Salmonella Saintpaul Outbreak from Tomatoes
July 09, 2008
Salmonella Saintpaul Outbreak from Tomatoes
The Centers for Disease Control and Prevention (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. The consumption of raw tomatoes is linked to the illness.
Since April, 943 persons infected with Salmonella Saintpaul 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. 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 (356), Utah (2), Virginia (29), Vermont (2), Washington (4), Wisconsin (10), and the District of Columbia (1). One ill person is reported from Ontario, Canada. The ill person reported travel to the United States and became ill on the day of the return trip to Canada.
Among the 645 persons with information available, illnesses began between April 10 and June 26, 2008, including 225 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 to 3 weeks. Therefore, an illness reported today may have begun 2 to 3 weeks ago. Patients range in age from <1 to 99 years; 50% are female. The rate of illness is highest among persons 20 to 29 years of age; the rate of illness is lowest in children 10 to 19 years of age and in persons 80 years of age. At least 130 persons have been hospitalized and 2 deaths associated with the infection have been reported.
Clinical features of Salmonella Infection
Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. Infection is usually diagnosed by culture of a stool sample. Salmonella infections resolve in 4 to 7 days and usually do not require treatment other than oral fluids. 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, which may lead to death. In these severe cases, intravenous fluids and medications may be necessary. Antibiotics, such as ampicillin, trimethoprim-sulfamethoxazole, or ciprofloxacin, may be administered for 3 to 5 days.
Advice to consumers
At this time, the FDA is advising U.S. consumers to limit their tomato consumption to those that are not the likely source of this outbreak. 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 at: http://www.fda.gov/oc/opacom/hottopics/tomatoes.html*. 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:
- Refrigerate within 2 hours or discard cut, peeled, or cooked tomatoes.
- Avoid purchasing bruised or damaged tomatoes and discard any that appear spoiled.
- Thoroughly wash all tomatoes under running water.
- Keep tomatoes 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.
- The 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. Cherry tomatoes, grape tomatoes, and tomatoes sold with the vine still attached from any source may be offered.
Reference: Centers for Disease Control and Prevention. Investigation of Outbreak of Infections Caused by Salmonella Saintpaul. http://cdc.gov/salmonella/saintpaul/. Accessed July 5, 2008.
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