Foodborne Illness and the Kitchen

http://online.wsj.com/article/SB10001424052702304665904576383582242952932.html?mod=WSJ_topics_obama

Food Safety News - Germany: Sprouts cause of E. coli outbreak

They have determined that Spouts are to blame for the E. coli outbreak that caused illness in nearly 3000 and killed approximately 30 people.  This has been a particularly virulent strain resulting in nearly 800 cases of HUS, which is over 25%, higher than seen in past outbreaks involving E. coli O157:H7 .

The source has been difficult to determine, changing from item to item over the last weeks.   Initially, cucumbers were identified as the source, but then it switched to sprouts.  Then they said it was not the sprouts, but now it is the sprouts again.  Much of the issue was related to the low percentage of people actually claiming to eat sprouts, only 28%. But if you handle sprouts, you know how they get over everything when you handle them.  Plus, they slide them into dishes and you really don’t know that they are there.  I think it also speaks to the level of contamination that must have been present.  Thinking further, we know that sprouts are a big issue in the way they are grown -  warm water spayed over seeds for days while the seeds sprout and those sprouts grow.

http://www.nytimes.com/2011/06/11/world/europe/11ecoli.html?_r=1&partner=rss&emc=rss

 

 http://www.thelocal.de/national/20110609-35553.html

CDC: No Progress in Salmonella During Past 15 Years

According to the CDC, the US has not made progress on reducing the incidence of Salmonella infections over the past 15 years. In fact, there has been an increase of 10% over recent years. Illnesses from other foodborne pathogens, namely E. coli, have decreased.

Why?

·      There are numerous sources of Salmonella – from wild birds to reptiles to farm animals.

·       It has the ability to survive in dry environments. 

·      Many strains have a low infectious dose. 

·      Infection can result in severe diarrhea, lasting for days, and in some cases, leading to life threatening situations.

In all, this organism has a higher likelihood of being present to take advantage of any lapses in our handling and preparation of food -  from the farm, to processing, to retail or foodservice, and to the consumer’s home.  Increased regulatory presence may be one part of the picture, but there also needs to be compliance all along the food chain -  Good Agricultural Practices in the field, GMPs and HACCP in the processing sector, and proper handling and preparation by retail and foodservice establishment employees as well as by the consumer.

There is still an amazing amount of people who don’t use a thermometer or know proper cooking temperatures, or that don’t properly clean to prevent cross contamination, especially washing fruit and veggies from the field (where birds poop).  Salmonella is adapted to take advantage of these miscues, whether it is a tub of peanut butter open to cross contamination,  a cantaloupe from a field where manure was improperly applied, or a chicken that was improperly cooked on the grill.

No Progress in Salmonella During Past 15 Years

Food safety annual report card targets hard-to-prevent infection

http://www.cdc.gov/media/releases/2011/p0607_vitalsigns.html?source=govdelivery

Salmonella infections have not decreased during the past 15 years and have instead increased by 10 percent in recent years, according to a new Vital Signs report released today by the Centers for Disease Control and Prevention. During the same time period, illnesses from the serious Shiga toxin-producing E. coli O157 have been cut nearly in half and the overall rates of six foodborne infections have been reduced by 23 percent, the report said.

The Vital Signs report summarizes 2010 data from CDC's Foodborne Diseases Active Surveillance Network (FoodNet), which serves as America's report card for food safety by tracking whether nine of the most common infections transmitted through foods are increasing or decreasing.

"Although foodborne infections have decreased by nearly one-fourth in the past 15 years, more than 1 million people in this country become ill from Salmonella each year, and Salmonella accounts for about half of the hospitalizations and deaths among the nine foodborne illnesses CDC tracks through FoodNet," said CDC Director Thomas R. Frieden, M.D., M.P.H. "Salmonella costs hundreds of millions of dollars in direct medical costs each year. Continued investments are essential to detect, investigate, and stop outbreaks promptly in order to protect our food supply."

Salmonella, which is responsible for an estimated $365 million in direct medical costs each year in the United States, can be challenging to address because so many different foods like meats, eggs, produce, and even processed foods, can become contaminated with it and finding the source can be challenging because it can be introduced in many different ways.

In response to that challenge, the U.S. Food and Drug Administration, which regulates eggs, produce and many processed foods, has developed new rules for the egg industry to follow under its recently expanded regulatory authorities.

"Last summer, FDA began implementing new shell egg safety requirements that should significantly reduce illnesses caused by Salmonella enteritidis in eggs," said FDA Deputy Commissioner for Foods Michael R. Taylor. "The recently enacted Food Safety Modernization Act wisely mandates a comprehensive approach to preventing illnesses from many types of Salmonella and a wide range of other contaminants that can make people sick. The current outbreak of E. coli in Europe demonstrates the importance of the new law, and FDA is committed to implementing the new law as fully as possible within available resources."

In 2010, FoodNet sites, which include about 15 percent of the American population, reported nearly 20,000 illnesses, 4,200 hospitalizations and 68 deaths from nine foodborne infections. Of those, Salmonella caused more than 8,200 infections, nearly 2,300 hospitalizations and 29 deaths (54 percent of the total hospitalizations and 43 percent of the total deaths reported through FoodNet). CDC estimates that there are 29 infections for every lab-confirmed Salmonella infection.

The rate of E. coli O157 cases reported by FoodNet sites was 2 cases per 100,000 people in 1997 and, by 2010, had decreased to .9 cases per 100,000 people. The nearly 50 percent reduction in E. coli O157 incidence is considered significant when compared to the lack of change in Salmonella incidence. CDC credits the reduction in E. coli to improved detection and investigation of outbreaks through CDC's PulseNet surveillance system, cleaner slaughter methods, testing of ground beef for E. coli, better inspections of ground beef processing plants, regulatory improvements like the prohibition of STEC O157 in ground beef and increased awareness by consumers and restaurant employees of the importance of properly cooking beef. The U.S. Department of Agriculture, the agency that regulates meat, has led these efforts.

"Thanks to our prevention based approach to food safety, as well as industry and consumer efforts, we have substantially reduced E. coli O157 illnesses," said Elisabeth Hagen, M.D., Under Secretary for Food Safety in the U.S. Department of Agriculture. "This report demonstrates that we've made great progress. However, far too many people still get sick from the food they eat, so we have more work to do. That is why we are looking at all options, from farm to table, in-order to make food safer and prevent illnesses from E. coli, Salmonella, and other harmful pathogens."

The pathogens included in the overall 2010 rate reduction of 23 percent when compared to 1996-1998 are: campylobacter, E. coli STEC O157, listeria, Salmonella, vibrio and yersinia. Rates of vibrio infection were 115 percent higher than in 1996-1998, and 39 percent higher than in 2006-2008. Most vibrio infections are the result of eating raw or undercooked shellfish.

People who want to reduce their risk of foodborne illness should assume raw chicken and other meat carry bacteria that can cause illness and should not allow them to contaminate surfaces and other foods, such as produce. While it's important to wash produce thoroughly, they should never wash meat and poultry. They should also cook chicken, other meats, meat, poultry, and eggs thoroughly well, avoid consuming unpasteurized milk and juice as well as and unpasteurized soft cheese, and make sure shellfish are cooked or treated for safety before eating.

About FoodNet

FoodNet is a collaboration of CDC, ten state health departments, the U.S. Department of Agriculture's Food Safety and Inspection Service, and the Food and Drug Administration. FoodNet collects information to analyze foodborne disease trends and track rates of laboratory-confirmed illnesses caused by Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing E. coli O157 and non-O157, Shigella, Vibrio and Yersinia. Annual data are compared with data from 2006-2008 and with data from the first years of surveillance (1996-1998) to measure progress. FoodNet covers 46 million people, or about 15 percent of the American population. The sites are the states of Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, and Tennessee, and selected counties in California, Colorado, and New York.

About Vital Signs

CDC Vital Signs is a report that appears on the first Tuesday of the month as part of the CDC journal Morbidity and Mortality Weekly Report (MMWR). Vital Signs is designed to provide the latest data and information on key health indicators—cancer prevention, obesity, tobacco use, alcohol use, HIV/AIDS, motor vehicle safety, health care-associated infections, cardiovascular health, teen pregnancy, asthma, and food safety.

Update on E. coli Outbreak in Germany

Update 7/26/12
Research done by MSU indicates that this strain of E. coli's toxin production is linked to its biofilm formation, and this is the basis for how it affected so many, in this case 3800 people with 54 deaths.
http://news.msu.edu/story/deadly-e-coli-strain-decoded/


UPDATE 6/7/2011 - A reported 2300 illnesses and 23 deaths now related to E. coli O104 in Germany.  Unfortunately, the cause still eludes investigators.  At first, cucumbers were suggested, and then sprouts.  But there is insufficient evidence to say either is the cause. 

6/3/2011
In Germany, a novel strain of E.coli is now responsible for approximately 2000 cases of illness with approximately 500 having HUS (Hemolytic Uremic Syndrome) and has resulted in 19 deaths.  This strain, E. coli O104, is a novel strain that posses the traits of two different pathogenic E.coli. 

·         One is EAEC (Enteroaggregative E. coli) which has the capabilities of “sticking’ to the intestinal lining, and producing a mucoid film that protects it.  EAEC normally results in prolonged diarrheal illness.

·         The other is STEC E. coli that produces a shiga toxin.  The illness is characterized by severe bloody diarrhea and can result in HUS, a life threatening condition that results from the loss of kidney function.

·         Put together, through having genes from both, this organism is extremely pathogenic.  By being able to persist in the intestinal tract longer, there is increased risk for HUS.

The illness appears to have started in Northern Germany.  People have been asked to avoid cucumbers, leafy greens, and raw tomatoes, although the exact source of contamination is not known at this point.

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19883

Penn State’s resident expert on EAEC, Dr. Edward Dudley, has supplied some excellent reviews of EAEC. Contact me if interested.

While there is no apparent risk at this time in the US, except perhaps for those that have traveled to Germany in the past month, it is always important to follow good personal hygiene with preparing and handling food.

·         Wash hands thoroughly before preparing food, especially after using the restroom.

·         If you have diarrhea, avoid preparing food.  If you work in a foodservice, retail or food manufacturing facility, stay home.

·         Farmers and gardeners should always practice Good Agricultural Practices, especially when using manure as a fertilizer.  Fertilizers should be properly composted prior to application.

Food Safety News Items for 5/27/11

USDA Revises Recommended Cooking Temperature for All Whole Cuts of Meat, Including Pork, to 145 °F - while foodservice (FDA regulated) has been at 145ºF, USDA just lowered the consumer recommended temperature to 145ºF (from 160ºF). However, USDA also recommends a 3 minute hold time after cooking.http://www.fsis.usda.gov/News_&_Events/NR_052411_01/index.asp

Cucumbers May Be Culprit in Massive E. coli Outbreak in Germany- This strain, E. coli O104:H4 (not O157:H7) has caused over 200 cases of HUS in Europe with at least 2 deaths . It is believed that these organic cucumbers were fertilized with improperly treated manure. Demonstrates the importance of following GAP principles.
http://news.sciencemag.org/scienceinsider/2011/05/cucumbers-may-be-culprit-in-mass.html

USDA Urged to Prohibit Antibiotic-Resistant Salmonella in Ground Meat and Poultry – a consumer group is pushing to have USDA prohibit antibiotic resistant strains of Salmonella. This action is controversial in that it would add a huge burden for USDA to test and for companies to monitor, considering the low level of issues we have seen. A broad scale risk assessment should be first completed.http://www.cspinet.org/new/201105251.html


A cluster of Listeria monocytogenes infections in hospitalized adults, Midlands, England, February 2011 – Prepackaged sandwiches made by an outside purveyor the likely cause, however the investigation found issues within the hospital kitchen as well.Eurosurveillance, Volume 16, Issue 20, 19 May 2011


Studies Focus on Feed Ingredient's Effects on Levels of E. coli O157:H7 in Cattle – Study that shows a higher prevalence of E. coli O157:H7 in cattle fed with distillers grain in the feed compared to those fed without distillers grain. More work is needed to see if the distillers grain included in the feed is having any selective properties. Part of the push to discover and eliminate this organism upstream in the food chain.http://www.ars.usda.gov/is/pr/2011/110519.htm

Spuds, on the Verge of Being Expelled, Start a Food Fight in the Cafeteria – Taking potatoes away from kids? So on empty stomachs, kids can go home and eat candy and drink soda.
http://online.wsj.com/article/SB20001424052748704810504576305250845743700.html

USDA Approves LISTEX as Processing Aid Against Listeria – For those who do not live in Geekdom, this product is a phage,( or virus that attacks bacteria), that is added to food products to kill Listeria. Phage are very specific to their host, in this case, Listeria. I will be interested to see how consumers respond when they find out that companies are treating their food products with ‘viruses’.http://biuroprasowe.netpr.pl/pr/186367/usda-approves-listex-as-processing-aid-against-listeria

Food Safety News Items for May 6, 2011

Here are a few interesting headlines from the week ending May 6. Happy Friday from sunny (finally) State College. Titles and links. MB


CDC: Over 50? Heat cold cuts to 165 degrees to avoid Listeria – If pregnant women are asked to avoid deli meats, should older people also avoid them? Certainly if older people are classified as high risk due to conditions, it is probably something to consider, or even choosing products with certain preservatives. But not a huge risk when we consider the low prevalence and the good health of most 50 to 70+ year olds. It is also a good idea not to hold that store sliced deli meat for more than 3 or 4 days.
http://www.usatoday.com/yourlife/health/medical/2011-05-04-listeria-cdc-lunch-meat_n.htm

Importance of Hygiene, Surface Cleaning Underscored by Listeriosis Outbreaks – Staph (MRSA) is a concern in hospitals, so it is not hard to imagine that Listeria can be a large concern as well, especially preparing food for high risk populations. It is time for Hospital HACCP.

http://www.infectioncontroltoday.com/news/2011/05/importance-of-hygiene-surface-cleaning-underscored-by-listeriosis-outbreaks.aspx


FDA issues first new rules under Food Safety Modernization Act – The first two rules of FSMA – 1) Give FDA more authority to detain suspect food, or food produced under unsanitary conditions, and 2) Require importers to report if a food has been previously rejected by another country before it can be imported into the US. Nothing here as far as new requirements, but will increase FDA’s willingness to hold food products made in less-than-good facilities.

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm253983.htm

Florida: Grape Tomatoes Are Recalled – a single lot of tomatoes tested positive for Salmonella. No illnesses reported. However, has resulted in a CA salad company conducting a rather large recall.
http://www.fda.gov/Safety/Recalls/ucm254285.htm

Feds finally catching up with California farmers’ food safety standards – USDA adopting CA Leafy Greens standards for nation.
http://www.sacbee.com/2011/04/30/3590783/feds-finally-catching-up-with.html#ixzz1LZuzqy7c


CSU Report on Extending Shelf Life of Meat – A free report from Colorado State on practices for extending shelf-life of meat products. Not yet reviewed, but worth a look.

Click here to access the report.

Food For Thought: US Squanders Energy On Food Chain – “Between 1997 and 2002, in fact, over 80 percent of the increase in annual U.S. energy consumption was food related.” This is a good read, although the term “squanders’ seems a little overstated.


http://www.cnbc.com/id/42572375/

Radiation and the Food Supply

In light of the leakage from Japan’s nuclear facilities following the tsunami, questions have been raised regarding the safety of the US food supply.   Based upon the government reports, there is currently no risk to the US food supply.  This includes fallout here in the US from radiation released into the atmosphere and foods imported from areas with the potential for higher exposure.

EPA has only detected miniscule amounts of radiation in milk that can be attributed to the Japanese disaster, but these were so small that they pose no threat to human health.  The levels found were 5000 times lower than the level set by FDA.  Considering that and having a half-life of 8 days, there are currently no reasons to avoid drinking milk.

Radioactive material gets into milk when those materials drop from the atmosphere onto grasses which are then eaten by cow.  The EPA and FDA have increased the level of monitoring food, drinking water, and rainwater.  There have been a number of monitoring stations throughout the US that have detected some levels, but this was expected.  However, the levels seen must be put in perspective.

According to the EPA “Drinking water samples from two locations, Boise, Idaho and Richland, Washington, showed trace amounts of Iodine-131 – about 0.2 picocuries per liter in each case. Even an infant would have to drink almost 7,000 liters of this water to receive a radiation dose equivalent to a day's worth of the natural background radiation exposure we experience continuously from natural sources of radioactivity in our environment.”

FDA has said that no food is being exported from the affected area, and they are monitoring imported products from other areas of Japan, and at this point, there has not been any radiation detected.  In addition, the US imports very little food from Japan.  It is estimated that only 4% of our imported food comes from Japan.

There is specific concern with seafood with higher levels of radioactive materials making its way into the US.  Besides blocking seafood from the infected areas, FDA has increased its monitoring seafood coming into the US and state that there is no risk related to seafood.

http://www.fda.gov/newsevents/publichealthfocus/ucm247403.htm

Recalls - April 5, 2011

Industry News – PM
Turkey burger recall due to antibiotic-resistant Salmonella strain -
By Chris Scott on 4/5/2011 Meatingplace

The recall of Jennie-O frozen raw turkey burger products is due to the presence of Salmonella Hadar, a strain of the bacteria that is resistant to many commonly prescribed antibiotics.

The Centers for Disease Control is working with USDA's Food Safety and Inspection Service (FSIS) to identify any other illnesses that may be related to the recall, but have not yet been connected with it, according to documents posted on the CDC website.

Authorities are using DNA analysis to identify cases of illness linked to the outbreak, which has affected 12 people ranging in age from 1 year to 86 years old in 10 states. Jennie-O Turkey Store in Willmar, Minn., has recalled nearly 55,000 pounds of frozen raw turkey burger products mainly sold in Sam’s Club stores (See “Turkey burgers recalled on salmonella concerns related to illnesses,” on Meatingplace, April 4, 2011.)

Because the specific strain of Salmonella is resistant to antibiotics, the risk of hospitalization or being unable to treat the resulting illnesses is higher than instances of other outbreaks. The FSIS may also recall additional turkey products as it continues its investigation with the CDC and public health officials in all 10 states, according to the documents

For more information

http://www.cdc.gov/salmonella/hadar0411/040411/index.html

MB - This is a raw product that that is labeled to be cooked by the consumer before consumption. In the cases where illness has occurred, there would need to be a breakdown in consumer handling and preparation practices, either cross-contamination or undercooking. Since this Salmonella strain is resistant to antibiotics, it poses a bigger risk to those who become infected.


As seen with earlier outbreaks, people tend to undercook patties, especially frozen patties where it takes longer for heat penetration to occur into the center of the patty. And as is often done, there are many who rely on color rather than a thermometer for the end-point of the cooking process.



CERTAIN BULK AND PREPACKAGED RAW SHELLED WALNUTS MAY CONTAIN E. coli O157:H7 BACTERIA

Related alerts: 2011-04-04 | 2011-04-03

OTTAWA, April 3, 2011 - The Canadian Food Inspection Agency (CFIA) and Amira Enterprises Inc. are warning the public not to consume certain bulk and prepackaged raw shelled walnut products described below because these products may be contaminated with E. coli O157:H7.

All raw shelled walnuts sold from bulk bins, all package sizes and all lot codes / Best Before dates of the following raw shelled walnuts and products containing walnuts are affected by this alert. The affected products were available for purchase from January 1, 2011, up to and including April 4, 2011. The raw shelled walnuts are imported from the USA.

http://www.inspection.gc.ca/english/corpaffr/recarapp/2011/20110403e.shtml
http://www.marketwire.com/press-release/Public-Advisory-E-coli-Outbreak-1422244.htm

MB - The Canadian consumer advisory advises to cook the walnuts. Surely this opens the opportunity for cross contamination with a highly pathogenic organism. It may have better to advise individuals to throw-out all suspect product.



Salmonella numbers tied to RI bakery rise to 56

Associated Press - April 1, 2011 5:15 PM ET

PROVIDENCE, R.I. (AP) - Fifty-six people have reportedly fallen ill with suspected cases of salmonella amid an outbreak that may be linked to a Rhode Island bakery.

That's up from 39 people as of 3 days ago. The Rhode Island Department of Health said Friday that 26 of those who have reported illness have been hospitalized and 24 have laboratory-confirmed cases of salmonella.

A man in his 80s who had tested positive for salmonella died on March 23.

Officials say many of the affected people ate doughnut-like pastries called zeppoles (ZAY'-puh-luhz) made by DeFusco's Bakery in Johnston.

The pastries also were sold at other stores around the state and have been recalled. The bakery has voluntarily shut down until further notice.

Copyright 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

MB - There must have been some heavy contamination in this bakery since this product is not one that would should allow for growth.



The Smokehouse LLC Recalls One Batch Of Portier Fine Foods Norwegian Smoked Salmon Because Of Possible Health Risk
FDA Release
Contact:
The Smokehouse
1-914-630-4788

FOR IMMEDIATE RELEASE - March 29, 2011 -The Smokehouse LLC of Mamaroneck, New York, is conducting a voluntary recall of PORTIER FINE FOODS Norwegian Smoked Salmon of various size packages including 4 oz., 8 oz., 16 oz. and random weight sizes, Batch Code 066 only, due to potential contamination with Listeria monocytogenes. Listeria monocytogenes is an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women.

PORTIER FINE FOODS Norwegian Smoked Salmon with code 066 was distributed and sold on March 7, 2011 to retailers in NY, NJ, CT.

Batch Code 066 (represents Julian date of March 7, 2011) is located on a white label on the rear of gold boards, which are in clear, vacuum packed packages. This is the only batch code affected. The product was also labeled with an “EXPIRES ON” date of 3/21 (3/21/11). Since the product may be stored frozen, the likelihood exists that the affected code (066) may still be available in consumers’ homes.


Thomas Produce Recalls Jalapeno Peppers Because of Possible Health Risk

Thomas Produce of Boca Raton, FL, is recalling 320 boxes of Jalapeno Peppers because they have the potential to be contaminated with Salmonella, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems.
Product: Jalapeno peppers from Thomas Produce
Distributed: Sold to distributors in Florida, New York, North Carolina, New Jersey, Minnesota, and Pennsylvania from 2/15/2011 to 2/18/2011.
Why: Possble Salmonella contamination
Illnesses reported: None
For more information: Contact Richard Wilson of Thomas Produce Company at 1-561-482-1111 Monday through Friday between 9 a.m. and 4:30 p.m. EST.

Food Safety News - Salmonella outbreak linked to zeppoles

MB- Approximately 20 people are reported to be infected with Salmonella from the consumption of zeppoles, an Italian stuffed puff pastry. From reports, this appears to be a case of cross contamination. The empty cooked shells were reportedly stored in empty egg crates. Too often, less concern is placed upon bread items as a source for foodborne pathogens. But Salmonella can survive in dry process environments and potentially contaminate foods if proper care is not taken. Salmonella does not need to grow on the food, just be present in sufficient numbers to cause illness. In this case, Salmonella may have been present on the egg cases and was transferred to the pastry. If one had to guess, the egg crates were probably stored at room temperature, giving Salmonella a chance to grow on the unclean surface. (Makes me question the source of the eggs as well).
Tainted zeppole shells now eyed in salmonella probe
http://newsblog.projo.com/2011/03/tainted-zeppole-shells-now-eye.html
1:00 PM Sun, Mar 27, 2011
PROVIDENCE, R.I. -- The Rhode Island Department of Health has increased to 23 the number of possible salmonella cases in people who consumed zeppoles made by DeFuscos's Bakery in Johnston.
And the department now says the source of the salmonella contamination may not be just the cream used in the filling of the zeppole shells, but the shells themselves.
Andrea Bagnall-Degos, a Health Department spokeswoman, said Sunday that lab tests have confirmed 13 cases of salmonella so far among the suspected 23 reported illnesses. Thirteen people have been hospitalized; 10 remained in the hospital as of midday Sunday, she said.
DeFusco's Bakery voluntarily closed after health inspectors found that pastry cream was stored at unsafe temperature and in unsanitary conditions.
Bagnall-Degos said the health department has now determined that the bakery stored zeppole shells in used egg crates, possibly exposing the shells to raw egg residue.
"The probable source [of the salmonella contamination] is raw eggs," she said. "We're still working to find the source of the infection of the eggs."
The department is also working to determine all the locations where the zeppoles and zeppole shells were sold.
The pastries were distributed by American Bakery Supplies in West Warwick . Its customers include all five Crugnale Bakery locations in Providence, East Providence, North Providence, Cranston and Cumberland, Calvitto's Pizza & Bakery in Narragansett, Sal's Bakery in Providence, and Focaccia World in Johnston.
The health department advises that all baked goods from DeFusco's be discarded and any zeppole purchased from stores that offer DeFusco products be discarded immediately.
The first reported case of illness was March 21, two days after St. Joseph's Day.
Anyone who has fallen ill, particularly with nausea, vomiting and diarrhea after eating baked goods purchased from DeFusco's or zeppole from any of the stores where the baked goods are sold, should contact a doctor, the Health Department warned.

In general, it takes one to three days for a salmonella infection to produce symptoms, including nausea, cramps, diarrhea and fever. The illness generally lasts four to seven days and can be especially severe in the very young, the elderly and anyone whose immune system is weak. When hospitalization occurs, it's usually because the diarrhea has become severe, according to a fact sheet from the federal Centers for Disease Control and Prevention.