By: James Peacock

The Salmonella outbreak linked to papayas imported from Mexico continues to get worse, as the CDC’s latest update shows. There are now 141 people sickened in this outbreak, up 32 from the last update. Forty-five people have been hospitalized, and one death has been reported in New York. This outbreak has been investigated by the CDC since July, and has expanded quite a bit from the 47 people that were originally affected. Persons sickened in the outbreak have reported their illnesses between May 17 and July 27, 2017. There are currently two different strains of Salmonella bacteria being reported in relation to the papaya-caused outbreak. In the early stages of the outbreak investigation, only infections caused by Salmonella Kiambu were being reported. After the first few updates, however, the CDC has expanded this to include illnesses caused by Salmonella Thompson. While the two strains do overlap in the illnesses they cause over time, the infections caused by Salmonella Kiambu cluster between May 15 and June 19. Infections caused by Salmonella Thompson cluster between June 20 and July 27.

The cases of illness connected with this outbreak have been spread out over 19 different states. States affected by the outbreak include: Connecticut with 5 cases, Delaware with 4 cases, Iowa with 2 cases, Illinois with 2 cases, Kentucky with 3 cases, Louisiana with 2 cases, Maryland with 8 cases, Massachusetts with 6 cases, Michigan with 1 case, Minnesota with 4 cases, North Carolina with 3, New Jersey with 27 cases, New York with 39 cases, Ohio with 1 case, Oklahoma with 4 cases, Pennsylvania with 8 cases, Texas with 7 cases, Virginia with 14 cases, and Wisconsin with 1 case.

Papaya Recalls

There has been a series of recalls associated with this outbreak, going back to July 26. On that day, Grande Produce issued a recall for papaya that it had imported from the Carica de Campeche farm in Mexico. The FDA would eventually trace the Salmonella infections back to this farm, and sent out an advisory warning against selling papayas imported from there. Testing done on papaya from this farm revealed not only Salmonella Thomson and Kiambu, but also Salmonella Agona, Salmonella Gaminara, and Salmonella Senftenberg. With this high variety in Salmonella bacteria, it is not at all surprising that there have been two strains tied to this outbreak. In fact, it would not be at all surprising if there were other infections tied to a third or fourth strain.

The second papaya recall came on August 4, when Agroson’s LLC issued a recall for more than 2,000 boxes of Cavi-brand Maradol Papaya that had been imported form the same farm. Although there had not been any cases of illness linked to papaya distributed by Agroson’s, the company heeded the warning of the FDA and made the recall out of an abundance of caution. The third papaya recall came a few days later, and was issued by Freshtex Produce. This recall, which affected the Valery brand, was for papayas distributed throughout the state of Illinois. Again, there were no Salmonella infections tied to this brand by health officials, so the recall came out of an abundance of caution. The CDC and other health officials expect, due to the distribution of cases of illness, that there will be other distributors and brands linked to the outbreak as the investigation progresses.

Salmonella

Salmonella infections, commonly referred to as Salmonellosis, are one of the most common forms of foodborne illness. The CDC estimates that up to 1.2 million cases of Salmonella poisoning occur annually in the United States. This estimate does include the fact that many Salmonella cases go unreported and undiagnosed. The tracking of Salmonellosis by health officials first took place in 1962, but scientists have been aware of the bacterium for at least the last 125 years. The work of Dr. Salmon and his assistant, Theobald Smith, allowed for the isolation of Salmonella bacteria just 30 years after the acceptance of germ theory. Since that time, the bacteria that make up the Salmonella enterica species have been found to have a variety of strains, or serotypes. These serotypes are based on the various antigens found on the surface and flagella of the bacteria. At the first usage of this method of categorization, 44 different serotypes had been identified. Today there are more than 2000 known serotypes of Salmonella bacteria, but most of them are uncommon sources of foodborne illnesses.  Salmonella infections are often caused by Salmonella serotypes Enteritidis, Typhimurium, Newport, javiana, Heidelberg, I 4,[5], 12:i:-, Muenchen, Montevideo, and Saintpaul. Salmonella serotypes Thompson and Kiambu are less common.

Out of the CDC estimated 1.2 million annual cases of illness, about 19,000 of them require hospitalization, and about 450 deaths occur annually. While there are actually two distinct types of illness that can be caused by Salmonella bacteria, nontyphoidal salmonellosis and typhoid fever, nontyphoidal salmonellosis is by far the more common type. In fact, there has not been an outbreak of typhoid fever caused by Salmonella since 1999. Salmonellosis will usually produce symptoms within a 6 to 72 hour window after exposure to the bacteria. The symptoms produced by salmonellosis will generally include headaches, fever, diarrhea, abdominal cramps, nausea, and vomiting. Recovery from a case of Salmonella poisoning will typically start after about a day, but symptoms can last for up to a week.

There is a chance that the infection will worsen and cause one of several complications. The most common complication is dehydration. Severe dehydration can be very serious, and will often lead to hospitalization. Other complications include reactive arthritis and septicemia, also known as blood poisoning. While both of these complications are very serious, they are much less common than dehydration. Those with certain risk factors, including the elderly, children, and others with suppressed immune systems are at an increased risk of developing a more serious case of Salmonellosis. These risk factors also heighten the chance that one of the many complications associated with Salmonella poisoning will occur. Salmonella bacteria can be found in a wide variety of foods and drinks, so it is important to practice proper food safety techniques in order to reduce the chance of infection. Salmonella has been known to cause outbreaks through meats, poultry, eggs, fish, yeast, shrimp, milk, dairy products, spices, coconut, raw egg, peanut butter, fruits, vegetables, and chocolate. If you or a loved one begins to show the symptoms of Salmonella poisoning, contact a medical professional.

Sources:

https://www.cdc.gov/salmonella/kiambu-07-17/index.html

https://www.fda.gov/Safety/Recalls/ucm570258.htm

https://www.fda.gov/Safety/Recalls/ucm568780.htm

https://www.fda.gov/Safety/Recalls/ucm570424.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery