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USA | 317 people infected with seven outbreak strains of Salmonella Heidelberg

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As of October 11, 2013, a total of 317 individuals infected with the outbreak strains of Salmonella Heidelberg have been reported from 20 states and Puerto Rico. Most of the ill persons (73%) have been reported from California.

Since the last update on October 8, 2013, a total of 39 additional ill persons have been identified from 9 states and Puerto Rico: Arizona (2), California (19), Florida (2), Kentucky (1), Missouri (5), Nevada (1), New Mexico (2), Puerto Rico (1), Texas (4), and Virginia (2).

Of the 39 additional ill persons, two have estimated illness onset dates after September 24, 2013, the last illness onset date reported in the October 8, 2013 outbreak announcement. Since the last update, one ill person originally reported from Hawaii was found to be a resident of Florida. This person is now included in the Florida case count.

Among 310 persons for whom information is available, illness onset dates range from March 1, 2013 to September 26, 2013. Ill persons range in age from less than 1 year to 93 years, with a median age of 20 years. Fifty-one percent of ill persons are male. Among 189 persons with available information, 79 (42%) reported being hospitalized. Thirteen percent of ill persons developed blood infections as a result of their illness. Typically, approximately 5% of persons ill with Salmonella infections develop blood infections. No deaths have been reported.

Illnesses that occurred after September 5, 2013 might not be reported yet 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.

Investigation Update

To date, seven strains of Salmonella Heidelberg have been included in this investigation based on epidemiologic, laboratory and traceback information. The information collected for cases associated with each strain indicates that each of the strains is linked to this outbreak of multidrug-resistant Salmonella Heidelberg infections and that Foster Farms brand chicken is the likely source.

CDC’s NARMS laboratory conducted antibiotic-resistance testing on clinical isolates collected from ten ill persons infected with three of the seven outbreak strains. Nine of these isolates exhibited drug resistance to one or more commonly prescribed antibiotics. Of those, three were multidrug resistant. One isolate was susceptible to all antibiotics tested. To date, isolates collected from ill persons were resistant to combinations of the following antibiotics: ampicillin, chloramphenicol, gentamicin, kanamycin, streptomycin, sulfisoxazole, and tetracycline. Antimicrobial resistance may increase the risk of hospitalization or possible treatment failure in infected individuals.

On October 10, 2013, USDA-FSIS announced that Foster Farms submitted and implemented immediate substantive changes to their slaughter and processing to allow for continued operations. FSIS inspectors will verify that these changes are being implemented on a continuous and ongoing basis. Additionally, the agency will continue intensified sampling and testing of chicken products from these facilities for at least the next 90 days.

CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill persons and to interview them about foods eaten before becoming ill. USDA-FSIS is continuing to work closely with CDC and state partners during this investigation.

Initial Announcement

October 8, 2013

CDC is collaborating with public health and agriculture officials in many states and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) to investigate a multistate outbreak of Salmonella Heidelberg infections. Public health investigators are using DNA “fingerprints” of Salmonella bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may be part of this outbreak. They are using data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections. Seven strains of Salmonella Heidelberg bacteria have been identified as being linked to this outbreak. Four of these strains are rarely reported to PulseNet. The other three strains are more common, with several ill persons infected with each strain reported to CDC monthly. The DNA fingerprints of the Salmonella Heidelberg bacteria associated with the current outbreak include the strain that was also associated with a multistate outbreak of Salmonella Heidelberg linked to Foster Farms brand chicken during 2012-2013.

As of October 7, 2013, a total of 278 individuals infected with the outbreak strains of Salmonella Heidelberg have been reported from 17 states. Most of the ill persons (77%) have been reported from California. The number of ill persons identified in each state is as follows: Alaska (2), Arkansas (1), Arizona (11), California (213), Colorado (4), Connecticut (1), Florida (1), Hawaii (1), Idaho (2), Michigan (2), North Carolina (1), Nevada (8), Oregon (8), Texas (5), Utah (2), Washington (15) and Wisconsin (1).

Among 274 persons for whom information is available, illness onset dates range from March 1 to September 24, 2013. Ill persons range in age from <1 year to 93 years, with a median age of 20 years. Fifty-one percent of ill persons are male. Among 183 persons with available information, 76 (42%) reported being hospitalized. No deaths have been reported.

The outbreak can be visually described with a chart showing the number of people who became ill each day or week. This chart is called an epi curve. Illnesses that occurred after September 1, 2013 might not be reported yet 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. For more details, please see Salmonella Outbreak Investigations: Timeline for Reporting Cases.

Investigation of the Outbreak

Epidemiologic, laboratory, and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies indicate that consumption of Foster Farms brand chicken is the likely source of this outbreak of Salmonella Heidelberg infections.

In interviews, ill persons answered questions about foods consumed and other exposures during the week before becoming ill. One hundred and five (80%) of 132 ill persons interviewed report consuming chicken prepared at home in the week before becoming ill. This proportion is significantly higher when compared with results from a survey of healthy persons Adobe PDF file [PDF - 29 pages] in which 65% reported consuming chicken prepared at home in the week before they were interviewed. Among those who had brand information available, 48 (79%) of 61 ill persons reported that they had consumed Foster Farms brand chicken or another brand likely produced by Foster Farms.

The National Antimicrobial Resistance Monitoring SystemExternal Web Site Icon (NARMS) retail meat surveillance program is an ongoing collaboration among the U.S. Food and Drug Administration’s Center for Veterinary Medicine, CDC, and participating state public health laboratories. NARMS monitors antibiotic resistance in Salmonella, Campylobacter, Enterococcus, and Escherichia coli bacteria isolated from raw retail meats. NARMS laboratorians isolated four of the seven outbreak strains from five retail samples of Foster Farms chicken breasts and wings collected in California. Four of these isolates exhibited drug resistance to one or more commonly prescribed antibiotics. Of these, two were multidrug resistant (defined as resistance to three or more classes of antibiotics). Not all isolates from poultry exhibited the same antibiotic-resistance pattern. To date, isolates collected from poultry were resistant to combinations of the following antibiotics: ampicillin, chloramphenicol, gentamicin, kanamycin, streptomycin, sulfisoxazole, and tetracycline.

Additionally, CDC’s NARMS laboratory conducted antibiotic-resistance testing on clinical isolates collected from five ill persons infected with two of the seven outbreak strains. Four of these isolates exhibited drug resistance to one or more commonly prescribed antibiotics. Of those, two were multidrug resistant. One isolate was susceptible to all antibiotics tested. To date, isolates collected from ill persons were resistant to combinations of the following antibiotics: ampicillin, chloramphenicol, gentamicin, kanamycin, streptomycin, sulfisoxazole, and tetracycline. Antimicrobial resistance may increase the risk of hospitalization or possible treatment failure in infected individuals.

Testing conducted by the Washington State Public Health Laboratories identified one of the outbreak strains of Salmonella Heidelberg in one leftover intact sample of raw Foster Farms chicken collected from an ill person’s home in Washington.

Preliminary laboratory testing identified four of the seven outbreak strains from multiple chicken product samples at three Foster Farms facilities; additional analysis is ongoing. USDA-FSIS has issued a Public Health AlertExternal Web Site Icon due to concerns that illnesses caused by strains of Salmonella Heidelberg are associated with raw chicken products produced by Foster Farms at three facilities in California. At this point in the investigation, FSIS is unable to link the illnesses to a specific product and a specific production period. The products were mainly distributed to retail outlets in California, Oregon and Washington State. Raw products from the facilities in question bear one of the establishment numbers inside a USDA mark of inspection or elsewhere on the package “P6137,” “P6137A,” and “P7632.”

CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill persons and to interview about foods eaten before becoming ill. USDA-FSIS is continuing to work closely with CDC and state partners during this investigation.


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