Investigation Update: Multistate Outbreak of Human Salmonella Montevideo Infections

Update for January 23, 2010

CDC is collaborating with public health officials in many states, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS), and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Salmonella serotype Montevideo infections. Investigators are using DNA analysis of Salmonella bacteria obtained through diagnostic testing to identify cases of illness that may be part of this outbreak.

As of 12:00 noon EST on January 22, 2010, a total of 184 individuals infected with a matching strain of Salmonella Montevideo have been reported from 38 states since July 1, 2009.  The number of ill persons identified in each state with this strain is as follows:  AL (2), AZ (5), CA (30), CO (2), CT (4), DE (2), FL (2), GA (3), IA (1),  IL (11), IN (3), KS (3), LA (1), MA (12), MD (1), ME (1), MI (1), MN (4), NC (9), ND (1), NE (1), NH (1), NJ (7), NY (15), OH (9), OK (1), OR (8), PA (3),  RI (2), SC (1), SD (3), TN (3), TX (7), UT (7), VA (1), WA (14), WV (1), and WY (2). Because this is a commonly occurring strain, public health investigators may determine that some of the illnesses are not part of this outbreak.

Among the persons with reported dates available, illnesses began between July 2, 2009 and January 1, 2010.  Infected individuals range in age from <1 year old to 88 years old and the median age is 37 years.  Fifty-two percent of patients are male.  Among the 125 patients with available information, 35 (28%) were hospitalized. No deaths have been reported.

The outbreak can be visually described with a chart showing the number of persons who became ill each day. This chart is called an epidemic curve or epi curve. Illnesses that occurred after January 4, 2010 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 3 weeks. Please see the Salmonella Outbreak Investigations: Timeline for Reporting Cases for more details.

Investigation of the Outbreak

A widely distributed contaminated food product might cause illnesses across the United States. The identity of the contaminated product often is not readily apparent.  In outbreaks like this one, identification of the contaminated product requires conducting detailed standardized interviews with persons who were ill.  It may also require conducting interviews with non-ill members of the public ("controls") to get information about foods recently eaten and other exposures to compare with information from the ill persons. The investigation is often supplemented by laboratory testing of suspected products. In addition, investigators sometimes use purchase information provided by ill persons to trace suspect products back to the point of production. This process is labor intensive and typically takes weeks. It is not always successful.

During January 16-21, 2010, CDC and public health officials in multiple states conducted an epidemiologic study by comparing foods eaten by 39 ill and 39 well persons. Preliminary analysis of this study has suggested salami as a possible source of illness. Ill persons (51 percent) were significantly more likely than well persons (15 percent) to report eating salami. Additionally, 11 ill persons have been identified who purchased the same type of sliced salami variety pack at different grocery store locations before becoming ill. These data suggest this product may be the source of some of these illnesses. This sliced salami variety pack was recently recalled by Daniele International Inc. On January 23, 2010, FSIS issued a notice that Daniele International Inc. is recalling approximately 1,240,000 pounds of ready-to-eat varieties of Italian sausage products (including salame/salami) in commerce and potentially available to customers in retail locations because they may be contaminated with Salmonella. (http://www.fsis.usda.gov/News_&_Events/Recall_006_2010_Release/index.asp). The manufacturer has voluntarily halted production of salami products.

This recall followed isolation of Salmonella in a private laboratory from a retail sample of a salami product produced by Daniele International. FSIS reviewed and affirmed these private laboratory results. This Salmonella strain is different from the strains causing the outbreak. In addition, this product was different than the sliced salami variety pack purchased at different grocery store locations by the 11 ill persons. CDC and its public health partners are continuing the epidemiological investigation to verify that the outbreak is controlled, and to identify the specific products or ingredients that became contaminated and how the contamination occurred, and to identify any other food vehicles that may be involved. It is possible that more than one food product may be causing illnesses. The investigation is on-going.

Clinical Features/Signs and Symptoms

Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12–72 hours after infection. Infection is usually diagnosed by culture of a stool sample. The illness usually lasts from 4 to 7 days. Although most people recover without treatment, severe infections may occur. Infants, elderly persons, and those with weakened immune systems are more likely than others to develop severe illness. When severe infection occurs, Salmonella may spread from the intestines to the bloodstream and then to other body sites and can cause death unless the person is treated promptly with antibiotics.

More general information about Salmonella can be found here under Salmonella FAQs.

Advice to Consumers

• Recalled products may still be in grocery stores and in consumers’ homes including in the freezer. Recalled products should not be consumed. Consumers are advised to review the list of recalled products and labels at http://www.fsis.usda.gov/News_&_Events/Recall_006_2010_Release/index.asp.
• Consumer with questions regarding the recall should contact the Daniele International, Inc. Hotline at (888) 345-4160 and its PR contact, Levick at (202) 973-1335.
• If you have a recalled product, do not eat it; return it to the place of purchase or dispose of in a closed plastic bag and placed in a sealed trash can to prevent people or animals, including wild animals, from eating it.
• No illness has been linked to salami products produced by other companies.
• Consumers with food safety questions can "Ask Karen," the FSIS virtual representative available 24 hours a day at AskKaren.gov
• The toll-free USDA Meat and Poultry Hotline 1-888-MPHotline (1-888-674-6854) is available in English and Spanish and can be reached from l0 a.m. to 4 p.m. (Eastern Time) Monday through Friday. Recorded food safety messages are available 24 hours a day.
• Consumers without internet access can also telephone 1-800-CDC-INFO (1-800-232-4636), 24 hours a day, 7 days a week, for product recall information from the USDA-FSIS website and for other information on salmonellosis.
• Persons who think they might have become ill from eating a recalled product should consult their health-care providers. Infants, elderly persons, and persons with impaired immune systems are more likely than others to develop severe illness.

General Information

• General Information: Salmonella
• CDC's Role During a Multi-State Foodborne Outbreak Investigation

Previous Updates on this Outbreak

• January 22, 2010