A total of 107 people in 31 states have now been linked to the multi-drug resistant Salmonella Heidelberg ground turkey outbreak, the Centers for Disease Control and Prevention said Thursday.

Last week, agricultural giant Cargill responded to the outbreak by recalling 36 million pounds of ground turkey–the largest Class I U.S. Department of Agriculture recall to date. Many of the new illnesses identified by state, local, and federal public health officials, were caused by a strain of Salmonella Heidelberg that is a “closely related PFGE pattern” to that of the original Heidelberg strain, now linked to 84 illnesses.

With the new numbers, which add 23 people and 5 states to the outbreak, CDC is reminding consumers to check their homes for recalled ground turkey products.

All of the recalled product comes from a single processing plant in Springdale, Arkansas, but ended up in dozens of different products ground turkey products sold nationwide under a variety of brand names, including Honeysuckle White, Shady Brook Farms, Riverside, Aldi’s Fit and Active Fresh, Spartan, Giant Eagle, Kroger and Safeway.

Recalled turkey was produced between February 20 and August 2. Products subject to recall bear the establishment number “P-963” inside the USDA mark of inspection. Public health officials recommend consumers and restaurants not handle, cook, or serve these products.

Both of the “closely related” PFGE patterns of Salmonella Heidelberg linked to the outbreak were found in ground turkey samples taken from an Ohio patient’s home and retail samples of ground turkey collected as part of routine surveillance through the National Antimicrobial Resistance Monitoring System (NARMS), according to CDC. NARMS is a joint project of FDA, CDC, and USDA to measure trends in drug resistance.

Federal food safety officials have come under fire for the lag time between when NARMS first detected the strain of Salmonella Heidelberg and when authorities took action. The surveillance system logged four retail positives, all linked to Cargill’s Arkansas facility, between March and June. The positives led foodborne illness investigators to suspect a link between the plant and slowly-unfolding the outbreak, but officials say epidemiological evidence did not support the hypothesis until the end of July.

The USDA’s Food Safety and Inspection Service issued a public health alert July 29 and Cargill’s multi-million pound recall on August 1. Cargill was not alerted to the NARMs positives until July 29.

“[NARMS] is a separate surveillance system,” said Dr. Chris Braden, Director of the Division of Foodborne, Waterborne and Environmental Diseases at CDC, when reporters questioned why the positives, which present a danger to consumers, weren’t communicated rapidly to Cargill and regulators.

“It’s not meant for outbreak investigation. But nonetheless, the data may be helpful in these investigations as we have seen in this particular circumstance.  So we are engaged in trying to integrate a lot of these data in many of our questions that we ask in public health across surveillance systems,” said Braden.

During the same call with reporters, Dr. David Goldman, Assistant Administrator for the Office of Public Health Science at the USDA’s Food Safety and Inspection Service hashed out the relationship between NARMS and FSIS.

“We certainly have a NARMS liaison that is someone within FSIS who is responsible for maintaining a relationship with the NARMS program, and its findings,” said Goldman. “But NARMS is principally designed to examine trends or changes in antimicrobial resistance among a variety of products over time.  And in fact, if you were to go to their website, you can see an example of those reports.  And there’s a bit of a lag both in the annual reports as well as in the current sample data.

“There’s a bit of a lag in terms of the — it’s reporting in — near real-time,” conceded Goldman. “We do look at that data. Right now we are not reporting antimicrobial resistance data to the plants that we regulate.  But it is part of a policy consideration here at FSIS.”

In FDA’s official statement on the matter, the agency pointed to successful coordination.

“This situation highlights how public health systems working closely together and sharing information can enhance outbreak detection and response, limiting the burden of outbreaks on the public,” said FDA, explaining that the NARMs data was helpful in the investigation.

Consumer advocates are calling for a review of the government’s handling of the investigation.

Salmonella infections can be life-threatening, especially to those with compromised immune systems, including the young and the elderly. The most common manifestations of salmonellosis are diarrhea, abdominal cramps, and fever within six to 72 hours. Additional symptoms may be chills, headache, nausea and vomiting that can last up to seven days. Individuals concerned about an illness should contact a health care provider.


Salmonella Heidelberg cases by state as of Aug. 9, 2011. CDC map: