Harry Eagar of MauiNews.com reports that state epidemiologists are investigating whether several illnesses on Maui in the last few weeks were caused by spoiled Spam musubi and, if they were, whether there was a connection.
Whether there was a common source or not, health officials are taking the opportunity to alert consumers to some not-so-obvious dangers with familiar local snacks.
This is not your mother’s Spam musubi.
Lance Wong, supervisor of the Food and Drug Branch of the Department of Health, says that in the old days, Spam musubi was made a few at a time by mom-and-pop stores and sold to workers for lunch.

“They were eaten right away,” before bacteria had time to do their dirty work.
Officially, the old days ended for Spam musubi in May 1994, when the Health Department felt compelled to require retail vendors to put time stamps on perishable foods set out at room temperature for sale.
It’s not just musubi but all “potentially dangerous” foods, which basically is anything you normally would refrigerate against spoilage.
But with Spam musubi, as with most foods made with rice, it was common to lay them out on a counter. Under current rules, they must be displayed under a heating lamp that keeps them over a minimum of 140 degrees. While chilling also protects the rice from bacteria growth, chilling hardens cooked rice.
Today, says Wong, big commercial kitchens produce “thousands and thousands of Spam musubi that are shipped to all different islands.”
Under the regulations written in 1994 and later turned into legislation, perishable snacks have to be time stamped with the beginning of manufacture and the last permissible minute of sale — a span of just four hours.
In nine cases of gastrointestinal illness caused by staphylococcus infections on Maui since July, investigators suspect musubi.
Six incidents affecting nine people are from a known cause. Two were young children who were taken to an emergency care department.
Staph infections are among about 40 reportable illnesses that physicians are required to report to the Department of Health.
The nature of the ailment may not always be reported though, says Wong. If a patient goes to a personal physician with a tummy ache, the physician may not run a microbiologic test, the only way to confirm staph.
There are diagnostic tip-offs. With a staph tummy ache, there usually is vomiting but no fever.
But the Disease Investigation Branch does sometimes become aware of suspicious incidents that may have a common origin. Doctors report cases, and people call the local Sanitation Branch of the Health Department to say they suspect they have food poisoning.
One way or another, the first hint of a connected outbreak arises. Investigators then begin checking in detail the history of the patients. Usually, says Wong, they begin by asking what the person ate over the past 24 to 48 hours, and where.
In the Maui cases, health officials are suspicious that Spam musubi was the cause of the nine illnesses because it seems to be the one common food item among the nine. They are investigating whether the musubi might all have originated in the same kitchen.
However, according to Wong, the problem might have arisen later, and not with the maker but the eaters.
If you buy a Spam musubi, says Wong, you should eat it soon after purchase.
Putting it in your pocket is asking for trouble, and even putting it in a refrigerator won’t help if it had already been held at an unsafe temperature (between 45 and 140 degrees) for a while.
These precautions apply to musubi, bentos and similar foods, but not to cookies and other nonperishables.