Persons Infected with the Outbreak Strain of
Salmonella Typhimurium, United States, by State, September 1, 2008 to January 25, 2009
Epidemic Curve
CDC
is collaborating with public health officials in many states and the
United States Food and Drug Administration (FDA) to investigate a
multistate outbreak of human infections due to
Salmonella serotype Typhimurium.
As of 9PM EDT, Sunday, January 25, 2009, 501 persons infected with the outbreak strain of
Salmonella
Typhimurium have been reported from 43 states. The number of ill
persons identified in each state is as follows: Alabama (1), Arizona
(11), Arkansas (4), California (62), Colorado (12), Connecticut (9),
Georgia (6), Hawaii (3), Idaho (11), Illinois (6), Indiana (4), Iowa
(3), Kansas (2), Kentucky (3), Maine (4), Maryland (8), Massachusetts
(42), Michigan (25), Minnesota (35), Missouri (9), Mississippi (3),
Nebraska (1), New Hampshire (11), New Jersey (23), New York (19),
Nevada (5), North Carolina (6), North Dakota (10), Ohio (67), Oklahoma
(2), Oregon (10), Pennsylvania (14), Rhode Island (4), South Dakota
(2), Tennessee (9), Texas (6), Utah (5), Vermont (4), Virginia (20),
Washington (13), West Virginia (2), Wisconsin (3), and Wyoming (2).
Additionally, one ill person was reported from Canada.
Among
the persons with confirmed, reported dates available, illnesses began
between September 1, 2008 and January 9, 2009. Patients range in age
from <1 to 98 years; 47% are female. Among persons with available
information, 22% reported being hospitalized. Infection may have
contributed to eight deaths.
The outbreak can be visually
described with a chart showing the number of persons who became ill
each day. This chart is called an epidemic curve or epi curve. The epi curve and information about interpreting it may be found here.
It shows that most illnesses began after October 1, 2008. Illnesses
that occurred after December 25, 2008 may not yet be reported due to
the time it takes between when a person becomes ill and when the
illness is reported. This takes an average of 2 to 3 weeks. Please see
the
Salmonella Outbreak Investigations: Timeline for Reporting Cases for more details.
Although
we cannot yet say the outbreak is over, the numbers of new cases have
declined over the last two weeks. The outbreak appears to have reached
its peak in December and is now in decline.
Outbreak Investigation
The investigation is ongoing, and exposures to peanut butter and other peanut butter-containing products are being examined.
Peanut Butter
Preliminary
analysis of the first national case-control study conducted by CDC and
public health officials in multiple states on January 3 and 4, 2009,
comparing foods eaten by ill and well persons indicates that peanut
butter is a likely source of the bacteria causing the infections.
An investigation by the Minnesota Department of Health suggested King Nut brand 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 strain of
Salmonella
Typhimurium from an open 5-pound container of King Nut brand creamy
peanut butter. King Nut creamy peanut butter is distributed in many
states 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.
The Connecticut Department of Public Health Laboratory and the Georgia Department of Agriculture independently isolated
Salmonella from unopened 5-pound containers of King Nut brand peanut butter. Officials in Connecticut have identified the
Salmonella found in their container as the outbreak strain. Further tests are pending in Georgia to determine if the
Salmonella in their container is also the outbreak strain.
To date, 15 clusters of infections in five states have been reported in
schools and other institutions, such as long-term care facilities and
hospitals. Among 14 clusters for which we have detailed information,
King Nut is the only brand of peanut butter used in those facilities.
King
Nut is produced by Peanut Corporation of America (PCA) in Blakely,
Georgia. This facility, which is no longer producing any products, has
expanded its recall to include all peanut butter and peanut paste
produced at this plant since July 1, 2008. Peanut butter and peanut
butter paste was not sold directly to consumers but was distributed to
institutions, food service providers, food manufacturers and
distributors in many states and countries. Peanut butter and peanut
paste is commonly used as an ingredient in many products, including
cookies, crackers, cereal, candy, ice cream, pet treats, and other
foods.
Other Peanut Butter Containing Products
To
clarify whether other peanut-butter containing foods are associated
with the outbreak, CDC along with state partners conducted a second
national case-control study. Between January 17 and 19 2009, telephone
interviews were conducted with 75 persons who became ill with the
outbreak strain and 399 well persons. Preliminary analysis of data
received as of 9PM, Sunday, January 18, reveals an association between
illness and consumption of pre-packaged peanut butter crackers,
specifically with Austin and Keebler brands.
Austin and
Keebler brand peanut butter crackers are produced by the Kellogg
Company in North Carolina, using peanut paste from the Peanut
Corporation of America. On January 14, 2009, the Kellogg Company put a
precautionary hold on these peanut butter crackers, and on January 16
recalled these products. Other peanut butter containing products
produced by a variety of companies may have been made with the
ingredients recalled by PCA. CDC and state health departments continue
to investigate the association of other brands and foods that contain
peanut butter with illness.
Salmonella Typhimurium
was isolated in Canada from Austin brand peanut butter crackers
purchased in the United States. Officials in Canada have identified the
Salmonella found in these peanut butter crackers as the outbreak strain.
More
than 180 peanut butter-containing products produced by a variety of
companies may have been made with the ingredients recalled by PCA. The
list of currently recalled products can be found on the FDA website*.
FDA and the product manufacturers are working to determine the list of
affected products, which may be extensive. Many companies have already
announced whether their products include ingredients being recalled by
Peanut Corporation of America, Georgia, and more companies are expected
to make similar announcements. The current list of recall announcements
from companies can be found at FDA website*.
Recommendations
Based on available information, CDC and FDA recommendations include:
For consumers
-
Use FDA’s online database
to check if foods you’re concerned about are on the recall list. Those
without Internet access may call 1-800-CDC-INFO (available 24 hours a
day, seven days a week) for product recall information.
-
Do
not eat products that have been recalled and throw them away in a
manner that prevents others from eating them. These products include
Austin and Keebler brand peanut butter crackers and King Nut brand
peanut butter produced since July 1, 2008. (FDA's web site has recalled lot numbers).
-
Postpone
eating other peanut butter containing products (such as cookies,
crackers, cereal, candy and ice cream) until more information becomes
available about which brands may be affected.
-
Call
the consumer hotline phone number that may be on any product packaging
you have to get information directly from the product manufacturer.
-
Persons who think they may have become ill from eating peanut butter are advised to consult their health care providers.
-
For consumers with pets, please visit Questions and Answers Related to the
Salmonella Typhimurium Outbreak and Pets.
For retailers
-
Stop selling recalled products.
For directors of institutions and food service establishments
-
Ensure that they are not serving recalled products.
For manufacturers
-
Inform
consumers about whether their products could contain peanut butter or
peanut paste from Peanut Corporation of America (PCA). If a
manufacturer knows their products do not contain peanut paste from PCA,
they should inform consumers of that.
To date, no association has been found with major national brand name jars of peanut butter sold in grocery stores.
For more information
Public health officials will advise the public if more products are identified as being associated with the outbreak.
Clinical Features/Signs and Symptoms
Most persons infected with
Salmonella
develop diarrhea, fever, and abdominal cramps 1272 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.
More general information about
Salmonella can be found here under
Salmonella FAQs.
More information on this investigation can be found below.
CDC's Role in Food Safety
As
an agency within the U.S. Department of Health and Human Services
(HHS), CDC leads federal efforts to gather data on foodborne illnesses,
investigate foodborne illnesses and outbreaks, and monitor the
effectiveness of prevention and control efforts. CDC is not a food
safety regulatory agency but works closely with the food safety
regulatory agencies, in particular with HHS’s U.S. Food and Drug
Administration (FDA) and the Food Safety and Inspection Service within
the United States Department of Agriculture (USDA). CDC also plays a
key role in building state and local health department epidemiology,
laboratory, and environmental health capacity to support foodborne
disease surveillance and outbreak response. Notably, CDC data can be
used to help document the effectiveness of regulatory interventions.
