Mexico’s National Health, Safety and Food Quality Service (Servicio Nacional de Sanitad, Inocuidad y Calidad Agroalimentaria) issued the following statement yesterday on the outbreak of Salmonella Agona that is believed to be associated with the consumption of papayas from a Mexican grower (translated with the aid of Google).

The National Health, Safety and Food Quality Service (SENASICA) and the United States Food and Drug Administration (FDA) are conducting a joint investigation into the origin of an outbreak of Salmonella and, where appropriate, the strain of the bacteria.

“We are in constant coordination with working groups from both institutions in order to pinpoint the source of contamination and to not draw conclusions before the investigation,” explained the Chief Director SENASICA, Enrique Sanchez Cruz.

He noted that, at present, one cannot attribute the source of the outbreak to Mexican papayas because only 57% of the 97 people who are have been confirmed to FDA as being part of the outbreak reported having consumed the fruit.

Sanchez Cruz said that one of the leading suppliers of papaya to the U.S. market, Agromod, voluntarily withdrew from its product from the market until the conclusion of the investigation of the Mexican and U.S. authorities. Other producers are continuing to operate in a normal fashion.

He explained that the entire operation of the company is being reviewed, including production, packaging, transport, storage and distribution of the product, up to the point it reaches the U.S. market.

The head of SENASICA has already invited the Ministry of Health in Mexico, through the Federal Commission for Protection against Health Risks (COFEPRIS), to participate in investigation. It should be noted that the Ministry of Health has reported no outbreak of Salmonella linked to the consumption of papaya in our country.

It is clear that in any area of ​​production, packaging or handling of agricultural products, there is an ongoing risk of contamination, as these activities and the primary process in the field are conducted in open conditions where risk factors exist.

For this reason, health authorities carry out permanent actions to reduce risks through the establishment of preventive measures in the orchards, harvesting, storing, packaging and transport; these include the hygiene of workers, controls on the inputs used, the quality of irrigation water and for washing, among other biosecurity measures.

It is important to stress that the investigation [of this outbreak] should include a review the handling and distribution of the product within the United States.

Um……

I assume FDA has informed the Mexican government that samples taken from 2 papaya shipments – one collected at Agromod Produce (McAllen, TX) and one collected at the US border – were found to be contaminated with the Salmonella Agona outbreak strain. And that 10 other papaya samples that had not yet entered the USA were determined to be contaminated with other strains of Salmonella.

The outbreak, by the way, now consists of 99 cases (up from the 97 cases reported over the weekend) from 23 states.

Here’s a breakdown of the affected states, with additional details supplied by state agencies (boldface), either via email or posted on the state web sites.

• Arkansas:- 1 case
• Arizona:- 3 cases. One person was hospitalized but has since been released. Two of the three Arizona patients reported papaya consumption.
• California:- 7 cases; none hospitalized. Of the three individuals who were specifically asked, two reported having consumed papaya prior to becoming ill
• Colorado:- 1 case; the victim, an adult female, became ill in May. She reported having consumed papaya – possibly out-of-state – prior to becoming ill.
• Georgia*:- 8 cases. One person hospitalized.
• Illinois:- 17 cases. Eight people were hospitalized. Cases have been reported in Chicago (5), Cook-suburban (4), DuPage (4), Kane (1), Lake (1), Will (1) and Winnebago (1)
• Louisiana*:- 2 cases; one hospitalized. Neither person had consumed papaya.
• Massachusetts:- 1 case
• Minnesota:- 3 cases, each from a different, unrelated household; none hospitalized. Two of the people traveled to Mexico during the typical exposure period prior to becoming ill; only one of the three people reported possible consumption of papaya while in Mexico.
• Missouri:- 3 cases
• Nebraska:- 2 cases, including one child and one adult. The adult was hospitalized and later released. One of the two outbreak victims recalled having eaten papaya.
• Nevada:- 1 case
• New Jersey:- 1 case
• New Mexico:- 3 cases
• New York:- 7 cases. Of the three cases being handled by the state (i.e. outside of New York City), none reported having consumed papaya.
• Ohio:- 1 case
• Oklahoma:- 1 case. The patient was a three-year-old child. The child’s parents indicated that the child did not consume papayas.
• Pennsylvania:- 2 cases
• Tennessee:- 1 case. No hospitalizations.
• Texas:- 25 cases. Six people hospitalized. In 2010, Texas reported 28 cases with similar genetic profiles to this year’s Salmonella Agona outbreak strain (see below).
• Virginia:- 2 cases. One person hospitalized. Neither person recalls having eaten papaya.
• Washington:- 5 cases, including four adults and one child. Two of the cases were exposed during trips to Mexico. The Washington cases appear to be connected to papaya consumption, although one of the victims was unavailable for an interview.
• Wisconsin:- 2 cases

In addition to these confirmed cases, one case of Salmonella Agona has been reported in Kentucky, but the state has not yet been able to confirm whether or not this case is linked to the multi-state outbreak. The individual did not indicate having eaten papaya.

CDC reports that 10 outbreak victims were hospitalized; however, based on reports I’ve obtained from some state public health agencies, that total should be 19 (including eight in Illinois, six in Texas, and one each in Arizona, Georgia*, Louisiana*, Nebraska and Virginia).

* Updated July 27, 2011.

According to CDC’s July 26, 2011 Investigation Update, this strain of Salmonella Agona is not a stranger to the USA. Last year, local, federal and state public health agencies investigated an outbreak of Salmonella Agona that sickened 119 people in 14 states between May 28th and September 10th. The four genetic fingerprints (PFGE patterns) associated with the current outbreak were first identified during the 2010 outbreak. The source of the 2010 outbreak was never determined, despite an investigation that focussed on fresh fruit, including papaya.

Why have FDA and CDC pointed the accusatory finger at papaya supplied by Agromod Produce, Inc.? Quoting from CDC’s July 26th report,

“Among 52 ill persons for whom information is available, 57% have reported consuming papayas in the week before illness onset. This is significantly different compared to results from a survey of healthy persons in which 11% of persons of Hispanic/Latino ethnicity and 3% of non-Hispanic/Latino ethnicity reported consuming papaya in the 7 days before they were interviewed. Product information such as date and location of purchase of papayas were collected from ill persons and used by local, state, and federal public health, agriculture, and regulatory agencies to conduct traceback investigations. Agromod Produce, Inc. was identified as a common supplier of papayas purchased by ill persons.”

Agromod is not convinced that its production and handling is at fault. I’m told that the company employs a three-step washing process. The first wash, according to Raul Magaña of Agromod, is done using well water with soap; the second wash uses chlorinated water; and the third wash contains a fungicide. Mr. Magaña informs me that the well water is tested regularly and is pathogen free; the chlorine level in the second wash is maintained with automatic dosing equipment. The company has issued the following statement, which is posted on its web site:

Dear Consumer:

All of the employees of Agromod Produce are committed to supplying consumers with safe and flavorful papayas, every bite, every time.

Please be assured that we are working closely with the Food and Drug Administration to identify the sources of the current “Salmonella agona” food-borne outbreak potentially associated with our product.

Your health is important to us. Despite the fact that no illnesses have been definitively linked to our products at this time, we have taken the step to voluntarily recall all Agromod papayas sold prior to July 23, 2011.

If you have purchased Agromod’s Blondie, Yaya, Mananita, or Tastylicious papayas prior to July 23, please discard them in a sealed container or return them to the place of purchase.

If you have any concerns that you may be infected with Salmonella, we encourage you to seek immediate medical attention. For more information on Salmonella, please visit the Food and Drug Administration website, www. fda.gov.

If you have any questions regarding this voluntary recall please email us at recall@agromodproduce.com

We will continue to update our website as more information becomes available.

Finally, CDC offers the following advice to “Consumers, Retailers, and Others”

Contaminated papayas may still be in grocery stores and in consumers’ homes.

• Consumer should not eat recalled papayas, and restaurant and food service operators should not serve them.
• Consumers who have papayas in their homes can check with the place of purchase to determine if the fruit came from Agromod Produce, Inc.
• Recalled papayas should be disposed of in a closed plastic bag placed in a sealed trash can. This will prevent people or animals from eating them.
• Persons who think they might have become ill from eating possibly contaminated papayas should consult their health care providers.
• Consumers and food preparers should wash their hands before and after handling any papayas. Rinse the papayas under running water, and then dry them with a clean cloth or paper towel before cutting. Promptly refrigerate cut papayas.

I would take that advice one step further. Avoid prepared fruit salads that may contain papaya.