Salmonella Outbreak Associated with Papayas

FDA and CDC are reporting that 47 have become ill with a particular strain of Salmonella from Cariberia brand Maradol papaya.  According to the FDA report, "The FDA, CDC, MDH and other state and local officials are investigating Salmonella Kiambu and Salmonella Thompson illnesses linked to Caribeña brand Maradol papayas from Mexico distributed by Grande Produce disclaimer icon in San Juan, TX."

FDA Outbreak
https://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm568097.htm
FDA Investigates Multiple Salmonella Outbreak Strains Linked to Papayas

Fast Facts

• The FDA is advising consumers not to eat Caribeña brand Maradol papayas because they are linked to an outbreak of salmonellosis. Maradol papayas are green before they ripen and turn yellow, so consumers should not eat Caribeña brand regardless of the color. If anyone has these papayas in their home, they should dispose of them immediately. These can be identified by a red, green and yellow sticker shown here.
• Papaya samples taken by MDH from a Baltimore retail location tested positive for the strains of Salmonella Kiambu and Thompson found in ill people.
• CDC is advising consumers not to eat any Maradol papayas. FDA continues its traceback investigation. At this time, Caribeña brand papayas from Mexico have been identified as a brand linked to these illnesses. Additional brands will be announced as the information becomes available.
• CDC reports 47 cases,12 hospitalizations and one death from 12 states in the Salmonella Kiambu outbreak. The states involved are IA, KY, LA, MA, MD, MN, NJ, NY, PA, TX, UT and VA. CDC is working to collect additional information to determine whether the recent Salmonella Thompson illness in Maryland is part of this multistate outbreak.

CDC Outbreak Notice
https://www.cdc.gov/salmonella/kiambu-07-17/index.html
Multistate Outbreak of Salmonella Kiambu Infections Linked to Maradol Papayas
Posted July 21, 2017 4:00 PM ET

At A Glance
Case Count: 47 (https://www.cdc.gov/salmonella/kiambu-07-17/epi.html)
States: 12 (https://www.cdc.gov/salmonella/kiambu-07-17/map.html)
Deaths: 1
Hospitalizations: 12
Recall: No


Highlights


Read the Advice to Consumers, Restaurants, and Retailers >>(https://www.cdc.gov/salmonella/kiambu-07-17/advice.html)
CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Salmonella Kiambu infections.
A total of 47 people infected with the outbreak strain of Salmonella Kiambu have been reported from 12 states.
Twelve ill people have been hospitalized. One death has been reported from New York City.
Epidemiologic and laboratory evidence(https://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/index.html) collected to date indicates that Maradol papayas are a likely source of this multistate outbreak.
CDC recommends that consumers not eat, restaurants not serve, and retailers not sell Maradol papayas until we learn more.
If you aren’t sure if the papaya you bought is a Maradol papaya, you can ask the place of purchase. Restaurants and retailers can ask their supplier.
When in doubt, don’t eat, sell, or serve them and throw them out.
Wash and sanitize countertops as well as drawers or shelves in refrigerators(https://www.cdc.gov/foodsafety/communication/clean-refrigerator-steps.html) where papayas were stored.
This investigation is ongoing. CDC will provide updates when more information is available.
Introduction

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Salmonella Kiambu infections.

Public health investigators are using the PulseNet(https://www.cdc.gov/pulsenet/index.html) system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is performed on Salmonella bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis(https://www.cdc.gov/pulsenet/pathogens/pfge.html) (PFGE) and whole genome sequencing(https://www.cdc.gov/amd/) (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE.

As of July 21, 2017, 47 people infected with the outbreak strain of Salmonella Kiambu have been reported from 12 states. A list of the states and the number of cases in each can be found on the Case Count Map page(https://www.cdc.gov/salmonella/kiambu-07-17/map.html). WGS showed that isolates from people infected with Salmonella Kiambu are closely related genetically. This close genetic relationship means that people in this outbreak are more likely to share a common source of infection.

Illnesses started on dates ranging from May 17, 2017 to June 28, 2017. Ill people range in age from less than 1 year to 95, with a median age of 27. Among ill people, 67% are female. Among 31 people with available information, 18 (58%) are of Hispanic ethnicity. Among 33 people with available information, 12 (36%) report being hospitalized. One death was reported from New York City.

This outbreak can be illustrated with a chart showing the number of people who became ill each day. This chart is called an epidemic curve or epi curve. Illnesses that occurred after June 23, 2017 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 4 weeks. Please see the Timeline for Reporting Cases of Salmonella Infection(https://www.cdc.gov/salmonella/reporting-timeline.html) for more details.
Investigation of the Outbreak

Epidemiologic and laboratory evidence(https://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/index.html) collected to date indicate that Maradol papayas are a likely source of this multistate outbreak. This investigation is ongoing.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Eleven (44%) of 25 people interviewed reported eating papayas. This proportion was significantly higher than results from a survey[PDF- 29 pages](https://www.cdc.gov/foodnet/surveys/FNExpAtl03022011.pdf) of healthy Hispanic people in which 16% reported eating papayas in the months of May and June in the week before they were interviewed.

An illness cluster in Maryland was identified. An illness cluster is defined as two or more people who do not live in the same household who report eating at the same restaurant location, attending a common event, or shopping at the same location of a grocery store in the week before becoming ill. In Maryland, several ill people reported eating papayas purchased from the same location of a grocery store. Salmonella Kiambu and Salmonella Thompson were isolated from samples collected from ill people. Investigating illness clusters provides critical clues about the source of an outbreak. If several unrelated ill people ate or shopped at the same location of a restaurant or store within several days of each other, it suggests that the contaminated food item was served or sold there.

The Maryland Department of Health collected papayas from the grocery store associated with the illness cluster to test for Salmonella. One sample yielded the outbreak strain of Salmonella Kiambu and another sample yielded Salmonella Thompson. Both samples were from Maradol papayas. WGS showed that the Salmonella Kiambu papaya isolate is closely related genetically to the Salmonella Kiambu isolates from ill people. This result provides more evidence that people in this outbreak got sick from eating contaminated Maradol papayas. CDC is working to collect additional information to determine whether the recent Salmonella Thompson illness in Maryland is part of this multistate outbreak.

Based on the available evidence, CDC recommends that consumers not eat, restaurants not serve, and retailers not sell Maradol papayas until we learn more. CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill people and to interview them. Further investigation is under way to determine the point in the supply chain where the papayas were contaminated. Updates will be provided when more information is available.