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The 21 foodborne illness outbreaks logged on the CDC’s “List of seleced Outbreak Investigations” for 2018 show Salmonella was the pathogen behind the vast majority of multistate events in the past 12 months. But, the list doesn’t include information on the number of intrastate outbreaks.
Investigators from the Centers for Disease and Prevention provide assistance to state officials during outbreaks that are defined by state boundaries, but the federal agency does not include one-state outbreaks in its regular reporting.
Public perception is, understandably, that the number of food-related outbreaks has been increasing in recent history. That perception has spurred people to post theories on social media, placing the blame on everything from terrorist attacks to wimpy immune systems they say have been compromised by too much hand sanitizer and parents who vaccinate their children.
However, food safety experts say there’s more to the equation than year-to-year numbers and urban myths.
Top scientists at the CDC, the Food and Drug Administration, the U.S. Department of Agriculture, dozens of academic research facilities, and food industry organizations all say technological advances are key variables in the outbreak detection formula. Since 2009, the development of new laboratory techniques has fine tuned the detection and identification of pathogens.
Whole genome sequencing (WGS) is largely responsible for those improvements. And, a database that CDC has been building in recent years — and a similar international project — is allowing public health officials to link seemingly unrelated patients from far flung areas by using so-called DNA fingerprints of specific strains of pathogens.
That technology allows disease detectives to identify outbreaks earlier by enabling scientists to match lab test results from sick people to pathogens isolated from samples of food. Many such food samples are collected as part of routine, random testing programs by the FDA, USDA, and state health officials.
Matthew Wise, deputy chief of CDC’s Outbreak Response and Prevention Branch, told Food Safety News high-tech tools can also help contain outbreaks.
“The good news is that CDC’s national laboratory network, PulseNet, uses whole genome sequencing more often to identify the most common bacterial culprits and connect the dots between sick people and contaminated food,” Wise said.
“We are also providing funding to support state and local health departments’ capacity for epidemiologic work. As a result, we may be finding more outbreaks in the early stages so we can work with state and federal partners to identify the source faster and alert people as to what to avoid to prevent getting sick.”
Food companies recalled products in relation to some of the outbreaks. In the case of the Salmonella outbreak traced to kratom products, multiple companies recalled teas, powders, dried and capsulized forms of the plant. The FDA used its authority to mandate a recall when one kratom company refused to pull its product.
Here are the outbreaks — separated by pathogen — on the CDC’s 2018 “List of seleced Outbreak Investigations.” Individual outbreak stories from 2018 and previous years, including announcements and updates, are available on the Food Safety News website by clicking on the “Outbreaks” button on the navigation bar.
E. COLI OUTBREAKS
Romaine lettuce – E. coli O157:H7
Announced by the CDC on April 10, this 36-state outbreak was declared over June 28. Patients ranged in age from 1 to 88 years old.
Investigators identified romaine lettuce from the Yuma, AZ, growing area as a common denominator among outbreak victims, but by the time the public was warned to avoid romaine from that area, growers were virtually finished with the season’s harvest. Consequently, no companies recalled any product in relation to the outbreak. In June the FDA and CDC announced the outbreak strain of E. coli O157:H7 had been found in water from an open irrigation canal that runs through the produce fields and past a cattle feed lot that can handle up to 100,000 head at one time.
Romaine lettuce – E. coli O157:H7
Announced Nov. 20, this 15-state outbreak is ongoing in the United States, according to the most recent updat from the CDC on Dec. 18. The outbreak crossed international lines, with the Canadian officials reporting patients in five provinces with infections from the outbreak strain of E. coli. Investigations in both countries showed romaine lettuce from the Central Coast region of California as the common denominator among patients.
The outbreak strain for this outbreak is different from the one that caused the outbreak in the spring. However, it matches the outbreak strain of a U.S./Canada outbreak in November and December 2017.
In the ongoing U.S. outbreak, people in 15 states had been confirmed infected with the outbreak strain as of the CDC’s most recent updat on Dec. 18. They range in age from 1 to 84 years old.
Canadian officials declared the outbreak in their country was over as of Dec. 24. Canadian numbers — 29 people infected; 10 hospitalized; 2 developed HUS; no deaths. Patients’ ages ranged from 2 to 93 years old. Illness onset dates reported by the Public Health Agency of Canada ranged from mid-October to mid-November.
In response to this outbreak, many growers and other entities in the supply chain voluntarily recalled romaine and stopped serving it effective Nov. 20, at the request of the FDA. Harvest has since shifted to the Yuma area and the voluntary moratorium on shipping romaine has been replaced with a voluntary labeling program that reveals the harvest date and region.
Investigators identified the outbreak strain of E. coli behind the current outbreak in California in sediment of an irrigation pond at Adam Brothers Farms Inc. in Santa Barbara County. FDA investigators have said other growers and distributors have not been ruled out as possible sources of contaminated romaine in this outbreak. By the time the E. coli was found on the Adams property, romaine harvest in the region had ended, so no romaine was recalled.
Ground beef – E. coli O26
The announcement of this four-state outbreak and related recalls didn’t come until weeks after the last confirmed victim became sick. The CDC declared the outbreak over as of Sept. 20. Cargill Meat Solutions of Fort Morgan, CO., recalled more than 65 tons of product.
LISTERIA OUTBREAKS
Deli Ham
Announced Oct. 4, this two-state outbreak was declared over as of Dec. 18. Patients ages ranged from 70 to 81 years old.
Epidemiologic, laboratory, and traceback evidence indicated that deli ham products from Johnston County Hams Inc. in Smithfield, NC, was contaminated with the same DNA fingerprint as was isolated from the outbreak patients. The contamination in the ham was discovered during routine inspections by federal regulatory officials who collected samples of deli ham at the production facility in 2016 and in early 2018.
On Oct. 3, Johnston County Hams Inc. recalled ready-to-eat deli ham products that were produced between April 3, 2017, and Oct. 2, 2018
Pork products
Announced Nov. 21, this four-state outbreak has not yet been declared over. Patients ranged in age from 35 to 84 years old. It can take up to 70 days after exposure to Listeria monocytogenes for symptoms of infection to develop. once diagnosed, it can take another two to 10 weeks for confirmed test results to be added to the CDC’s case count.
A day before the outbreak announcement from the CDC, a company called 165368 C. Corp. and doing business as Long Phung Food Products recalled “Vietnamese Style” pork products made from May 21 through Nov. 16 this year.
The USDA’s Food Safety and Inspection Service reported it received notification of a cluster of listeriosis patients on Oct. 22 and began working with the CDC to determine the source of the pathogen. On Nov. 19, whole genome sequencing of investigative samples collected from Long Phung Foods Establishment M13561 showed a match with the samples from ill people.
CYCLOSPORA OUTBREAKS
This year marked the first time the Cyclospora parasite was found in fresh produce grown in the United States.
Del Monte Fresh Produce vegetable-dip trays
Announced June 15, this four-state outbreak was declared over Sept. 5. Patients ranged in age from 13 to 79 years old.
Epidemiologic evidence showed pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip were the likely vehicle of this outbreak. On June 15, Del Monte Fresh Produce recalled packaged vegetable trays of pre-cut fresh broccoli, cauliflower, celery sticks, carrots and dill dip. It was not possible to determine if an individual component of the vegetable trays was the likely vehicle of infection, according to the CDC.
Fresh Express salad mix sold by McDonald’s
Announced July 13, CDC and FDA officials reported this 16-state outbreak was not associated with the Cyclospora parasite infection outbreak linked to the Del Monte vegetable-dip trays. The CDC declared this outbreak over on Sept. 12. Patients ranged in age from 14 to 91 years old.
Epidemiologic and traceback evidence indicated that salads purchased from McDonald’s restaurants were linked to this outbreak. On July 13 McDonald’s voluntarily stopped selling salads at more than 3,000 locations in 14 states.
On July 26, the FDA completed final analysis of an unused package of romaine lettuce and carrot mix distributed to McDonald’s by the Fresh Express. The analysis confirmed the presence of Cyclospora in that sample. The FDA investigation reviewed distribution and supplier information for romaine and carrots but did not identify a single source or point of contamination.
VIBRIO PARAHAEMOLYTICUS
imported crab meat
Announced July 13, this outbreak was declared over as of Sept. 27. Patients ranged in age from 26 to 78 years old.
Epidemiologic, laboratory, and traceback evidence indicated that crab meat labeled as fresh or precooked and imported from Venezuela was making people sick. State and local health officials collected information from restaurants and grocery stores wher ill people reported buying fresh crab meat. The FDA and regulatory officials in Maryland traced back the source of the crab meat and identified multiple Venezuelan suppliers.
As a result of the outbreak investigation, FDA increased testing of fresh crab meat from Venezuela. FDA testing did not find Vibrio parahaemolyticus in any samples tested, but did find Salmonella and Listeria monocytogenes bacteria. That contaminated crab meat was not allowed to be sold in the United States.
SALMonELLA OUTBREAKS
Frozen shredded coconut
Announced Jan. 16, this nine-state outbreak was declared over as of Feb. 15. Patients ranged in age from 1 to 82 years old.
Epidemiologic, laboratory, and traceback evidence indicated that Coconut Tree brand frozen shredded coconut, distributed by Evershing International Trading Co., was the likely source of this outbreak. On Jan. 3, 2018, Evershing International Trading recalled all 16-ounce Coconut Tree Brand Frozen Shredded Coconut after Salmonella was identified in the product by officials in Massachusetts.
Raw, fresh sprouts at Jimmy John’s
Announced Jan. 19, this three-state outbreak was declared over as of Feb. 28. Patients ranged in age from 26 to 56 years old.
Epidemiologic evidence indicates that raw sprouts served at Jimmy John’s restaurants were the most likely source of this outbreak. Eight of the 10 patients reported eating at multiple Jimmy John’s restaurant locations. Of these eight people, all eight reported eating raw sprouts on a sandwich from Jimmy John’s in Illinois and Wisconsin.
Various kratom products
Announced Feb. 20, this 41-state outbreak was declared over as of May 24, but both CDC and FDA are continuing to investigate other illnesses and product contamination. Patients in this outbreak ranged in age from less than 1 to 75 years old.
This outbreak was detected when a cluster of people infected with Salmonella I 4,[5],12:b:- was identified by CDC’s PulseNet. During the investigation, health and regulatory officials in several states and the FDA collected various leftover and unopened kratom products to test for Salmonella contamination. Multiple product recalls have been initiated by several different companies. The FDA website has a list of contaminated kratom products, which were from several retail locations and online retailers. A list of the recalled kratom products is also available on the FDA website.
Chicken salad from Triple T Specialty Meats and sold by Fareway stores
Announced Feb. 22, the CDC declared this eight-state outbreak over on April 6. Patients ranged in age from less than 1 to 89 years old.
Public health officials in Iowa first detected this outbreak and linked the illnesses to chicken salad sold at Fareway grocery stores. The CDC searched the PulseNet database and identified illnesses in other states. Fareway stopped selling chicken salad in all of its stores on Feb. 9 after the Iowa Department of Inspections and Appeals contacted the company about the illnesses.
Investigators in Iowa collected chicken salad from two Fareway grocery store locations in the state for laboratory testing. An outbreak strain of Salmonella Typhimurium was identified in both samples. On Feb. 21 Triple T Specialty Meats Inc., which produced the chicken salad, recalled all of the chicken salad it produced from Jan. 2 through Feb. 7.
Dried coconut
Announced March 21, the CDC declared this outbreak involving eight states and Washington D.C. over as of May 18. Patients ranged in age from 1 to 73 years old.
Eight of 10 outbreak victims reported eating dried coconut before becoming sick. Four of them reported buying it from Natural Grocers stores. Federal and state investigators collected and tested leftover dried coconut from ill people’s homes, as well as dried coconut from Natural Grocers store locations wher ill people shopped and from the Natural Grocers’ Distribution Center. Lab tests showed the outbreak strain of Salmonella Typhimurium in an unopened sample of Natural Grocers Coconut Smiles Organic and in an opened, leftover sample of Natural Grocers Coconut Smiles Organic collected from an ill person’s home. The FDA also found the outbreak strain in samples of International Harvest Brand Organic Go Smile! Dried Coconut Raw and Go Smiles Dried Coconut Raw.
On March 16, International Harvest Inc. recalled bags of Organic Go Smile! Raw Coconut and bulk packages of Go Smiles Dried Coconut Raw.
Eggs from Rose Acre Farms
Announced April 16, this 10-state outbreak was declared over as of June 14. Patients ranged in age from 1 to 90 years old.
More than half of the patients interviewed reported eating dishes made with shell eggs in restaurants before becoming sick. Outbreak investigators traced the source of some of the shell eggs supplied to these restaurant locations to Rose Acre Farms’ Hyde County, NC, farm. FDA investigators inspected the farm and collected samples. Laboratory testing identified the outbreak strain of Salmonella Braenderup in environmental samples taken at the farm. On April 13 Rose Acre Farms of Seymour, IN, recalled more than 206 million shell eggs.
Pre-cut melon distributed by Caito Foods
Announced June 8, this nine-state outbreak was declared over as of July 26. Patients ranged in age from less than 1 to 97 years old.
Information collected from stores wher ill people shopped indicated that Caito Foods LLC supplied pre-cut melon to the stores. On June 8 Caito Foods, LLC recalled fresh-cut watermelon, honeydew melon, cantaloupe, and fresh-cut fruit medley products containing one or more of those melons that were produced at the Caito Foods facility in Indianapolis.
Kellogg’s Honey Smacks cereal
Announced June 14, the CDC reported on Sept. 26 that it was closing its investigation into this 36-state outbreak. The agency stopped short, however, of saying the outbreak is over, mainly because of the long shelf life of the implicated breakfast cereal, which has best-by dates through June 14, 2019.
Three out of every four outbreak patients interviewed reported eating Kellogg’s Honey Smacks cereal before becoming sick. Investigators collected unopened packages of the cereal from retailers and from leftover cereal from patients’ homes. Tests showed the outbreak strain of Salmonella in unopened and leftover cereal. On June 14 the Kellogg Co. initiated an international recall of all Honey Smacks cereal that were on the market within the cereal’s one-year shelf-life.
Hy-Vee Spring Pasta Salad
Announced July 18, this 10-state outbreak was declared over as of Sept. 5. Patients ranged in age from 1 to 89 years old.
Epidemiologic evidence indicated that Spring Pasta Salad purchased at Hy-Vee grocery stores was a likely source of this outbreak. In interviews, 76 percent of patients reported eating Spring Pasta Salad from Hy-Vee grocery stores in Iowa, Kansas, Minnesota, Nebraska, and South Dakota. The ill people in North Dakota, Oregon, and Tennessee traveled to states wher Hy-Vee grocery stores are located. On July 16 Hy-Vee Inc. removed Spring Pasta Salad products from all of its stores. The next day Hy-Vee formally recalled its Spring Pasta Salad.
Raw turkey products
Announced July 19, this 38-state outbreak is ongoing. As of the most recent updat from the CDC on Dec. 21, the patients range in age from 1 to 99 years old.
Ill people reported buying many different brands of raw turkey products from multiple stores. Also, three of the 108 patients interviewed as of Dec. 21 became sick after pets in their home ate raw ground turkey pet food. Four of the 108 ill people interviewed worked in a facility that raises or processes turkeys, or lived with someone who did.
The outbreak strain of Salmonella is resistant to multiple antibiotics, including ampicillin, streptomycin, sulfamethoxazole, tetracycline, kanamycin, gentamicin, nalidixic acid, ciprofloxacin and fosfomycin.
Extensive testing by state and federal officials across the country has revealed Salmonella in raw turkey, in live turkeys, at slaughtering facilities and at processing plants. Federal officials say the pathogen is widespread in the industry and the ongoing outbreak likely involves multiple products from multiple sources.
However, in recent weeks two Jennie-O Turkey Store locations recalled raw ground turkey in relation to the outbreak. Jennie-O Turkey Store Sales LLC in Barron, WI recalled 91,388 pounds of raw ground turkey products and Jennie-O Turkey Store Sales LLC in Faribault, MN recalled 164,210 pounds of raw ground turkey products.
Empire Kosher chicken
Announced Aug. 29, the CDC declared this six-state outbreak over as of Dec. 7. Patients ranged in age from less than 1 to 76 years old.
In interviews, ill people reported eating kosher chicken, and when asked about the specific brand eaten, several people reported Empire Kosher brand. The outbreak strain was also identified in samples of raw chicken collected from two facilities, including one facility that processes Empire Kosher brand chicken. The samples, collected by USDA-FSIS at the slaughter and processing establishment, were part of USDA-FSIS’ routine testing under the Salmonella performance standards. Whole genome sequencing showed that the Salmonella strain from the samples matched the Salmonella strain from ill people.
Eggs from Gravel Ridge Farms
Announced Sept. 10, this 11-state outbreak was declared over as of Oct. 25. Patients ranged in age from 1 to 94 years old.
Of the patients interviewed by epidemiologists, 81 percent said they ate restaurant dishes made with eggs before becoming ill. The restaurants reported using shell eggs in the dishes eaten by ill people. FDA and state investigators traced the shell eggs to Gravel Ridge Farms in Cullman, AL.
Laboratory testing found the outbreak strain of Salmonella Enteritidis in environmental samples from Gravel Ridge Farms. Officials in Alabama also detected the outbreak strain of Salmonella Enteritidis in eggs. Whole genome sequencing showed the Salmonella bacteria from the environmental samples and from Gravel Ridge Farms eggs matched the Salmonella bacteria isolated from ill people. On Sept. 8 Gravel Ridge Farms recalled cage-free large eggs with use by dates of July 25 through Oct. 3.
Ground beef from JBS
Announced Oct. 4, this 28-state outbreak is ongoing, as of the most recent updat from the CDC on Dec. 12. Patients range in age from less than 1 to 99 years old.
The USDA-FSIS and state partners traced the source of the ground beef eaten by ill people in this outbreak to JBS Tolleson Inc. On Oct. 4, the company recalled approximately 6.5 million pounds of beef in relation to this outbreak. JBS recalled an additional 5.2 million pounds of beef on Dec. 4.
Officials in Arizona collected an unopened package of ground beef from an ill person’s home as part of the outbreak investigation. The outbreak strain of Salmonella Newport was identified in the ground beef. Whole genome sequencing showed that the Salmonella identified in the ground beef matched the Salmonella in samples from ill people. The ground beef was one of the products recalled by JBS on Oct. 4.
Raw chicken products
Announced Oct. 17, this 29-state outbreak is ongoing. Patients range in age from less than 1 to 105 years old.
Evidence collected as of Oct. 17 shows many types of raw chicken products from a variety of sources are contaminated with Salmonella Infantis and are making people sick, according to the CDC. In interviews, ill people report eating different types and brands of chicken products purchased from many different locations.
The outbreak strain has been identified in samples taken from raw chicken pet food, raw chicken products from 58 slaughter and/or processing establishments, and from live chickens. Antibiotic resistance testing shows that the outbreak strain is resistant to multiple antibiotics.
Samples were collected at slaughter and processing establishments as part of FSIS’s routine testing under the Salmonella performance standards. Whole genome sequencing showed that the Salmonella from those samples matches the Salmonella from ill people.
Duncan Hines cake mix
Announced Nov. 7, this three-state outbreak is ongoing. Patients range in age from 26 to 72 years old.
Health officials in Oregon identified the outbreak strain of Salmonella Agbeni in a box of Duncan Hines “Classic White Cake Mix” as part of an unrelated investigation. The CDC compared the pathogen found in Oregon with Salmonella strains in the PulseNet database and found it matched samples collected from patients in three states.
On Nov. 7 ConAgra Brands recalled Duncan Hines cake mix in Classic White, Classic Yellow Cake, Classic Butter Golden Cake, and Confetti Cake flavors, with various “best if used by” dates ranging from March 7 to 13, 2019.
Tahini from Achdut Ltd.
Announced Nov. 28, this three-state outbreak is ongoing. Patients range in age from 17 to 52 years old.
In interviews, all of the patients reported eating tahini in the days before becoming sick. The FDA had identified Salmonella Concord in a sample of tahini collected at the point of import. The tahini was Baron’s brand manufactured by Achdut Ltd. Whole genome sequencing results showed that the Salmonella strain identified in imported tahini matches the Salmonella strain identified in ill people. On Nov. 27 Achdut Ltd. recalled a variety of tahini products in relation to the outbreak. The FDA website has a list of the tahini products that were recalled.
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