By: Pooja Sharma

According to New York City Department of Health and Mental Hygiene, the Salmonella Kiambu outbreak linked to Caribena Maradol papayas from Mexico has already sickened 47 individuals and killed 1 in New York City. A strict warning has been issued by the CDC and several state local health agencies to not eat Caribena brand papayas regardless of color. Maradol Papayas are green before they ripen and then turn yellow.

Since the outbreak, this Mexico brand is the only one that has been linked to the illnesses, but there are chances of other brands becoming linked this outbreak too. Other brands will be announced as the officials identify them. It’s still not clear whether the Maryland’s Salmonella Thompson illness cluster is a part of this outbreak or not.

The states currently involved in this outbreak include: Kentucky, Massachusetts, Iowa, Louisiana, New Jersey, New York, Minnesota, Texas, Utah, Virginia, and Pennsylvania. A total of 12 people has been hospitalized thus far. Twelve people in New Jersey and 13 people in New York have been sickened – making them the most affected states of the outbreak. Next in line come: Virginia (6), Maryland (5), and Pennsylvania (4). Other states have reported 1-2 case counts at this time. Among the sickened people, the median age of people affected is 27, and 67% are females. The papayas that are the source of this outbreak were distributed by Grande Produce in San Juan, Texas. But, Grande Produce’s distribution pattern doesn’t explain all the illnesses that officials have come across. This means that other unidentified distribution firms could also be linked to distributing contaminated papayas.

Reports of the Salmonella outbreak cropped up in May and have continued until the present time. The first investigation regarding the multiple illnesses was done in late June in Maryland. CDC collected their first epidemiological and laboratory evidence to label Maradol papayas as the possible source of this outbreak. Ill people in Maryland were questioned about what they ate before falling ill, 44% of them reported eating papayas. CDC then isolated samples collected from ill people. Salmonella Thompson and Salmonella Kiambu were the two samples that were found in the ill people. CDC then identified ill clusters (People who are sickened and don’t belong to the same household but are reported to have shopped at the same grocery store, eating at a common event, or dining at the same restaurant). Several people reported having bought the papayas of the same brand. The Maryland Department of Health then collected papayas from the same grocery store and tested them for contamination. These samples of papayas were associated with Salmonella Kiambu and Salmonella Thompson and both belonged to Maradol papayas. Salmonella Kiambu isolates were found to be genetically related to Salmonella Kiambu isolates from ill people. All the positive samples were yellow Caribena Maradol papayas and none of the green tested positive.

On July 19, 2017, Maryland issued an advisory asking its residents not to eat or buy Caribena brand Maradol papayas. Caribena brand papayas come from Mexico and are distributed in Texas.

Public Health officials are using PulseNet system to identify illnesses that are a part of this outbreak. PulseNet uses techniques, such as pulsed field gel electrophoresis and whole genome sequencing, to first isolate the bacteria from the samples that are collected. It then uses DNA fingerprinting to identify the type of bacteria responsible for the illness. PulseNet is developed by CDC and its database system is very useful to identify any potential outbreaks.

Investigators still do not know all the sources and distribution chains that have been linked to outbreak. This is also the reason why no recalls have been issued yet. And therefore, CDC has advised not to buy Maradol papayas and asked the restaurants not to serve them. In case, you have a hard time in identifying what Maradol papayas really are or if your papaya at home is affected, they are an oval fruit that generally weighs 3 pounds or more. They are yellow on the outside and turn salmon-colored when they ripen. If you have a papaya in the house or are being served a papaya at any restaurant, make sure that you ask if it’s a Maradol papaya or not.

Salmonella Outbreaks

Salmonella outbreaks are more common in summer than winter. People who are more at risk are young children, older people and those who have weakened immune systems. Salmonella bacteria live inside the intestine of humans, birds, and other animals. These bacteria make their way into food when it gets infected by the contaminated feces. The CDC has estimated that there are approximately 1.2 million illnesses and 450 deaths due to Salmonella annually in the United States. Some long term consequences of Salmonella include abnormal bowel movements for a few months after the infection and reactive arthritis, which is pain in joints that can last for months or years.

People infected by Salmonella generally show symptoms between 12-72 hours after they have been exposed to the bacteria. The symptoms include: diarrhea, vomiting, and abdominal cramps. Even if you at any time feel that these symptoms can easily be dealt with at home, you should still consult a doctor at once. Some people do recover without treatment, while others, on the other hand, suffer from dehydration and need to get hospitalized. Antibiotics are not usually needed. Salmonella is diagnosed by stool samples and blood tests. To prevent dehydration, make sure that you are drinking a lot of rehydration beverages. Don’t rely too much on fruit juices, as they don’t have enough electrolytes to sustain the hydration in the body. Having a healthy diet can help, too. It is also a good idea to avoid fatty foods along with sugary and spicy foods.

Commonly infected food with Salmonella include: raw meat, poultry, seafood, and eggs. Fruits and vegetables become contaminated when water that is used in the field or during processing is contaminated with Salmonella. In outbreaks limited to a restaurant or a party, Salmonella contamination in fruits and vegetables can also occur when juices from raw meat, seafood, poultry etc. comes in contact with uncooked fruits and vegetables. The best way to prevent such outbreaks from spreading is to maintain proper hygiene, which includes washing hands after coming in contact with raw meat, bird feces, using the toilet, changing the diaper etc. Also, make sure that you keep all the cooked foods separate from raw/unwashed foods.

Sources:

  1. http://www.cbsnews.com/news/salmonella-outbreak-yellow-maradol-papayas/
  2. https://www.cdc.gov/salmonella/index.html
  3. http://edition.cnn.com/2017/07/21/health/papaya-salmonella-outbreak/index.html
  4. http://www.necn.com/news/health/New-Yorker-Dead-Amid-Papaya-Salmonella-Outbreak-That-Has-Sickened-47-435937753.html