Food Poisoning Information

According to Delaware County Health Commissioner Shelia Hiddleson, although food samples tested negative for C. perfringens bacteria, the stool samples tested positive for the toxin that C. perfringens forms in the gastrointestinal tract.

A specific food has not been able to be identified as the source of illness. Ongoing food and stool testing is being conducted by the CDC lab.

“I am extremely proud of our team! This investigation included countless hours of phone calls and interviews along with multiple inspections. We are also appreciative of our community for being very cooperative during this investigation and for understanding our work in protecting the public’s health. We are also thankful for the work of our partners at the Ohio Department of Health and the CDC,” said Delaware County Health Commissioner Shelia Hiddleson.

In response to this outbreak, Brian Niccol, CEO of Chipotle Mexican Grill stated that “Chipotle Field Leadership will be retraining all restaurant employees nationwide beginning next week on food safety and wellness protocols.” Click here for complete statement.

Health District staff identified 647 people who self-reported gastrointestinal symptoms after consuming food from the Chipotle on Sawmill Parkway between Thursday July 26 – Monday July 30, 2018.

What is Clostridium Perfringens?

Clostridium perfringens are bacteria that produce toxins harmful to humans. Clostridium perfringens and its toxins are found everywhere in the environment, but human infection is most likely to come from eating food with Clostridium perfringens in it. Food poisoning from Clostridium perfringens fairly common, but is typically not too severe, and is often mistaken for the 24-hour flu.

The majority of outbreaks are associated with undercooked meats, often in large quantities of food prepared for a large group of people and left to sit out for long periods of time. Because of this, it is sometimes referred to as the “food service germ.” Meat products such as stews, casseroles, and gravy are the most common sources of illness from C. perfringens. Most outbreaks come from food whose temperature is poorly controlled. If food is kept between 70 and 140 F, it is likely to grow Clostridium perfringens bacteria.

People generally experience symptoms of Clostridium perfringens infection 6 to 24 hours after consuming the bacteria or toxins. Clostridium perfringens toxins cause abdominal pain and stomach cramps, followed by diarrhea. Nausea is also a common symptom. Fever and vomiting are not normally symptoms of poisoning by Clostridium perfringens toxins.

Illness from Clostridium perfringens generally lasts around 24 hours, and is rarely fatal.

The Type C strain of Clostridium perfringens can cause a more serious condition called Pig-bel Syndrome. This syndrome can cause death of intestinal cells and can often be fatal.

To prevent infection by Clostridium perfringens, follow the these tips:

  • Cook foods containing meat thoroughly
  • If keeping foods out, make sure they maintain a temperature of 140 F (60 C)
  • When storing food in the refrigerator, divide it into pieces with a thickness of three inches or less so that it cools faster
  • Reheat foods to at least 165 F (74 C)

References

“Clostridium perfringens.” Illinois Department of Public Health. Available at http://www.idph.state.il.us/Bioterrorism/factsheets/clostridium.htm.

Rohrs, Barbara. “Clostridium perfringens.” Ohio State University Extension Family and Consumer Sciences. Available at http://ohioline.osu.edu/hyg-fact/5000/5568.html.

To download E. coli complaint – COMPLAINT

Authors: Amelia Keaton, R. Hassan, S. Luna, I. Lee, R. Magalhaes, M. Bidlack, L. Smith, R. Maves, D. Freer, K. Flinn, G. Monk, P. Graf, K. Trinh, J. Crandall, D. Noveroske, G. Fortenberry, L. Ramos, R. Recio, C. Peak, E. McDonald, T. Waltz, K. Patel, D. Wagner, J. Espiritu, L. Christensen, L. Gieraltowski

Background: Shiga toxin-producing Escherichia coli (STEC) infections are a substantial cause of foodborne illness and a cause of hemolytic-uremic syndrome (HUS). In November 2017, CDC assisted the US Navy in a response to an outbreak of STEC illnesses in recruits at a Marine Corps Recruit Depot in San Diego (MCRD). We investigated to determine the source of this outbreak and identify prevention and mitigation measures.

Methods: In October 2017, medical providers identified a high number of gastrointestinal (GI) illnesses at MCRD. Recruits with diarrhea submitted stool specimens for culture and/or culture-independent diagnostic testing (CIDT) for GI pathogens. We performed pulsed-field gel electrophoresis (PFGE) on culture isolates. Case-patients were then defined as follows: confirmed (PFGE-confirmed STEC infection matching outbreak strains), probable (diagnosis of HUS and/or CIDT evidence of STEC), and suspected (bloody diarrhea). We conducted environmental evaluations of facilities, training areas, and barracks. A case-control study was performed using PFGE-confirmed case-patients and platoon-matched controls. We performed product traceback for foods identified as exposure risks by interview or case-control study.

Results: We identified 62 confirmed, 62 probable, and 120 suspected case-patients. Thirty case-patients required hospitalization and 15 had HUS. Case-patient ages ranged from 17-28 years (median: 18 years). Poor hygiene practices among recruits and inconsistent cooking temperatures within dining facilities were noted. Forty-three case-patients and 135 controls were interviewed about food, hygiene, and environmental exposures. Consumption of undercooked beef was found to be significantly associated with illness, (mOR 2.40, CI 1.04-5.72, p=0.04). We identified a single ground beef supplier for MCRD, but MCRD records did not document which specific lots of ground beef were used.

Conclusions: Case-control analysis and environmental observations suggested undercooked ground beef as a potential source for this outbreak. We recommended the Navy and Marine Corps retain lot information, address food handling concerns, and improve hygiene among recruits.

REF:  https://www.cdc.gov/eis/downloads/eis-conference-2018-508.pdf, page 117

SEATTLE, WA – Marler Clark, the Nation’s Food Safety Law Firm, has hired two new attorneys over the past year. Jenny Schell and Josh Fensterbush both graduated from Seattle University School of Law, the alma mater of managing partner, Bill Marler. Unfortunately, 2018 has been one of the busiest years for Marler Clark representing victims of foodborne illness. The firm has 100 clients from the romaine E. colioutbreak alone as well as clients from:

  • Cyclosporaoutbreak linked to Fresh Express salads
  • Cyclosporaoutbreak linked to Del Monte vegetable trays
  • Salmonellaoutbreak linked to Jimmy John’s sprouts
  • Salmonellaoutbreak linked to Fareway chicken salad
  • Salmonella outbreak linked to Rose Acre Farms
  • Salmonellaoutbreak linked to Caito cut melons
  • Salmonella outbreak linked to Kellog’s Honey Smacks
  • Salmonellaoutbreak linked to Hy-Vee pasta salad

Jenny joined Marler Clark in August 2018. Before joining us, she served as a judicial clerk for Associate Chief Justice Charles W. Johnson of the Washington State Supreme Court. While in law school, Jenny was a legal extern for Judge Beth Andrus in King County Superior Court and worked with organizations such as the ACLU of Washington and the Washington Appellate Project. She speaks fluent Spanish and worked in immigration defense before law school.

Jenny graduated from Seattle University School of Law, magna cum laude, in 2017. She also has a B.A. with honors in history from Lewis & Clark College. Outside of work, she enjoys playing music and doing anything outdoors, especially if she can take her dog with her.

Josh joined Marler Clark in March 2017, after graduating from Seattle University School of Law, Cum Laude. During law school, Josh served as a legal extern to Commissioner Kanazawa at Division 1 of the Washington State Court of Appeals, as a local Casework Coordinator for the International Refugee Assistance Project and was also appointed Research & Technical Editor of the Seattle University Law Review.

At Marler Clark, Josh serves in multiple capacities to bring about effective results for claimants of foodborne injuries. He has worked on a variety of cases involving E. coli, hepatitis A, Salmonella, and Listeriaoutbreaks, and his work regularly involves conducting discovery matters, researching critical litigatory issues, drafting pleadings and motions, and participating in mediations and trial preparation.

Josh is also proud alumnus of Victoria University of Wellington, New Zealand, where he earned a Bachelor of Arts Degree in International Relations and Philosophy. His activities during that time not only influenced him to pursue a legal education, but also fostered in him a deep love for the outdoors, biking, rugby, and beer.

Marler Clark, The Food Safety Law Firm, has represented thousands of individuals in claims against food companies whose contaminated products have caused life altering injury and even death. Marler Clark formed after managing partner, Bill Marler, began litigating foodborne illness cases in 1993, when he represented Brianne Kiner, the most seriously injured survivor of the historic Jack in the Box E. coliO157:H7 outbreak, in her landmark $15.6 million settlement with the company.  The 2011 book, Poisoned: The True Story of the Deadly E. coli Outbreak that Changed the Way Americans Eat, by best-selling author Jeff Benedict, chronicles the Jack in the Box outbreak and the rise of Bill Marler as a food safety attorney.  A new edition of the book is coming out later this year.

According to press reports, the Perry County Health Department, more than 30 cases of Salmonella infection have been reported in the past five days, nearly six times the number they usually see in a year.

Health department officials said they don’t have enough information yet to determine a source and that the investigation is ongoing.

“We are speaking with Department of Health and Senior Services in St. Louis, our counterparts up there,” said Sheila Hahs, the department’s RN communicable disease coordinator. “They have specialists who do all the calculations and figure out what caused what.”

Hahs said that the investigators are putting together a survey that will be used as part of the inquiry into the source of the outbreak.

“It depends on how many people come up symptomatic,” Hahs said. “This could go on for a while. We could be having secondary cases.”

On Thursday, Perry County Memorial Hospital reported that there had been at least 23 cases of Salmonella infection diagnosed since Monday in patients ranging in age from 2 to 68, both through the PCMH emergency department and local doctors’ offices. By Friday, that number had risen to 32.

Of these, three have required acute hospital admission, two were admitted for short-term observation and treatment, and one was transferred to a hospital in Cape Girardeau.  The others are reportedly recovering at home with medication and hydration.

All cases resulting in positive tests for Salmonella bacteria were reported to the health department.

“Laboratories are required to report communicable diseases such as this,” Hahs said. “There is a reportable list that all labs and doctors’ offices have and when one of them comes across as the diagnosis, then that has to be reported.”

Doctors at PCMH were able to make rapid diagnoses thanks to a recent equipment upgrade in the hospital’s laboratory department. The new testing units, installed in July, cut the waiting period on test results from days to hours.

“It’s something that we purchased earlier this year,” said PCMH vice-president of operations Chris Wibbenmeyer, who also oversees the hospital’s laboratory department. “We actually have four units that this testing can be ran on. It was testing that we didn’t have before.”

Wibbenmeyer said the timing of the upgrades, which include a new, highly specialized gastrointestinal test panel that can accurately and quickly identify 22 of the most common organisms that cause abdominal symptoms, proved lucky in light of the outbreak.

“It just so happens that us implementing this G.I. panel happened just shortly before this outbreak,” Wibbenmeyer said. “It’s worked really well because it speeds up the diagnostic time by days. That’s beneficial to everyone. It has other testing capabilities — it’s not just GI testing  — and in all of those areas, we’ve reported significant reductions in the turnaround time for results and have improved the timeliness of getting appropriate medications to the patients. It’s proven its worth over and over again.”

Officials with two separate health departments are investigating possible cases of Salmonella among people who attended the Arapahoe County Fair, or 4-H events associated with the fair, from July 21 to July 29.

The source of the Salmonella, which causes an intestinal infection, has not been identified and the Tri-County Health Department is searching for the origin.

The investigation began Aug. 3 and seven cases of Salmonella have been identified so far.

“If you went to the Arapahoe County Fair or attended a 4-H event associated with the Fair and have these symptoms, we encourage you to see your health care provider,” said the Executive Director of Tri-County Health Department. “While symptoms usually resolve on their own, your health care provider can advise on whether you need additional treatment.”

Transylvania Public Health has received confirmatory laboratory tests from the N.C. State Laboratory of Public Health. Of those people who were tested by their medical providers, a majority were positive for norovirus. We believe this outbreak was caused by being exposed to a highly-contagious virus in a public place.

Although more information is continuing to come in, Transylvania Public Health has received more than 70 cases of nausea, vomiting and diarrhea reported by medical providers, as well as phone calls reporting similar symptoms in more than 200 people since Tuesday, July 31.

Norovirus typically causes diarrhea, vomiting, nausea and stomach pain that lasts for 1 to 3 days. Other symptoms can include fever, headache and body aches. These symptoms and length of illness match closely with the symptoms being reported by those who are ill.

People get norovirus from direct contact with an infected person, consuming food or water that has been contaminated with norovirus or touching contaminated surfaces and then putting your unwashed hands in your mouth. It only takes a few virus particles to make someone sick, and those who are ill shed billions of these particles. People are most contagious when they are having symptoms like vomiting and for the first few days after recovering, although they can spread norovirus for two weeks or more after they feel better.
Norovirus symptoms usually appear 24-48 hours after being exposed to the virus. Many (but not all) of the people who reported symptoms to us recalled visiting a local restaurant 1-2 days before becoming ill. Other people reported having close contact with someone who had norovirus symptoms prior to becoming ill.

Public health officials do not believe that this outbreak is connected to the multi-state recall of salads due to cyclosporasis contamination.

According to press reports: “The McDonald’s in Brevard reopened Friday after closing voluntarily to deep clean the restaurant in the middle of the food illness outbreak.”

NICD updated this Listeria Outbreak at the end of July.  Of note, the numbers of ill have continued to drop following the recall of Tiger Brands Enterprise Foods polony in March. However, it appears that some of the “recalled” product is still being consumed.  NICD’s partial report is below.

1,060 laboratory-confirmed cases have been reported from 01 January 2017 to 17 July 2018. The number of new cases reported each week has decreased since the implicated products were recalled on 04 March 2018 with no new cases of listeriosis reported during the week prior to release of this sitrep (Figure 1). Neonates ≤28 days of age are the most affected age group (42%, 443/1 060), followed by adults aged 15 – 49 years of age (32%, 334/1 060) – Figure 2. Most cases have been reported from Gauteng Province (58%, 614/1 060), followed by Western Cape (13%, 136/1 060) and KwaZulu-Natal (8%, 83/1 060) provinces (Table 1). Final outcome (i.e. death or discharge) is known for 76% (806/1 060) of total cases to date; 27% (216/806) with known outcome died.

Following a recall of the implicated products, the number of cases has steadily decreased. However, it is anticipated that cases could still be reported for the following reasons:

  • The incubation period of listeriosis can be up to 70 days.
  • The implicated products have a long shelf life and it is possible that despite the recall some products have not been removed from retail or consumer’s homes.
  • Cross-contamination at retail and in the home can occur.

Post recall (05 March 2018 to date), all new cases of laboratory-confirmed listeriosis are contacted by IMT members, and a comprehensive food history is obtained. Exposure to food products implicated in the listeria outbreak is determined.

Of 87 post-recall cases, 65 have been interviewed to date.

Of those interviewed, 38/65 (58%) of ill people or their proxy reported consuming polony prior to their illness onset; brands manufactured by Tiger Brands Enterprise Foods were most commonly reported to have been consumed where brand of polony was known.

Prior to 2017, an average of 60 to 80 laboratory-confirmed listeriosis cases per year (approximately 1 per week), were reported in South Africa. In July 2017, an increase in laboratory-confirmed cases of listeriosis was reported to National Institute for Communicable Diseases (NICD) which triggered further investigation. On 05 December 2017, the listeriosis outbreak was declared by the Minister of Health, Dr. Aaron Motsoaledi. The source of the outbreak was identified as ready-to-eat processed meat products manufactured at Tiger Brand’s Enterprise Foods’ Polokwane production facility. A recall of affected products was initiated on 04 March 2018.

The recalls (hopefully, without illnesses) over the past week liked to whey powder tainted with Salmonellathat has food its way into popular snack items for chocolate cakes to Ritz and Gold Fish crackers is concerning, but a clear indicator that product testing and recalls appear to be working – that is a good thing.

Of even great concern are the outbreaks linked to Salmonellathat have sickened 100’s of people, putting dozens in the hospital.  From sprouts, shell eggs, cut fruit, cereal, pasta salad and turkey, the last few months have people questioning the safety of our food supply and asking questions about Salmonella.

As for the why the outbreaks, it could be better surveillance by state, local and national health authorities utilizing cutting edge tools such as PFGE and WGS.  It could be a lack of support for inspectors.  It is certainly possible that it is more imports with a greater supply chain with a great chance for contamination or temperature abuse. It also could be we are eating more mass produced fresh, ready to eat foods without a “kill step.”

As for the questions about Salmonella, here is a bit(e) of information:

Salmonella is a bacterium that causes one of the most common enteric (intestinal) infections in the United States – salmonellosis.  It has long been said that, in 1885, pioneering American veterinary scientist, Daniel E. Salmon, discovered the first strain of Salmonella. Actually, Theobald Smith, research-assistant to Dr. Salmon, discovered the first strain of SalmonellaSalmonella cholerae suis. But, being the person in charge, Dr. Salmon received credit for the discovery. In any case, today the number of known strains of the bacteria totals over two thousand.

The term Salmonella refers to a group or family of bacteria that variously cause illness in humans. Salmonella serotype typhimurium and Salmonella serotype enteritidis are the most common in the United States. Salmonella javiana is the fifth most common serotype in the United States and accounted for 3.4% of Salmonella isolates reported to the CDC during 2002. According to one study:

During the 1980s, S. Enteritidis emerged as an important cause of human illness in the United States. In 1976, the incidence of S. Enteritidis was 0.55 per 100,000 population and represented only 5% of all Salmonella isolates. By 1985, this proportion reached 10%, and the rate increased to 2.4 per 100,000 population. During the same time, total Salmonella infection rates rose from 10.7 per 100,000 in 1976 to 24.3 in 1985. The highest rates of S. Enteritidis were seen in the Northeast, although rates in the western region also increased during this time.

The number of outbreaks of S. Enteritidis infection also increased during the 1980s, particularly in the northeastern United States. Laboratory subtyping of S. Enteritidis isolates from outbreaks indicated that phage types (PT) 8 and 13a were the most common phage types in the United States. Although PT4 was common in Europe, where it coincided with a large increase in S. Enteritidis infections, it was seen in the United States only among persons with a history of foreign travel.

Of the Salmonella outbreaks that occurred from 1985 through 1999, “[f]ive hundred twenty-two (62%) outbreaks of S. Enteritidis infection were associated with food prepared at commercial food establishments (restaurants, caterers, delicatessens, bakeries, cafeteria, or market).”

Symptoms of a Salmonella Infection

Salmonella infections can have a broad range of illness, from no symptoms to severe illness. The most common clinical presentation is acute gastroenteritis. Symptoms include diarrhea, and abdominal cramps, often accompanied by fever of 100°F to 102°F (38°C to 39°C). Other symptoms may include bloody diarrhea, vomiting, headache and body aches. The incubation period, or the time from ingestion of the bacteria until the symptoms start, is generally 6 to 72 hours; however, there is evidence that in some situations the incubation can be longer than 10 days. People with salmonellosis usually recover without treatment within 3 to 7 days. Nonetheless, the bacteria will continue to be present in the intestinal tract and stool for weeks after recovery of symptoms—on average, 1 month in adults and longer in children.

Typhi and Paratyphi generally cause a bacteremic illness—Salmonella found in the blood—of long duration. This illness is called enteric, typhoid, or paratyphoid fever. Symptoms start gradually, and include fever, headache, malaise, lethargy, and abdominal pain. In children, it can present as a non-specific fever. The incubation period for S. Typhi is usually 8 to 14 days, but it can range from 3 to 60 days. For S. Paratyphi infections, the incubation period is similar to that of non-typhoidal Salmonella, 1 to 10 days.

Complications of a Salmonella Infection

In approximately 5% of non-typhoidal infections, patients develop bacteremia. In a small proportion of those cases, the bacteria can cause a focal infection, where it becomes localized in a tissue and causes an abscess, arthritis, endocarditis, or other severe illness. Infants, the elderly, and immune-compromised persons are at greater risk for bacteremia or invasive disease. Additionally, infection caused by antimicrobial-resistant non-typhoidal Salmonella serotypes appears to be more likely to cause bloodstream infections.

Overall, approximately 20% of cases each year require hospitalization, 5% of cases have an invasive infection, and one-half of 1% die. Infections in infants and in people 65 years of age or older are much more likely to require hospitalization or result in death. There is some evidence that Salmonella infections increase the risk of developing digestive disorders, including irritable bowel syndrome.

Although most persons that become ill with diarrhea caused by Salmonella recover without any further problems, a small number of persons develop a complication often referred to as reactive arthritis. The terminology used to describe this type of complication has changed over time. The term “Reiter’s Syndrome” was used for many years, but has now fallen into disfavor. The precise proportion of persons that develop reactive arthritis following a Salmonella infection is unknown, with estimates ranging from 2 to 15%. Symptoms of reactive arthritis include inflammation (swelling, redness, heat, and pain) of the joints, the genitourinary tract (reproductive and urinary organs), or the eyes.

More specifically, symptoms of reactive arthritis include pain and swelling in the knees, ankles, feet and heels. It may also affect wrists, fingers, other joints, or the lower back. Tendonitis (inflammation of the tendons) or enthesitis (inflammation where tendons attach to the bone) can occur. Other symptoms may include prostatitis, cervicitis, urethritis (inflammation of the prostate gland, cervix or urethra), conjunctivitis (inflammation of the membrane lining the eyelid) or uveitis (inflammation of the inner eye). Ulcers and skin rashes are less common. Symptoms can range from mild to severe.

One study showed that on average, symptoms developed 18 days after infection. A small proportion of those persons (15%) had sought medical care for their symptoms, and two thirds of persons with reactive arthritis were still experiencing symptoms 6 months later. Although most cases recover within a few months, some continue to experience complications for years. Treatment focuses on relieving the symptoms.

There are a lot of gaps in our knowledge surrounding this complication. Since there is no specific test for reactive arthritis, doctors rely on signs and symptoms of the patient in order to make the diagnosis. However, there are no clearly defined criteria or set of symptoms used to diagnose this condition. The role of genetics is also unclear. It is thought that the presence of a gene called human leukocyte antigen (HLA)-B27 predisposes a person to develop reactive arthritis, along with other autoimmune diseases; however, several studies have shown that many persons that develop reactive arthritis lack this genetic factor.

Diagnosis of Salmonella Infections

Salmonella bacteria can be detected in stool. In cases of bacteremia or invasive illness, the bacteria can also be detected in the blood, urine, or on rare occasions in tissues. The test consists of growing the bacteria in culture. A fecal, blood or other sample is placed in nutrient broth or on agar and incubated for 2-3 days. After that time, a trained microbiologist can identify the bacteria, if present, and confirm its identity by looking at biochemical reactions. Treatment with antibiotics before collecting a specimen for testing can affect bacterial growth in culture, and lead to a negative test result even when Salmonella causes the infection.

Treatment for Salmonella Infections

Salmonella infections usually resolve in 3 to 7 days, and many times require no treatment. Persons with severe diarrhea may require rehydration, often with intravenous fluids. Antimicrobial therapy (or treatment with antibiotics) is not recommended for uncomplicated gastroenteritis. In contrast, antibiotics are recommended for persons at increased risk of invasive disease, including infants younger than 3 months of age.

In situations in which antibiotics are needed, trimethoprim/sulfamethoxazole, ampicillin, or amoxicillin, are the best choices. Ceftriaxone, cefotaxime, or flouroquinolones are effective options for antimicrobial-resistant strains, although fluoroquinolones are not approved for persons less than 18 years of age. For persons with an infection in a specific organ or tissue (invasive disease), treatment with an expanded-spectrum cephalosporin is recommended, until it is known if the bacteria is susceptible to one of the more commonly used antibiotics listed above. For these rare situations, treatment with antibiotics for 4 weeks is generally recommended. For enteric fever, including S. Typhi infections, treatment for 14 days is recommended. The specific antibiotic chosen depends on the susceptibility of the bacteria and the response to treatment.

The Incidence of Salmonella Infections

In 2009, over 40,000 cases of Salmonella (13.6 cases per 100,000 persons) were reported to the Centers for Disease Control and Prevention (CDC) by public health laboratories across the nation, representing a decrease of approximately 15% from the previous year, but a 4.2% increase since 1996. Overall, the incidence of Salmonella in the United States has not significantly changed since 1996.

Only a small proportion of all Salmonella infections are diagnosed and reported to health departments. It is estimated that for every reported case, there are approximately 38.6 undiagnosed infections. The CDC estimates that 1.4 million cases, 15,000 hospitalizations, and 400 deaths are caused by Salmonella infections in the U.S. every year.

Salmonella can be grouped into more than 2,400 serotypes. The two most common serotypes in the U.S. are S. Typhimurium and S. Enteritidis. S. Typhi, the serotype that causes typhoid fever, is uncommon in the U.S. But, globally, typhoid fever continues to be a significant problem, with an estimated 12-33 million cases occurring annually. Moreover, outbreaks in developing countries have a high death-rate, especially when caused by strains of the bacterium that are resistant to antibiotic treatment.

Salmonella are found in the intestinal tract of wild and domesticated animals and humans. Some serotypes of Salmonella, such as S. Typhi and S. Paratyphi are only found in humans. For ease of discussion, it is generally useful to group Salmonellae into two broad categories: typhoidal, which includes S. Typhi and S. Paratyphi, and non-typhoidal, which includes all other serotypes.

The Prevalence of Salmonella in Food and Elsewhere

Eating contaminated food, especially food from animal origins, causes most Salmonella infections. One study found that 87% of all confirmed cases of Salmonella were foodborne, with 10 percent from person-to-person infection and 3% caused by pets. As explained in a comprehensive report issued by the USDA’s Economic Research Service:

Salmonella contamination occurs in a wide range of animal and plant products. Poultry products and eggs are frequently contaminated with S. enteritidis, while beef products are commonly contaminated with S. typhimurium. Other food sources of Salmonella may include raw milk or other dairy products and pork. Salmonella outbreaks also have been traced to contaminated vegetables, fruits, and marijuana.

Another study went into even greater detail in explaining the prevalence of Salmonella and the sources of human infection, stating as follows:

A food item was implicated in 389 (46%) outbreaks of S. Enteritidis infection from 1985 through1999; in 86 (22%) of these, more than one food item was implicated. Of the 371 outbreaks for which information was available, 298 (80%) were egg associated. This proportion ranged from 10 (71%) of 14 in 1985 to 19 (95%) of 20 in 1997. Of outbreaks caused by a single vehicle for which information was known, 243 (83%) of 294 were egg-associated, as were 55 (71%) of 77 outbreaks in which more than one food item was implicated.

Among single foods implicated in egg-associated outbreaks, 67 (28%) of 243 were foods that contained raw eggs (e.g., homemade ice cream, Caesar salad dressing, tiramisu, egg nog). Sixty-five (27%) of the outbreaks implicated traditional egg dishes such as omelets, French toast, pancakes, and foods that use egg batter, such as crab cakes, chile rellenos, egg rolls, and Monte Cristo sandwiches. Sixty-three (26%) outbreaks implicated dishes known to contain eggs, such as lasagna, ziti, and stuffing, which would have been expected to have been fully cooked but probably did not reach temperatures sufficient to kill S. Enteritidis. Thirty-six (15%) outbreaks implicated egg dishes that were “lightly cooked” (e.g., hollandaise sauce, meringue, cream pies). The food vehicles in 12 (5%) outbreaks were reported to contain eggs but could not be classified because information on how the dishes were prepared was not provided.

Seventy-three (20%) of the 371 confirmed outbreaks for which information was provided involved vehicles that did not contain eggs. Twenty (27%) of these outbreaks were associated with poultry (chicken or turkey), 8 (11%) with beef, and 6 (8%) with foods containing shrimp (3 outbreaks), bologna (1), pork (1), and pepper loaf (1). Other implicated foods included potatoes (3), beans (3), desserts (3), salad (3), macaroni and cheese (1), cheese sauce (1), goat cheese (1), chili (1), and a pureed diet (1). In 22 (30%) of the non–egg-associated outbreaks, more than one food was implicated. In four of these outbreaks, cross-contamination with raw eggs was suspected.

In sum, food remains the most common vehicle for the spread of Salmonella, and eggs are the most common food implicated. As one authority points out, “Studies showed that the internal contents of eggs can be contaminated with [Salmonella], and this contamination has been identified as a major risk factor in the emergence of human illness.” Part of this risk stems from the variety of ways that Salmonella can contaminate an egg. For example, the FDA has documented the following:

Bacteria can be on the outside of a shell egg. That’s because the egg exits the hen’s body through the same passageway as feces is excreted. That’s why eggs are required to be washed at the processing plant. All USDA graded eggs and most large volume processors follow the washing step with a sanitizing rinse at the processing plant. It is also possible for eggs to become infected by Salmonella Enteritidis fecal contamination through the pores of the shells after they’re laid. SE also can be inside an uncracked, whole egg. Contamination of eggs may be due to bacteria within the hen’s reproductive tract before the shell forms around the yolk and white. SE doesn’t make the hen sick.

Chicken is also a major cause of Salmonella. Beginning in 1998, the publisher of Consumer Reports magazine has conducted surveys and tested chicken at retail for Salmonella and Campylobacter. Its 2009 study found 14% of broiler chickens at grocery stores to contain Salmonella. A USDA Baseline Data Collection Program report done in 1994 documented Salmonella contamination on 20.0% of broiler-chicken carcasses. However, in 2009 the same USDA data collection survey showed the prevalence of Salmonella in broiler chickens at 7.5%. Additionally, turkey carries a lower risk with a prevalence of 1.66%.

While Salmonella comes from animal feces, fruits and vegetables can become contaminated. A common source is raw sprouts, which have been the subject of at least 30 reported outbreaks of foodborne illnesses since 1996. The U.S. Department of Health and Human Services cautions against consuming raw sprouts under any circumstances: “Unlike other fresh produce, seeds and beans need warm and humid conditions to sprout and grow. These conditions are also ideal for the growth of bacteria, including Salmonella, Listeria, and E. coli.”

Prevention

In general, safe cooking and preparation of food can kill existing Salmonella bacteria and prevent it from spreading. Additionally, safe choices at the grocery store can greatly reduce the risk of Salmonella.

  • Always wash your hands before you start preparing food.
  • Cook poultry until it reaches an internal temperature of 165 ºF.
  • Cook beef and pork until they reach 160ºF. High quality steaks (not needle or blade tenderized) can be safely cooked to 145ºF.
  • Cook eggs until they reach 160ºF or until the yoke is solid. Pasteurized eggs are available in some grocery stores.
  • Do not eat or drink foods containing raw eggs. Examples include homemade eggnog, hollandaise sauce, and undercooked French toast.
  • Never drink raw (unpasteurized) milk.
  • Avoid using the microwave for cooking raw foods of animal origin. Microwave-cooked foods do not reach a uniform internal temperature, resulting in undercooked areas and survival of Salmonella.
  • If you are served undercooked meat, poultry, or eggs in a restaurant don’t hesitate to send your food back to the kitchen for further cooking.
  • Avoid cross-contamination. That means that you should never allow foods that will not be cooked (like salads) to come into contact with raw foods of animal origin (e.g., on dirty countertops, kitchen sinks, or cutting boards). Wash hands, kitchen work surfaces, and utensils with soap and water immediately after they have been in contact with raw foods of animal origin.
  • Wash hands with soap after handling reptiles, amphibians or birds, or after contact with pet feces. Infants and persons with compromised immune systems should have no direct or indirect contact with such pets.
  • Reptiles, amphibians or birds, or any elements of their housing (such as water bowls) should never be allowed in the kitchen.
  • Avoid eating in animal barns, and wash your hands with soap and water after visiting petting zoos or farm settings.
  • Always wash your hands after going to the bathroom. The hands of an infected person who did not wash his or her hands adequately after using the bathroom may also contaminate food.

Steps for proper hand washing:

  • Wet your hands with clean warm running water;
  • Apply soap;
  • Rub your hands making lather for 20 seconds. Make sure that you scrub your hands entirely (not just the fingertips);
  • Rinse your hands under warm running water;
  • If possible, turn the faucet off using a paper towel;
  • Dry your hands using paper towels or an air dryer;
  • Do not use an alcohol-based (waterless) sanitizer instead of washing your hands when cooking or when hands are visibly soiled. Hand sanitizers are only effective when there is no visible organic matter (like dirt, food, or other matter) on the hands.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella and other foodborne illness outbreaks and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Our Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants. The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.

Additional Resources

Del Monte: As of July 19, 2018,  a total of 237 laboratory-confirmed cases of Cyclospora infection were reported in people who consumed pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip from 4 states.

The median illness onset date among patients is June 1, 2018 (range: May 14 to June 13). Ill people range in age from 13 to 79 years old, with a median age of 46. Fifty-three percent (53%) are female and 7 people have been hospitalized. No deaths have been reported.

Illnesses that began after June 7, 2018 might not have been reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

On June 15, 2018, Del Monte Fresh Produce recalled 6 oz., 12 oz., and 28 oz. vegetable trays containing fresh broccoli, cauliflower, celery sticks, carrots, and dill dip. Recalled products were sold in clear, plastic clamshell containers.

Recalled products were distributed to the following stores: Kwik Trip, Kwik Star, Demond’s, Sentry, Potash, Meehan’s, Country Market, FoodMax Supermarket, and Peapod.

McDonalds: As of July 19, 2018 (12pm EDT), a total of 163 laboratory-confirmed cases of Cyclospora infection were reported in people who consumed salads from McDonald’s restaurants; the cases were reported by 10 states. Note, the Florida case-patient purchased a salad while traveling in Kentucky.

On July 12, 2018, the Iowa Department of Public Health and the Illinois Department of Public Health reported an increase in cases of cyclosporiasis among people who ate salads sold at McDonald’s fast-food chain restaurants. CDC also has received reports of sick people in Kentucky, Minnesota, Missouri, Nebraska, Ohio, South Dakota, and Wisconsin who ate salads sold at McDonald’s locations in those states.

McDonald’s is cooperating with the investigation and has voluntarily stopped selling salads in more than 3,000 locations in the following 14 states: Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Missouri, Montana, Nebraska, North Dakota, Ohio, South Dakota, West Virginia, and Wisconsin.

Illnesses started on or after May 1, 2018. The median illness onset date is June 28, 2018 (range: May 20 to July 10). Ill people range in age from 16 to 87 years old, with a median age of 53. Sixty-six percent (66%) are female. At least three (3) people have been hospitalized; no deaths have been reported.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Cyclospora outbreaks. The Cyclospora Attorneys and Lawyers have represented victims of Cyclospora and other foodborne illness outbreaks and have recovered over $650 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.

If you or a family member became ill with a Cyclospora infection after consuming food and you are interested in pursuing a legal claim, contact the Marler Clark Hepatitis A attorneys for a free case evaluation.

As of June 18, 2018, 70 people infected with the outbreak strain of Salmonella Adelaide have been reported from seven states. A list of the states and the number of cases in each can be found on the Case Count Map page.

Illnesses started on dates ranging from April 30, 2018, to June 3, 2018. Ill people range in age from less than 1 year to 97, with a median age of 67. Sixty-seven percent are female. Out of 63 people with information available, 34 (54%) have been hospitalized. No deaths have been reported.

Illnesses that occurred after May 28, 2018, might 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 4 weeks. Please see the Timeline for Reporting Cases of Salmonella Infection for more details.

Epidemiologic and preliminary traceback evidence indicates that pre-cut melon supplied by Caito Foods, LLC of Indianapolis, Indiana is a likely source of this multistate outbreak.

  • Most of the ill people reported eating pre-cut cantaloupe, watermelon, or a fruit salad mix with melon purchased from grocery stores.
  • Information collected from stores where ill people shopped indicates that Caito Foods, LLC supplied pre-cut melon to these stores.

Salmonella:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella and other foodborne illness outbreaks and have recovered over $650 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants.  The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.

If you or a family member became ill with a Salmonella infection, including Reactive Arthritis or Irritable bowel syndrome (IBS), after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Salmonella attorneys for a free case evaluation.