In late October 2011 the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) announced a multi-state outbreak of Salmonella Enteritidis. The outbreak was identified through routine surveillance of reported salmonellosis conducted by the CDC. Several states were reporting a spike in case patients infected with Salmonella Enteritidis strain JEGX01.0008/JEGA26.0032, a designation assigned by PulseNet, a database of foodborne pathogen genetic test results maintained at the CDC. The outbreak was assigned CDC Outbreak ID# 1109NYJEG-2.
Patients infected with the outbreak strain lived in New York, Pennsylvania, New Jersey, Maryland, and Virginia. Early in the investigation patients were interviewed using the CDC hypothesis-generating questionnaire. Pennsylvania Department of Health epidemiologist Dr. Andre Weltman noted that many of the case-patients he interviewed had shopped at Wegmans stores and that they reported purchasing and consuming pine nuts from Wegmans. Investigators obtained shopper card records and discovered that ill persons had in fact purchased the same brand of pine nuts from bulk bins at Wegmans stores located in different cities and states. State and federal investigators conducted a traceback of the pine nuts consumed by ill persons and learned they originated in Turkey. Further investigation identified Sunrise Commodities, Inc., an Englewood Cliffs, New Jersey firm, as the importer and supplier of the bulk pine nuts to Wegmans stores.
- The outbreak strain of Salmonella Enteritidis was isolated in 14 samples of Turkish pine nuts or pesto by public health laboratories in several states and at the FDA.
- The Virginia Division of Consolidated Laboratory Services isolated the outbreak strain of Salmonella Enteritidis from Turkish pine nuts that were purchased from bulk bins at Wegmans stores and collected from an ill person’s home, and from retail samples of Turkish pine nuts collected from a Wegmans store where ill persons reported shopping.
- The New York State Department of Health, Wadsworth Center Laboratory, isolated the outbreak strain of Salmonella Enteritis’s from three separate samples of homemade pesto containing Turkish pine nuts from three unrelated ill persons’ homes. In addition, culture of two samples of Turkish pine nuts, which were purchased from bulk, bins at different Wegmans stores and collected from two ill persons’ homes (one who also provided one of the pesto samples) yielded the outbreak strain.
- The Pennsylvania Department of Health Bureau of Laboratories isolated the outbreak strain of Salmonella Enteritis’s from two samples of homemade pesto containing Turkish pine nuts from an ill person’s home, and from Turkish pine nuts which were purchased from bulk bins at two Wegmans stores and collected from two unrelated ill persons’ homes.
- The Maryland Department of Health and Mental Hygiene isolated the outbreak strain of Salmonella Enteritis’s from a sample of pesto containing Turkish pine nuts, and from a sample of Turkish pine nuts which were purchased from bulk bins at a Wegmans store and collected from an ill person’s home. The outbreak strain was also isolated from a sample of bulk pine nuts collected from a second Wegmans store in Maryland that was not associated with any illnesses.
- The FDA collected Turkish pine nuts from a warehouse used by Sunrise Commodities and from a warehouse used by a customer of Sunrise Commodities. The outbreak strain was isolated in samples from both warehouses.
- Four lots of the product covering two different crop years were implicated as matching the outbreak timeframe. On 11/3/2011, Sunrise initiated a recall of the lots with samples which were positive for Salmonella Enteritidis: 669510 (lot #29628) and 719885 9lot #27963). Genetic testing by PFGE of isolates cultured from these samples showed the Salmonella Enteritidis isolated in the contaminated pine nuts matched the strain found in outbreak associated case patients.
These findings prompted several recalls.
- On October 26, 2011 Wegmans Food Markets, Inc. recalled approximately 5,000 lbs. of Turkish Pine Nuts sold in the Bulk Foods department of most Wegmans stores in New York, Pennsylvania, New Jersey, Virginia, and Maryland between July 1 and October 18, 2011.
- On November 4, 2011, Badia Spices, Inc. recalled approximately 3,800 lbs. of pine nuts. Badia Spices, Inc. repacked bulk pine nuts, which were imported from Turkey and subsequently recalled by Sunrise Commodities of Englewood Cliffs, N.J. These pine nuts were sold in retail stores in Florida, New York, Pennsylvania, Maryland, and New Jersey between June and October 2011.
- On November 9, 2011, FDA confirmed the presence of Salmonella on tested Turkish pine nuts distributed by Sunrise Commodities. The company voluntarily recalled four lots of the bulk Turkish pine nuts, totaling more than 21,000 pounds. Each lot was packed in 22-pound boxes. Sunrise Commodities distributed the Turkish pine nuts in bulk to various food vendors in Florida, New Jersey, New York, and Canada. Sunrise Commodities issued a recall notification to its customers dated November 4, 2011, alerting them of the test results and of the epidemiologic investigation and asking them to notify their subsequent customers of the recall.
A total of 43 individuals infected with the outbreak strain of Salmonella Enteritidis were reported from 5 states. The number of ill persons identified in each state with the outbreak strain was as follows: Maryland (1), New Jersey (2), New York (28), Pennsylvania (8), and Virginia (4). Ill persons ranged in age from < 1 year to 94 years. The median age was 43 years old. Sixty percent were female. Two patients were hospitalized. There were no deaths.
See http://www.cdc.gov/pulsenet/whatis.htm for a description of PulseNet and how it is used in foodborne illness outbreak detection and investigation.
Multistate Outbreak of Human Salmonella Enteritidis Infections Linked to Turkish Pine Nuts, November 17, 2011, Final Update, http://www.cdc.gov/salmonella/pinenuts-enteriditis/.