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CDC Update: 4 Deaths, 767 Salmonella Cases in 36 States Linked to Cucumbers

Oct. 14 update: CDC has again updated the Salmonella Poona outbreak linked to imported Mexican cucumbers. The latest case count is 767 people infected from 36 states (the state added to the list is Florida). There have been 157 hospitalizations so far, the agency stated.

The Oct. 14 CDC update continues: Since the last update on October 6, 2015, 35 more ill people have been reported from 14 states. Illnesses that occurred after September 15, 2015 might not be reported yet. A series of events occurs between the time a person is infected and the time public health officials can determine that the person is part of an outbreak. This means that there will be a delay between when a person gets sick and confirmation that he or she is part of an outbreak. This takes an average of 2 to 4 weeks. Please see the Timeline for Reporting Cases of Salmonella Infection for more details. Also, cucumbers have a shelf life of up to 14 days. Some people may not have known about the recall and eaten the contaminated cucumbers after the recall.

As of October 13, 2015, 767 people infected with the outbreak strains of Salmonella Poona have been reported from 36 states. The number of ill people reported from each state is as follows: Alabama (1), Alaska (16), Arizona (118), Arkansas (11), California (205), Colorado (18), Florida (1), Hawaii (1), Idaho (24), Illinois (9), Indiana (4), Iowa (6), Kansas (2), Kentucky (1), Louisiana (5), Maryland (1), Minnesota (38), Missouri (12), Montana (15), Nebraska (7), Nevada (14), New Mexico (31), New York (6), North Dakota (6), Ohio (3), Oklahoma (12), Oregon (21), Pennsylvania (2), South Carolina (9), South Dakota (3), Texas (38), Utah (53), Virginia (1), Washington (24), Wisconsin (42), and Wyoming (7).

Among people for whom information is available, illnesses started on dates ranging from July 3, 2015 to September 29, 2015. Ill people range in age from less than 1 year to 99, with a median age of 17. Fifty percent of ill people are children younger than 18 years. Fifty-five percent of ill people are female. Among 561 people with available information, 157 (28%) report being hospitalized. Four deaths have been reported from Arizona (1), California (1), Oklahoma (1), and Texas (1).

Oct. 6 update: CDC announced on Tuesday that 61 more Salmonella Poona infections have been reported from 24 states, bringing the total to 732 cases in 35 states (Maryland was added to the list).

One related death has been reported in Oklahoma, bringing the total number of deaths to four, CDC stated. The other reported deaths have been one each in Arizona, California and Texas. Also, CDC reported that 150 people have been hospitalized in connection with this outbreak.

Given the 14-day shelf life of cucumbers and the gap between when someone gets sick and when that illness is reported to public health, it is not unexpected to continue to see illnesses reported after the recalls, the agency noted.

Sept. 29 update: The Centers for Disease Control & Prevention (CDC) again updated this outbreak on Tuesday, Sept. 29. There are currently three deaths, 131 hospitalizations and 671 confirmed cases being reported in 34 states. The deaths being reported are in Arizona, California and Texas (one each).

Since the previous update a week ago, there have been 113 more Salmonella infections reported to CDC from 19 states, and Alabama was added to the list of states reporting cases.

Bulk unwrapped cucumbers in box“Given the 14-day shelf life of cucumbers, it is not unexpected to continue to see illnesses reported after the recalls,” CDC noted.

Previous coverage follows:

 Sept. 22 update: The Centers for Disease Control & Prevention (CDC) again updated this outbreak on Tuesday, Sept. 22. There are currently three deaths, 112 hospitalizations and 558 confirmed cases being reported in 33 states. The deaths being reported are in Arizona, California and Texas (one each).

Since the previous CDC update a week ago, this latest report reflects an increase of 140 confirmed cases, 21 additional hospitalizations, and confirmed cases in residents of two additional states (Iowa and South Dakota, with one each).

Previous coverage follows:

The Centers for Disease Control & Prevention (CDC) updated this outbreak on Tuesday, Sept. 15. There are currently two deaths, 91 hospitalizations and 418 confirmed cases being reported in 31 states. The deaths being reported are in California and Texas (one each).

The total number of confirmed cases is 77 more than CDC’s most recent Sept. 9 update, and Indiana, with two cases, was added to the total list of states reporting confirmed cases of Salmonella linked to Mexican cucumbers.

Previous coverage follows:

The Centers for Disease Control & Prevention (CDC) updated this outbreak on Wednesday, Sept. 9. There are now two deaths, 70 hospitalizations and 341 confirmed cases being reported in 30 states. The deaths being reported are in California and Texas (one each). That is 56 more confirmed cases since CDC’s Sept. 4 update.

The Sept. 9 CDC update included this information:

  • 53 percent those sickened are children younger than 18 years.
  • Epidemiologic, laboratory, and traceback investigations have identified imported cucumbers from Mexico and distributed by Andrew & Williamson Fresh Produce as a likely source of the infections in this outbreak.
    • 91 (68 percent) of 134 people interviewed reported eating cucumbers in the week before their illness began.
    • Eleven illness clusters have been identified in seven states. In all of these clusters, interviews found that cucumbers were a food item eaten in common by ill people.
    • Arizona, California, Montana, and Nevada isolated Salmonella from samples of cucumbers collected from various locations that were distributed by Andrew & Williamson Fresh Produce.
    • On Sept. 4, 2015, Andrew & Williamson Fresh Produce voluntarily recalled all cucumbers sold under the “Limited Edition” brand label during the period from Aug. 1, 2015, through Sept. 3, 2015, because they may be contaminated with Salmonella.
      • The type of cucumber is often referred to as a “slicer” or “American” cucumber and is dark green in color. Typical length is 7 to 10 inches. In retail locations, the cucumbers are typically sold in a bulk display without any individual packaging or plastic wrapping.
      • Limited Edition cucumbers were distributed in the states of Alaska, Arizona, Arkansas, California, Colorado, Florida, Idaho, Illinois, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Montana, Nevada, New Jersey, New Mexico, Oklahoma, Oregon, South Carolina, Texas, and Utah. Further distribution to other states may have occurred.
      • Consumers should not eat, restaurants should not serve, and retailers should not sell recalled cucumbers.
        • If you aren’t sure if your cucumbers were recalled, ask the place of purchase or your supplier. When in doubt, don’t eat, sell, or serve them and throw them out.

The original Food Safety News story, posted Sept. 4, follows:

A multi-state outbreak of Salmonella Poona linked to imported Mexican cucumbers has apparently sickened more than 300 people from 27 states and hospitalized 53 of them, according to an alert posted Friday afternoon by the New Mexico Department of Health and additional reporting by Food Safety News.

statement released Friday by the California Department of Public Health reported that there has been one related death in California, and that additional cases were continuing to come in.

Mexican cucumbers in boxThe U.S. Centers for Disease Control and Prevention (CDC) released information on the outbreak at 8 p.m. Eastern Time Friday night.

According to CDC, “Among people for whom information is available, illnesses started on dates ranging from July 3, 2015 to August 26, 2015. Ill people range in age from less than 1 year to 99, with a median age of 13. Fifty-four percent of ill people are children younger than 18 years. Fifty-seven percent of ill people are female. Among 160 people with available information, 53 (33%) report being hospitalized. One death has been reported from California.”

Fifteen confirmed cases were announced Friday in New Mexico, as well as 11 confirmed cases (with two suspected) reported from eight counties in Montana.

Thursday’s total case count was 285, and the total on Friday was said to have climbed higher than that.

“I know that it’s over 300 now,” Mark DiMenna, deputy director of the Albuquerque Environmental Health Department, told Food Safety News.

He said the breakdown of the 285 S. Poona cases by state as of Sept. 3 was as follows: AK (8), AR (6), AZ (60), CA (51), CO (14), ID (8), IL (5), KS (1), LA (3), MN (12), MO (7), MT (11), NE (2), NM (15), NV (7), NY (4), ND (1), OH (2), OK (5), OR (3), SC (6), TX (9), UT (30), VA (1), WA (9), WI (2), WY (3).

He said that Albuquerque health inspectors come in from the field on Friday and contacted anybody in grocery stores or restaurants who might have received the Mexican cucumbers.

“We contacted anybody who we knew had gotten them and asked them to pull them off the shelves,” he said, adding that barring an official recall, product removal would be on a voluntary basis.

While DiMenna wouldn’t name the distributor involved, he noted that several outlets in his area had already been contacted by them.

“It’s an indication of the scale of that distributor,” he said.

On Friday, a San Diego produce distributor, Andrew & Williamson Fresh Produce, recalled cucumbers imported from Mexico for Salmonella risk. Andrew & Williamson also supplies vegetables to Red Lobster and In-And-Out restaurants, among others, according to an Oklahoma City TV station.

California health department officials stated that Andrew & Williamson had initiated a voluntary recall of their garden cucumbers after being informed of the epidemiologic association between these cucumbers and the Salmonella Poona outbreak.

cucumbers-featured“The recalled garden cucumbers can be identified in distribution channels as ‘Limited Edition’ brand pole grown cucumbers. The labeling on these cases indicates the product was grown and packed by Rancho Don Juanito in Mexico. These cucumbers were distributed between August 1 – September 3, 2015,” the department stated.

The Mexican cucumbers being linked to the current S. Poona outbreak are not the long, thin ones that come wrapped in plastic (English cucumbers) nor the small pickle-shaped type (Persian cucumbers). They are the thick-skinned, unwrapped type of garden-variety cucumbers and were sent to grocery stores and restaurants in New Mexico and other states through a produce distributor.

CDC reported Friday that several state health and agriculture departments are collecting leftover cucumbers from restaurants and grocery stores where ill people reported eating or shopping to test for the presence of Salmonella.

“The San Diego County Health and Human Services Agency isolated Salmonella from cucumbers collected during a visit to the Andrew & Williamson Fresh Produce facility. DNA ‘fingerprinting’ is being conducted to determine the PFGE pattern of the Salmonella isolated from these cucumbers. Results of additional product testing will be reported when available,” CDC stated.

The New Mexico Health Department noted in its Friday announcement that officials there were working with CDC, FDA, the New Mexico Environment Department, the Albuquerque Environmental Health Department, and multiple other state health departments on the outbreak investigation.

epi-curve-09-5-2015According to the state health department there, the 15 New Mexico cases are seven residents of Bernalillo County, two residents of Doña Ana County, two residents of Sandoval County, and one resident from McKinley, Santa Fe, and Valencia counties, respectively, with one case of unknown residence at this time.

Several of the New Mexicans sickened were hospitalized, ranged in age from 1 to 65 years of age, and approximately 60 percent are female. Illness onset ranged from July 30 to late August, according to the health department.

New Mexico health officials recommended that New Mexicans not buy, sell, eat, or serve cucumbers grown commercially in Mexico until additional information is available from the CDC and FDA.

“If you have any concerns we recommend that you ask your retail grocer where the cucumbers you purchased were grown. When in doubt as to their origin, do not eat them, and throw them out,” they stated.

California health officials sent out a photo of a box of the recalled cucumbers, noting that, “It is unlikely that cucumbers in retail grocery stores will have any identifying brand information. CDPH recommends that consumers check with their grocer to determine if the cucumbers they purchased are impacted by this warning.”

People who are at high risk for Salmonella infection include: infants, elderly, those with compromised immune systems, including persons on immunosuppressive therapies or medications, and pregnant women. Healthy adults rarely develop severe illness. It is important for people at high risk to follow the standard CDC guidance about Salmonella. People can decrease their risk of Salmonella infection through proper food handling and preparation and by practicing proper hand washing and hygiene practices.

Eating food contaminated with Salmonella can cause salmonellosis, an uncommon but potentially serious infection. Salmonellosis is characterized by an acute onset of headache, abdominal pain, diarrhea, nausea, and sometimes vomiting. Dehydration, especially among infants, may be severe.

This is not the first Salmonella outbreak linked to cucumbers. An outbreak of Salmonella Newport in 2014 affected a total of 275 people in 29 states and the District of Columbia, with illness onsets occurring during May 20 to Sept. 30, 2014. That outbreak was linked to cucumbers grown in the Delmarva region of Maryland’s Eastern Shore.

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