The U.S. Centers for Disease Control (CDC) is working with state public health, veterinary, and agriculture officials, and the U.S. Department of Agriculture’s Animal and Plant Health Inspection Service (APHIS) to investigate four multi-state outbreaks of human Salmonella infections linked to contact with live poultry. As of June 29, 2015, there were 181 people reported from 40 states infected with four outbreak strains of Salmonella. The number of ill people identified in each state: Alabama (17), Arizona (3), Arkansas (4), California (3), Colorado (2), Delaware (2), Georgia (4), Indiana (3), Iowa (1), Kentucky (4), Louisiana (2), Maine (2), Maryland (4), Massachusetts (1), Michigan (3), Minnesota (6), Mississippi (13), Missouri (1), Montana (3), Nevada (2), New Hampshire (1), New Jersey (3), New Mexico (2), New York (6), North Carolina (3), Ohio (15), Oklahoma (1), Oregon (5), Pennsylvania (12), South Carolina (10), South Dakota (2), Tennessee (6), Texas (5), Utah (4), Vermont (2), Virginia (11), Washington (6), West Virginia (2), Wisconsin (1), and Wyoming (4). These outbreaks can be illustrated with a chart showing the number of people who became ill each day. This chart is called an epidemic curve or epi curve. Illnesses that occurred after June 1, 2015, 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 4 weeks. Go here for more details. In interviews, ill people answered questions about contact with animals and foods consumed during the week before becoming ill; 82 (86 percent) of the 95 ill people interviewed reported contact with live poultry (e.g., chicks, chickens, ducks, ducklings) before becoming ill. Sixty-four ill people who had purchase records available reported purchasing live baby poultry from 17 different feed supply stores and hatcheries in multiple states. Ill people reported purchasing live poultry for backyard flocks to produce eggs or meat, or to keep as pets. Many ill people in these outbreaks reported bringing the live poultry into their homes, and others reported kissing or cuddling with the live poultry. These behaviors increase a person’s risk of a Salmonella infection. Preliminary findings of multiple traceback investigations of live baby poultry from homes of ill people have identified multiple hatcheries as the source of chicks and ducklings. These investigations are ongoing. Public health investigators are using the PulseNet system to identify illnesses that may be part of these outbreaks. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA “fingerprinting” is performed on Salmonella bacteria isolated from ill people by using a technique called pulsed-field gel electrophoresis, or PFGE. PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. A total of nine DNA fingerprints (outbreak strains) are included in these four outbreak investigations. CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill people and to interview them. CDC will provide updates when more information is available. Summaries of each of the four outbreak investigations are provided below.

Outbreak 1: Salmonella Enteritidis Investigation

As of June 29, 2015, 40 people infected with the outbreak strains of Salmonella Enteritidis have been reported from 16 states. The number of ill people identified in each state is as follows: Arizona (1), Georgia (2), Indiana (1), Maine (1), Minnesota (5), New Hampshire (1), Ohio (10), Oklahoma (1), South Carolina (2), Tennessee (1), Texas (2), Utah (3), Vermont (2), Virginia (4), Washington (3), and Wyoming (1). Two DNA fingerprints (outbreak strains) are included in this investigation. Among the people who reported the date they became ill, illnesses began between Jan. 6, 2015, and June 13, 2015. Ill people range in age from younger than one year to 81 years, and the median age is 41. Fifty-two percent of ill people are female. Among the 14 ill people with available information, 3 (21 percent) have been hospitalized. No deaths have been reported.

Outbreak 2: Salmonella Hadar Investigation

As of June 29, 2015, 69 people infected with the outbreak strains of Salmonella Hadar have been reported from 30 states. The number of ill people identified in each state is as follows: Arizona (2), Arkansas (2), California (1), Colorado (1), Delaware (2), Iowa (1), Kentucky (1), Louisiana (2), Maine (1), Maryland (3), Massachusetts (1), Michigan (1), Minnesota (1), Missouri (1), Montana (3), New Jersey (2), New Mexico (1), New York (1), North Carolina (2), Ohio (3), Oregon (4), Pennsylvania (11), South Carolina (3), South Dakota (2), Texas (2), Virginia (7), Washington (3), Wisconsin (1), West Virginia (1), and Wyoming (3). One DNA fingerprint (outbreak strain) is included in this investigation. Among the people who reported the date they became ill, illnesses began between February 24, 2015 and June 11, 2015. Ill people range in age from younger than one year to 89 years, and the median age is 37. Fifty-one percent of ill people are female. Among 30 ill people with available information, 19 (63 percent) have been hospitalized. No deaths have been reported.

Outbreak 3: Salmonella Indiana Investigation

As of June 29, 2015, 56 people infected with the outbreak strains of Salmonella Indiana have been reported from 16 states. The number of ill people identified in each state is as follows: Alabama (17), Arkansas (2), California (2), Colorado (1), Georgia (2), Maryland (1), Mississippi (13), Nevada (2), New Jersey (1), New Mexico (1), New York (5), North Carolina (1), Oregon (1), South Carolina (5), Tennessee (1), and Texas (1).  Five DNA fingerprints (outbreak strains) are included in this investigation. Among the people who reported the date they became ill, illnesses began between Feb. 20, 2015, and June 11, 2015. Ill people range in age from younger than one year to 82 years, and the median age is 2. Fifty-two percent of ill people are female. Among the 28 ill people with available information, nine (32 percent) have been hospitalized. No deaths have been reported.

Outbreak 4: Salmonella Muenchen Investigation

As of June 26, 2015, 16 people infected with the outbreak strains of Salmonella Muenchen have been reported from eight states. The number of ill people identified in each state is as follows: Indiana (2), Kentucky (3), Michigan (2), Ohio (2), Pennsylvania (1), Tennessee (4), Utah (1), and West Virginia (1). One DNA fingerprint (outbreak strain) is included in this investigation. Among the people who reported the date they became ill, illnesses began between and April 4, 2015 and June 5, 2015. Ill people range in age from younger than one year to 75 years, and the median age is 21. Sixty-three percent of ill people are female. Among eight ill people with available information, two (25 percent) have been hospitalized. No deaths have been reported. The National Antimicrobial Resistance Monitoring System (NARMS) is a U.S. public health surveillance system that tracks antibiotic resistance in foodborne and other enteric bacteria found in people, raw meat and poultry, and food-producing animals. NARMS is a partnership among the CDC, the U.S. Food and Drug Administration (FDA), the U.S. Department of Agriculture (USDA), and state and local health departments. The NARMS human surveillance program at CDC monitors antibiotic resistance in Salmonella and other bacteria isolated from clinical specimens submitted to NARMS by public health laboratories. CDC’s NARMS laboratory conducted antibiotic resistance testing on clinical isolates collected from seven ill people infected with one of the outbreak strains; all seven isolates were susceptible to all antibiotics tested on the NARMS panel. CDC’s NARMS laboratory continues to conduct antibiotic resistance testing on additional clinical isolates collected from ill persons infected with the outbreak strains. Results will be reported when they become available. (To sign up for a free subscription to Food Safety News, click here.)