County of San Diego Control Vector Program DEH

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Salmonella Cases Continued

Salmonella Illnesses Increasing and is Getting Hot

..... The number of people sickened in the ongoing salmonella outbreak has been increasing, and while certain types of tomatoes remain the suspected cause, U.S. health officials on Wednesday added hot peppers and cilantro as potential suspects.
....."We continue to get new reported cases every day," Dr. Robert Tauxe, deputy director of the division of foodborne, bacterial and mycotic diseases at the U.S. Centers for Disease Control and Prevention, said during a late afternoon teleconference. "This is the largest foodborne outbreak in the United States."
....Since the outbreak began in April, 1,017 people in 41 states, the District of Columbia and Canada have fallen ill, and at least 203 people have been hospitalized. One death -- a Texas man in his 80s -- has been associated with the outbreak. Also, a man in his 60s who died in Texas from cancer had a Salmonella Saintpaul infection at the time of his death, the CDC reported Wednesday on its Web site.
....An initial investigation of the outbreak, in New Mexico and Texas, suggested raw tomatoes as the likely source of the contamination. But a larger, nationwide study comparing persons who were ill in June found that those who were sickened were likely to have recently eaten raw tomatoes, as well as fresh jalapeno and serrano peppers, and fresh cilantro. These foods are typically consumed together, the CDC said.
.....Recently, many clusters of illnesses have been identified involving people who had eaten in restaurants. In one cluster, illnesses were linked to consumption of an item containing fresh tomatoes and fresh jalapeno peppers. In another two clusters, illnesses were linked to a food item containing fresh jalapeno peppers, leading federal officials to believe that jalapeno peppers caused some of the reported illnesses, the CDC said.
However, "at this we have not found any samples of tomatoes or peppers positive for Salmonella Saintpaul," Steve Sundlof, director of the U.S. Food and Drug Administration's Center for Food Safety and Applied Nutrition, told reporters at the teleconference.
Tauxe added, "Neither tomatoes nor jalapenos explain the entire outbreak at this point. ....We're presuming that both of them cause illness."
On Wednesday, Tauxe added that people at risk of infection, including infants and elderly people, should avoid eating jalapeno peppers.
.....Salmonella is a bacteria that can cause bloody diarrhea in humans. Some 40,000 cases of salmonellosis are reported in the United States each year, although the CDC estimates that because milder cases are not diagnosed or reported, the actual number of infections may be 30 or more times greater. Approximately 600 people die each year after being infected. For the update information on Salmonella, please visit the Centers for Disease Control Web site at www.cdc.gov

Tainted Tomato Toll Now 552 and Two Additional Salmonella Cases Reported in County.

... The County of San Diego Health and Human Services Agency (HHSA) has received confirmation that two San Diego County adults have tested positive for Salmonella. One adult was exposed in Texas; the other did not travel outside the state. These cases are related to the multi-state outbreak associated with consuming certain types of raw tomatoes.

....Since mid-April, 552 persons nationwide have been infected with Salmonella Saintpaul, the same strain of the disease identified in 33 states, including California. The huge increase in victims since the nationwide outbreak began on April 10 appeared largely a result of the state of Texas now reporting 265 illnesses, according to the latest count by the U.S. Centers for Disease Control and Prevention. The increase in people sickened by the singular strain of salmonella saintpaul was not unexpected. Last week, the count was below 200; two days ago, it jumped to more than 380. At least 32 states, plus the District of Columbia, have now reported cases. At least 53 people have been hospitalized, Ian Williams, chief of the CDC's OutbreakNet Team said. A four-year-old San Diego County child last week tested positive for Salmonella Saintpaul, and also was exposed to the disease in Texas. Including these two reported cases, there are a total of three San Diego County cases of the disease associated with the nationwide outbreak.

...“The investigation and surveillance conducted by HHSA Community Epidemiology and the County’s Department of Environmental Health will continue,” said Wilma Wooten, M.D., M.P.H., County Public Health Officer. “We urge the public to follow federal Food and Drug Administration recommendations to not consume certain raw tomatoes.”
To date in 2008, there have been 165 Salmonella cases in San Diego County not related to the nationwide outbreak.

....The California Department of Public Health recommends Californians use caution in selecting tomatoes based on guidance from the Food and Drug Administration. U.S health officials announced that the salmonella contaminant did indeed come from farms in Florida and Mexico. FDA preliminary data suggest that raw red plum, raw red Roma, or raw round red tomatoes are the cause. At this time, consumers should limit their tomato consumption to tomatoes that have not been implicated in the outbreak. FDA guidance is available at www.fda.gov

. ..Most people infected with Salmonella develop Salmonellosis Outbreak in Certain Types of Tomatoes diarrhea, fever, and abdominal cramps 12–72 hours after infection. The illness usually lasts 4 – 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. In these severe cases, antibiotic treatment may be necessary.
For more information on Salmonella, please visit the Centers for Disease Control Web site at www.cdc.gov and click on “Health Topics A-Z.”

....Since mid-April, more than 145 persons nationwide have been infected with Salmonella Saintpaul, the same strain of the disease identified in 16 states, including California.

The County of San Diego Health and Human Services Agency has received confirmation that a 4-year-old child who traveled to Texas has tested positive for Salmonella. The child was exposed to the disease in Texas. This case is related to the multi-state outbreak associated with consuming raw tomatoes.

“HHSA Community Epidemiology and the County’s Department of Environmental Health will continue monitoring the situation and will inform the public of any new local cases,” said Wilma Wooten, M.D., M.P.H., County Public Health Officer.

To date in 2008, there have been 138 Salmonella cases in San Diego County. The total does not include the one related to the tomato outbreak.

The California Department of Public Health (CDPH) confirmed on June 6 that one resident of Contra Costa County has Salmonella saintpaul. The Salmonella saintpaul is related to the multistate outbreak associated with consumption of tomatoes. State and local officials are investigating whether the individual, who had traveled out of state, consumed the tomatoes in California or in another part of the country.

Additionally, CDPH is working with public health officials in Oregon to determine if an Oregon resident confirmed to have Salmonella saintpaul associated with the multistate outbreak may have consumed tomatoes while visiting southern California.

CDPH is working closely with the federal Centers for Disease Control and Prevention, the U.S. Food and Drug Administration and local health departments in California to determine the source of the tomatoes that these individuals may have consumed and to identify any additional cases linked to this outbreak.

The California Department of Public Health recommends Californians use caution in selecting tomatoes based on guidance from the Food and Drug Administration. FDA has no indication that tomatoes grown in California are associated with this outbreak. FDA preliminary data suggest that raw red plum, raw red Roma, or raw round red tomatoes are the cause. At this time, consumers should limit their tomato consumption to tomatoes that have not been implicated in the outbreak.

FDA also recommends that retailers, restaurants, and other food service operators not offer raw red Roma, raw red plum, and raw red round tomatoes unless they are from sources that have not been associated with the outbreak. If unsure of where tomatoes are grown or harvested, consumers are encouraged to contact the store where the tomato purchase was made.

Restaurants, grocery stores and food-service operators have been advised by the FDA not to offer for sale or service raw red plum, Roma or red tomatoes and products made from these types of tomatoes.

Major supermarket chains including Ralphs, Vons and Albertsons have stopped selling the three kinds on the FDA list.

Taco Bell, El Pollo Loco Inc.,Subway, Fudruckers,Chipotle Mexican Grill, Chick Fil A, Sonic, Wendy's y Subway were among other restaurants voluntarily withdrawing tomatoes from their menus.

The following types of tomatoes are NOT likely to be the source of this outbreak. Consumers should continue to eat

• cherry tomatoes
• grape tomatoes
• tomatoes sold with the vine still attached
• tomatoes grown at home
• green tomatoes

About Salmonella

Most people infected with Salmonella develop diarrhea, fever, and abdominal cramps 12–72 hours after infection. The illness usually lasts 4 – 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. In these severe cases, antibiotic treatment may be necessary.

For more information on the Salmonella Outbreak, please visit the Centers for Disease Control Web site at www.cdc.gov

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