Maricopa County, AZ, is reporting nine illnesses from a rare strain of Salmonella paratypi which officials say is associated with raw minced or ground tuna used in sushi. Disease onset for the nine AZ cases was from April 3-16, 2015, and three people have been hospitalized, the county reported on Friday, May 15.“We are early into the investigation, but from the interviews we have completed with those who have gotten sick, there are multiple restaurants involved,” said Dr. Bob England, director of the Maricopa County Department of Public Health in Phoenix. “That is strong evidence that the contamination is occurring before it gets to the restaurant.” He advised anyone with Salmonella symptoms such as nausea, diarrhea and abdominal cramping, especially after recently eating raw ground tuna, to seek medical attention. The county’s health and environmental officials, along with those on the state and federal level, are working with their counterparts in California and New Mexico, where there are also Salmonella paratyphi illness cases linked to raw tuna sushi. New Mexico reported six confirmed cases as of Friday, while California, as of April 20, had 25 cases from five different counties potentially linked to consumption or raw tuna sushi. Salmonella illnesses usually last about 4-7 days. Most people recover without treatment, but illness can sometimes be severe leading to hospitalization, or, rarely, death. Although Salmonella is not common in raw fish, consumption of raw or undercooked meats and seafood can cause foodborne illnesses including Salmonella. The elderly, very young and those who have weakened immune systems are at higher risk for severe illness associated with Salmonella. The most common sources of Salmonella infection are undercooked poultry, eggs, and meat. Pet birds and reptiles, as well as other pets, can transmit Salmonella. To prevent illness, thorough hand-washing with soap and water prior to food preparation or consumption and after using the toilet is recommended. Salmonella can be killed by cooking foods to an internal temperature of 165 degrees F. Therefore, consumers of raw or undercooked fish and meat products may be at an increased risk of illness.