoma cases from supplemental case-control questionnaire responses

Total Oklahoma cases: 16
Total interviewed: 12/16 (4 refused or were lost-to-follow-up)
Consumed food from Taco Bell: 8/11

CDC reported that it was unsuccessful in determining the food source for this outbreak; however, the agency took pains to add that ground beef was an unlikely source, due to the restaurant chain’s handling and cooking processes. Patrons of the Taco Bell chain can draw some comfort from CDC’s assessment that its outlets follow appropriate handling and cooking procedures for raw ground beef.

Perhaps now that the Salmonella Enteritidis has hit the fan, CDC will deign to confirm the identity of the mysterious Restaurant A.