To view the full-sized map on the CDC’s website, please click on the image.

The victim count in ongoing Salmonella outbreaks traced to papayas from Mexico has topped 200, with U.S. officials not only reporting they linked two more farms to sick people, but that they expect to identify even more farms and victims.

Infections from three additional serotypes of Salmonella bacteria have been confirmed in outbreak victims, according to the Centers for Disease Control and Prevention. Those same serotypes have also been confirmed in papayas tested by the Food and Drug Administration. The two agencies posted updates Friday on their outbreak investigations, with little good news to report.

As of Thursday, there were 210 confirmed victims in the U.S. They are infected with seven different serotypes of Salmonella. The victims are spread across 23 states, with one death reported in New York, according to the CDC.

“Because three separate outbreaks linked to papayas from different farms have been identified, CDC is concerned that papayas from several other farms in Mexico might be contaminated with Salmonella and have made people sick,” the CDC reported Friday. “FDA continues testing papayas from Mexico to see if other papayas from other farms are contaminated with Salmonella.”

One bit of positive news in the FDA’s outbreak update on Friday was that papayas from the two additional Mexican farms were not distributed in the United States. They were tested and destroyed as part of FDA’s outbreak investigation and response.

However, the two farms sent papayas to the U.S. earlier this year, causing concern among CDC and state public health officials who say it’s likely that U.S. consumers contracted Salmonella infections.

“To the FDA’s knowledge, there are no papayas from these farms currently on the market, but the agency is continuing traceback and trace forward activities to see if other importers may have sourced papayas from them,” the agency reported Friday.

Food safety measures at the Carica de Campeche farm in Mexico are illustrated on the grower’s Facebook page with this and several other photos.

The three farms in Mexico that FDA has confirmed as having Salmonella-contaminated papayas are:

  • Carica de Campeche in Tenabo, in the state of Campeche;
  • Caraveo Produce in Tecomán, in the state of Colima; and
  • El Zapotanito in La Huerta, in the state of Jalisco.

Three brands of maradol papayas — all sourced from the Carica de Campeche farm, which was the first one linked to the current outbreaks — have been recalled in the United States. They are:

If anyone has these papayas in their home, they should dispose of them immediately.

The FDA is working to ensure that there are no other brands of papayas on the market that may have originated from the Carica de Campeche, Caraveo Produce of Mexico, and El Zapotanito farms.

Outbreak victim demographics
In the main outbreak investigation, the CDC has confirmed 201 victims with infections from one of four Salmonella serotypes: Salmonella Kiambu, Salmonella Thompson, Salmonella Agona and Salmonella Gaminara.

Those victims range in age from less than 1 year old to 95 years old. Their illnesses have onset dates ranging from May 17 through Aug. 20. The CDC reports additional victims who became sick after Aug. 1 likely have not yet been added to the tally because of the lag time between when a person become sick and when their illness is lab confirmed and reported to CDC, which can take up to a month.

Complete information is not available to the CDC for all 201 victims, but of details that have been reported show a higher than normal percentage of victims requiring hospitalization.

Of 158 victims with hospitalization details available, 65, which is 41 percent, had symptoms so severe they had to be admitted.

Also, a disproportionate number of victims are Hispanic. Of the 153 people with ethnicity reported, 101, which is 66 percent, are Hispanic, according to the CDC. Consequently, the agency is urging people who have Spanish-speaking family and friends to share links to outbreak updates that are posted in Spanish.

Two new outbreaks identified
For purposes of the investigation, the CDC is referring to recently discovered matches between Salmonella bacteria from sick people and two additional farms in Mexico as two separate outbreaks, rather than including them in the outbreak traced to the Carica de Campeche farm.

Two people confirmed as having infections from Salmonella Newport and one with an infection from Salmonella Infantis all reported eating papayas during the week before they became ill, according to the CDC. The three people were from the states of Illinois, Massachusetts and Michigan.

The FDA isolated the same strains of Salmonella serotypes on fruit from the Caraveo Produce farm in Tecomán, Mexico, as CDC documented from the three victims.

Six other people, from New Jersey, New York and Pennsylvania, were sickened by a single strain of Salmonella Urbana, which the CDC says suggests a common source.

The FDA isolated that strain of Salmonella Urbana on papaya from the El Zapotanio farm in La Huerta, Mexico.

Advice to consumers, restaurants and retailers
State and federal public health officials recommend applying the golden rule of food safety regarding papayas on hand in homes and businesses — when in doubt, throw it out.

To view the full information graphic on the CDC’s website, please click on the image.

Additional recommendations from CDC include:

  • If you have had whole, fresh papayas in your home or business, wash and sanitize countertops, cutting boards and utensils, as well as drawers or shelves in refrigerators where papayas were stored, with a solution of one tablespoon of chlorine bleach to one gallon of hot water; dry with a clean cloth or new paper towel.
  • Wash your hands with running water and soap following the cleaning and sanitation process.

Anyone who has eaten fresh papaya recently and developed symptoms of Salmonella infection is urged to seek medical attention and tell their doctors about the possible exposure so the proper diagnostic tests can be performed.

Salmonella bacteria can cause diarrhea, vomiting, stomach pain and fever.

Symptoms usually begin between 12 to 36 hours after exposure, but they may begin as early as 6 hours or as late as 72 hours after exposure.

Symptoms can be mild or severe and commonly last for two to seven days. Salmonella can infect anyone, but young children, older adults and people with weakened immune systems are the most likely to have severe infections.

Timeline provided by FDA
June 26 — the CDC notified the FDA about a Salmonella Kiambu cluster detected by PulseNet. All 47 cases have the same pattern by pulsed-field gel electrophoresis (PFGE). Whole Genome Sequencing (WGS) analysis was conducted on ten patient samples in the outbreak cluster and all were highly related. This indicates that the patients were likely sickened by the same type of food.

Maryland Department of Health (MDH) informed the FDA, CDC, and state partners that several ill people shopped at the same Baltimore retail location and purchased papayas. Records and samples of green and yellow papayas were collected.

July 17 — Maryland reported that three of ten samples had preliminarily tested positive for Salmonella. All positive samples were Caribeña brand yellow Maradol papayas from Mexico; none of the green papayas were positive. Further WGS testing linked one of the papaya samples to the Salmonella Kiambu outbreak and another to Salmonella Thompson. However, Maradol papayas are green before they ripen and turn yellow, so consumers should not eat Caribeña brand papayas regardless of the color.

July 19 — MDH issued an advisory warning consumers not to eat Caribeña brand yellow Maradol papayas. Further WGS testing linked one of the papaya samples to the Salmonella Kiambu outbreak and another to Salmonella Thompson.

July 26 — Grande Produce issued a press release to notify consumers that it had conducted a limited recall of Caribeña brand Maradol papayas distributed during the dates of July 10 to July 19, 2017.

July 27 — the FDA issued an outbreak posting advising consumers to avoid all Caribeña brand Maradol papayas, regardless of color or date of distribution.

Aug. 3 — following extensive traceback and testing, the FDA added papaya farm Carica de Campeche to Import Alert (IA) 99-35. Papayas from the Carica de Campeche farm tested positive for Salmonella Kiambu, Salmonella Thompson, Salmonella Agona, Salmonella Senftenberg, and Salmonella Gaminara.

Aug. 4 — Agroson’s LLC, issued a press release announcing the recall of certain Cavi brand Maradol papayas. Agroson’s states that the papayas were distributed on July 16-19, and available to consumers until July 31.

Aug. 4 — CDC announced it is adding Salmonella Thompson illness to this outbreak investigation because of epidemiological evidence. Also, FDA and Maryland state testing has indicated that both serotypes of Salmonella were present in a single fruit.

Aug. 7 — Freshtex Produce, LLC, issued a press release announcing the recall of Valery brand Maradol papayas that were distributed in the state of Illinois from July 10-13. These papayas may have been further distributed outside of Illinois.

Aug. 18 — CDC announced it is adding Salmonella Agona and Salmonella Gaminara illness to this outbreak investigation because of epidemiological evidence.

Sept. 1 — FDA and CDC announced increased case counts. In addition, FDA announced that papayas from two more farms in Mexico tested positive for Salmonella strains that matched illnesses not related to the previously identified outbreak. These additional farms were added to Import Alert (IA) 21-17 and the CDC added the two additional outbreaks to the ongoing investigation.

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