Fourth Time the Charm?

The CDC announced this week a total of 12 persons infected with the outbreak strain of STEC O26 have been reported from 5 states. The number of ill persons identified in each state is as follows: Iowa (5), Missouri (3), Kansas (2), Arkansas (1), and Wisconsin (1). Among persons for whom information is available, illness onset dates range from December 25, 2011 to January 15, 2012. Ill persons range in age from 9 years to 49 years old, with a median age of 25 years old. One hundred percent of ill persons are female. Among the 12 ill persons, 2 (17%) were hospitalized. None have developed HUS, and no deaths have been reported.  Preliminary results of the epidemiologic and traceback investigations indicate eating raw clover sprouts at Jimmy John’s restaurants is the likely cause of this outbreak.

Sound familiar?

Between November 1 through December 27, 2010, 94 individuals infected with the outbreak strain of Salmonella serotype I 4,[5],12:i:- have been reported from 16 states and the District of Columbia. The number of ill people identified in each state with the outbreak strain is as follows: California (1), Connecticut (1), District of Columbia (1), Georgia (1), Hawaii (1), Iowa (1), Illinois (51), Indiana (9), Massachusetts (1), Missouri (17), New York (1), Pennsylvania (2), South Dakota (1), Tennessee (1), Texas (1), Virginia (1), and Wisconsin (3). Collaborative investigative efforts of local, state, and federal public health and regulatory agencies have linked this outbreak to consumption of Tiny Greens Organic Farm’s Alfalfa Sprouts and Spicy Sprouts. The sprouts were distributed to Illinois, Indiana, Iowa, and Missouri, and may also have been distributed to other Midwestern states. Approximately half of the illnesses occurred in Illinois, where many of the ill individuals ate sandwiches containing sprouts at various Jimmy John’s outlets. Jimmy John’s restaurants have voluntarily suspended serving sprouts at their Illinois franchise locations.

On February 24, 2009, the Nebraska Department of Health and Human Services identified bacterial isolates from fourteen Nebraska residents who were infected with Salmonella Saintpaul. By PFGE testing, the genetic fingerprints of six of the fourteen cases matched exactly, and results were pending on the remaining eight cases. Onsets of illness for these initial fourteen cases stretched from the beginning to the middle of February 2009. Approximately two days later, Nebraska health authorities issued a nationwide notice to other state and federal health organizations, inquiring whether there were any additional reports of illness due to infection by Salmonella Saintpaul. Interviews with confirmed and suspect cases in the developing outbreak soon revealed a pattern of exposure to raw alfalfa sprouts, typically on sandwiches from Jimmy John’s restaurants, in the days before onset of illness. Health authorities, in collaboration with officials from the CDC and FDA, quickly identified CW Sprouts, Inc, a grower from Omaha, as the grower and supplier of the implicated sprout products. On March 3, 2009, CW Sprouts voluntarily recalled its alfalfa, onion, and gourmet sprout products sold under the SunSprout Enterprises brand name. In the two weeks following CW Sprouts’ March 3 recall, four other mid-western states reported Salmonella Saintpaul illnesses among residents. By March 18, the total number of confirmed cases in the outbreak had risen to 121, including 84 from Nebraska, 27 from Iowa, and five each from South Dakota and Kansas. All illnesses were linked to sprout products grown and sold by CW Sprouts. In total, thirteen states reported 228 confirmed illnesses in both outbreak clusters.

Between September 16, 2008, and October 4, 2008, Boulder County Public Health (BCPH) received a total of 19 confirmed and suspect cases of Shiga toxin producing E. coli (STEC) O157:NM. Of those cases, 14 were lab confirmed to have matching PFGE patterns, and the pattern was unlike any other reported outbreak. Because most of the cases in this outbreak became ill at a Boulder Jimmy John’s Restaurant, Boulder County Public Health lead the investigation into the outbreak. Ultimately, in addition to the 19 confirmed Boulder County cases, one case was identified in each of the following counties: Arapahoe, Broomfield, Jefferson and Weld. BCPH reported: “Of the cases not in Boulder County, 2 of 4 (50%) reported eating food from a Jimmy John’s restaurant—one at the sorority house and one at a Jimmy John’s restaurant located in Adams County, Colorado. All 17 cases (100%) in Boulder County reported eating food from Jimmy John’s restaurant located in Boulder.” Based on their detailed traceback investigation, investigators ultimately found that one company, Sprouts Extraordinaire, had supplied alfalfa sprouts to not only the Boulder Jimmy John’s, but also the Federal Height’s (Adams County) Jimmy John’s, as well as the Pita Pit in Greeley, Colorado, where another PFGE matched case had consumed sprouts two days before onset of illness.

Jimmy John’s, is the fourth time the charm?  And, with some 40 other prior outbreaks linked to sprouts in the last two decades, it is not like you are not on notice of a problem.