As the patient count continues to increase, officials have narrowed the likely source of a papaya-related Salmonella outbreak to one distributor selling the tropical fruit under the Cavi brand. No recalls have been initiated.

A total of 71 people from eight states now have been confirmed with infections, up from the 62 patients previously reported, according to an update late this afternoon from the Centers for Disease Control and Prevention. Samples from patients have shown the outbreak strain of Salmonella Uganda is resistant to some antibiotics.

The outbreak is marked by an unusually high hospitalization rate of 60 percent. A 20 percent hospitalization rate is normal for people with Salmonella infections. No one has died. No samples of the implicated papaya have returned positive test results for the outbreak strain of Salmonella.

Agroson’s LLC of Bronx, NY, distributed the suspect papayas, according to investigators working for the Food and Drug Administration. The company is the exclusive distributor of the imported papayas that likely made consumers from this outbreak sick, the FDA reported this afternoon. The papayas are sold under the brand name Cavi.

The FDA did not include specific distribution information in its update. 

“The FDA has consulted with the firm on the possibility of a recall. Should that happen, the FDA will update this advisory, including any recalled products, as more information becomes available,” according to the FDA notice.

“The evidence does not indicate that papayas from other distributors are implicated at this time, and FDA is narrowing its recommendations to consumers, restaurants, retailers, importers, suppliers, and distributors, limited to Cavi brand whole, fresh papayas.”

Initially, the FDA and CDC were recommending that consumers avoid all fresh papayas imported from Mexico. As of this afternoon, the agencies are limiting that warning to only Cavi brand papayas.

“With the exception of Cavi brand whole, fresh papayas, consumers no longer need to avoid papayas imported from Mexico,” according to the CDC’s update.

“Consumers who have any Cavi brand whole, fresh papayas in their homes should not eat them. Throw the papayas away, even if some of them were eaten and no one has gotten sick. Do not eat fruit salads or other mixes that include any Cavi brand papayas.”

Anyone who has fresh papayas but is not sure of the brand is encouraged to follow the food safety rule of thumb, “when in doubt, throw it out,” the CDC notice says. 

Also, consumers, restaurant and foodservice operators, and retailers should wash and sanitize places where Cavi brand papayas were stored, including countertops and refrigerator drawers or shelves. Follow these five steps from the CDC to clean refrigerators.

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Outbreak details
As of today, the CDC knows of illness onset dates from Jan. 14 through June 16. The sick people range in age from less than 1 year old to 90 years old. Of 45 people with the information available as of Friday, 27, or 60 percent, have been so sick they had to be admitted to hospitals.

The Hispanic community is being hit particularly hard, with 70 percent of the victims for whom the information is available having reported being of Hispanic descent, according to the CDC.

Public health officials expect additional illnesses to be reported because of the time it takes between when a person becomes ill and when the illness is reported. This takes an average of two to four weeks, according to the CDC.

Whole genome sequencing analysis of 43 isolates from ill people predicted antibiotic resistance to streptomycin and sulfisoxazole.

Most of the patients live in six New England states, with one each from Texas and Florida reporting visiting New England before becoming ill.

U.S. representative questions FDA efforts
Papaya outbreaks originating in Mexico have occurred with a regular frequency every summer since 2011. With 14 patients in her home state as of today, U.S. Rep. Rosa DeLauro, D-CT, is asking questions this time around.

Earlier this week, DeLauro, the vice-chair of the House Appropriations Subcommittee that funds FDA, questioned whether consumers were told “as soon as possible” about the Salmonella Uganda outbreak and its apparent connection to Mexican papayas.

In a letter to acting FDA Commissioner Ned Sharpless, DeLauro raises multiple questions, some of which push back on the ease Mexico papayas have in getting across the border.

Information about Salmonella infections
Food that is contaminated with Salmonella bacteria usually does not look, smell or taste spoiled. Anyone can become sick with a Salmonella infection, but infants, children, seniors and people with weakened immune systems are at higher risk of serious illness because their immune systems are fragile, according to the CDC.

Anyone who has eaten any fresh papayas and developed symptoms of Salmonella infection should seek medical attention. Sick people should tell their doctors about the possible exposure to Salmonella bacteria because special tests are necessary to diagnose salmonellosis. Salmonella infection symptoms can mimic other illnesses, frequently leading to misdiagnosis.

Symptoms of Salmonella infection can include diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise healthy adults are usually sick for four to seven days. In some cases, however, diarrhea may be so severe that patients need to be hospitalized. 

Older adults, children, pregnant women and people with weakened immune systems, such as cancer patients, are more likely to develop a severe illness and serious, sometimes life-threatening conditions.

It is possible for some people to be infected with the bacteria and to not get sick or show any symptoms, but to still be able to spread the infection to others.

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