19 June 2008

Outbreak of Salmonella Saintpaul in the United States

The United States Centers for Disease Control and Prevention (CDC) in collaboration with public health officials, the Indian Health Service and the US Food and Drug Administration (FDA) are investigating a multi-state outbreak of Salmonella serotype Saintpaul [1]. Epidemiologic investigations have identified the consumption of raw tomatoes as the likely source of illness. The specific type and source of tomatoes remains under investigation but is thought to be red plum, red Roma and/or round red tomatoes.

Since April 2008, 383 cases of Salmonella Saintpaul infection have been identified in 30 American states and the District of Columbia. Where information is available, the dates of onset of illness were between 10 April and 5 June 2008. At least 48 people have been hospitalised. No deaths have been officially attributed to the outbreak; however there was a death from cancer in a person who was also infected with Salmonella Saintpaul. It is likely that the actual number of cases is higher due to incomplete reporting and lack of investigation.

Salmonella infection

The signs and symptoms of Salmonella infection include diarrhoea, fever and abdominal cramps that usually begin 12 to 72 hours following consumption of contaminated food. Symptoms typically last four to seven days and most people make a full recovery without treatment. Infants, the elderly and those with underlying medical conditions are more likely to suffer complications including septicaemia. In cases of severe illness, antibiotic therapy may be necessary.

Advice for travellers

Travellers to the US are advised to only eat tomatoes that are not likely to be the source of the current outbreak. These include cherry tomatoes, grape tomatoes, tomatoes sold with the vine attached, and home-grown tomatoes. The FDA has published a list of tomatoes that are not considered to be the cause of this outbreak; this list can be found at: http://www.fda.gov/oc/opacom/hottopics/tomatoes.html.

In addition the following advice has been issued by CDC:

• Cut, peeled or cooked tomatoes should be refrigerated within 2 hours or otherwise discarded.
• Avoid bruised, damaged or soiled tomatoes.
• Thoroughly wash all tomatoes under running water.
• Store tomatoes separately from raw meats and seafood, and other raw produce.
• Wash utensils, chopping boards and surfaces with hot water and soap after preparing tomatoes.

Travellers should be aware that raw tomatoes are often used in the preparation of other foods, including guacamole and salsa.

Travellers returning from the US, who have symptoms of possible Salmonella infection, should seek medical care and inform their health care provider of their recent travel.

Reference

1. Centers for Disease Control and Prevention. Investigation of outbreak of infections caused by Salmonella Saintpaul. 18 June 2008. [Accessed 19 June 2008]. Available at http://www.cdc.gov/salmonella/saintpaul/