CDC is collaborating with public health officials in many states, the Indian Health Service, and the U.S. Food and Drug Administration (FDA) to investigate an ongoing multi-state outbreak of human Salmonella serotype Saintpaul infections. An initial epidemiologic investigation comparing foods eaten by ill and well persons identified consumption of raw tomatoes as strongly linked to illness. Recently, many clusters of illnesses have been identified in Texas and other states among persons who ate at restaurants. These clusters have led us to broaden the investigation to be sure that it encompasses food items that are commonly consumed with tomatoes.
Since April, 851 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in 36 states and the District of Columbia. These were identified because clinical laboratories in all states send Salmonella strains from ill persons to their State public health laboratory for characterization. The number of ill persons identified in each state is as follows: Arkansas (10 persons), Arizona (39), California (10), Colorado (11), Connecticut (4), Florida (1), Georgia (18), Idaho (3), Illinois (91), Indiana (11), Kansas (14), Kentucky (1), Maine (1), Maryland (29), Massachusetts (21), Michigan (6), Minnesota (2), Missouri (12), New Hampshire (3), Nevada (4), New Jersey (4), New Mexico (90), New York (26), North Carolina (5), Ohio (6), Oklahoma (19), Oregon (10), Pennsylvania (8), Rhode Island (3), Tennessee (6), Texas (346), Utah (2), Virginia (22), Vermont (2), Washington (4), Wisconsin (6), and the District of Columbia (1).
Among the 581 persons with information available, illnesses began between April 10 and June 20, 2008, including 173 who became ill on June 1 or later. Many steps must occur between a person becoming ill and the determination that the illness was caused by the outbreak strain of Salmonella; these steps take an average of 2-3 weeks. Therefore, an illness reported today may have begun 2-3 weeks ago. Patients range in age from <1 to 99 years; 49% are female. The number of illnesses is highest among persons 20 to 29 years old; the number of illnesses is lowest in children 10 to 19 years old and persons greater than 60 years old. At least 105 persons were hospitalized. No deaths have been officially attributed to this outbreak. However, a man in his sixties who died in Texas from cancer had an infection with the outbreak strain of Salmonella Saintpaul at the time of his death. The infection may have contributed to his death.
Only 3 persons infected with this strain of Salmonella Saintpaul were identified in the country during the same period in 2007. The previous rarity of this strain and the distribution of illnesses in all U.S. regions suggest that the implicated food is distributed throughout much of the country. Because many persons with Salmonella illness do not have a stool specimen tested, it is likely that many more illnesses have occurred than those reported. Some of these unreported illnesses may be in states that are not on todays map.
Clinical features of Salmonella Infection                                   
Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12-72 hours after infection. Infection is usually diagnosed by culture of a stool sample. The illness usually lasts 4-7 days. Although most people recover without treatment, severe infections may occur. Infants, elderly persons, and those with impaired immune systems are more likely than others to develop severe illness. When severe infection occurs, Salmonella may spread from the intestines to the bloodstream and then to other body sites, and can cause death. In these severe cases, antibiotic treatment may be necessary.
Advice to consumers
At this time, FDA is advising U.S. consumers to limit their tomato consumption to those that are not the likely source of this outbreak. These include cherry tomatoes; grape tomatoes; tomatoes sold with the vine still attached; tomatoes grown at home; and red plum, red Roma, and round red tomatoes from specific sources listed at: http://www.fda.gov/oc/opacom/hottopics/tomatoes.html*. Consumers should be aware that raw tomatoes are often used in the preparation of fresh salsa, guacamole, and pico de gallo, are part of fillings for tortillas, and are used in many other dishes.
Consumers everywhere are advised to:

• Refrigerate within 2 hours or discard cut, peeled, or cooked tomatoes.
• Avoid purchasing bruised or damaged tomatoes and discard any that appear spoiled.
• Thoroughly wash all tomatoes under running water.
• Keep tomatoes that will be consumed raw separate from raw meats, raw seafood, and raw produce items.
• Wash cutting boards, dishes, utensils, and counter tops with hot water and soap when switching between types of food products.

FDA recommends that U.S. retail outlets, restaurants, and food service operators offer only fresh and fresh cut red plum, red Roma, and round red tomatoes and food products made from these tomatoes from specific sources listed at: http://www.fda.gov/oc/opacom/hottopics/tomatoes.html#retailers*. Cherry tomatoes, grape tomatoes, and tomatoes sold with the vine still attached from any source may be offered.
FDA information on this investigation can be found at: http://www.fda.gov/oc/opacom/hottopics/tomatoes.html
Information on the safe handling of produce can be found at: www.cfsan.fda.gov/~dms/prodsafe.html

FOR IMMEDIATE RELEASE                                                                             CONTACT:  James McCurtis
June 24, 2008                                                                                          (517)241-2112; Cell: (517) 243-1678
                                                                                                                Jennifer Holton, MDA, 517-241-2485

Michigan’s Many E. coli Cases Linked to Ground Beef
Most cases report purchasing and consuming ground beef from Kroger

Lansing - The Michigan Department of Community Health (MDCH) is issuing a public health alert due to illnesses from E. coli associated with ground beef.  More than half of the Michigan patients report purchasing and consuming ground beef from Kroger Food Stores.  Product traceback is in progress and additional retailers and outlets may be identified.  MDCH has confirmed 15 E. coli cases that are genetically linked and 10 of those cases are hospitalized.
“Our top priority at the Michigan Department of Community Health is to protect the public,” said Dr. Gregory Holzman, chief medical executive for MDCH.  “Now that it is summertime and many people are having cook-outs, I strongly urge our residents to thoroughly cook their hamburgers.  We want to ensure that the public’s health and well-being is protected.”
“Kroger is fully cooperating with state and federal investigators,” said Don Koivisto, Michigan Department of Agriculture Director.  “It’s critical that consumers follow safe food practices to reduce the risk of foodborne illness such as cooking your meat thoroughly using a food thermometer to determine proper internal temperature.”
The 15 genetically linked cases, E. coli O157, are present in seven Michigan counties including Eaton (1), Macomb (2), Washtenaw (4), Saginaw (1), Genesee (1), Wayne (3) and Oakland (3).  Reported E. coli patients became ill between May 31 and June 8.  Additionally, individuals in Ohio also have been identified with the same genetic strain of E. coli O157.  The confirmed Ohio and Michigan cases have been linked both epidemiologically and genetically to this outbreak, according to the Centers for Disease Control and Prevention (CDC).
The symptoms of STEC infections vary for each person but often include severe stomach cramps, diarrhea (often bloody), and vomiting. If there is fever, it usually is not very high (less than 101˚F/less than 38.5˚C). Most people get better within 5–7 days.  Some infections are very mild, but others are severe or even life-threatening. 

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Keep your cookouts and picnics safe by following these basic food safety guidelines provided by the Partnership for Food Safety Education: 

• Wash your hands with warm water and soap for at least 20 seconds before and after handling food.
• Always marinate foods in the refrigerator, not on the counter or outdoors.  Don’t use sauce that was used to marinate raw meat or poultry on cooked food. Boil used marinade before applying to cooked food.
• If you partially cook food in the microwave, oven or stove to reduce grilling time, do so immediately before the food goes on the hot grill.
• When it’s time to cook the food, cook it to a safe internal temperature. Use a food thermometer to be sure.
• Beef, veal and lamb steaks and roasts: 145 °F for medium rare, 160 °F for medium, and 170 °F for well done.
• Ground pork and ground beef: 160 °F.
• Poultry: to at least 165 °F.
• Fin fish: 145 °F or until the flesh is opaque and separates easily with a fork.
• Shrimp, lobster and crabs: The meat should be pearly and opaque.
• Clams, oysters and mussels: Until the shells are open.
• Never place cooked food on a plate that previously held raw meat, poultry, seafood or eggs. Be sure to have on hand plenty of clean utensils and platters.

For additional information on proper food safety practices, visit MDA’s Web site at www.michigan.gov/foodsafety.  For additional information, visit www.usda.gov or www.cdc.gov and search for food safety or E. coli.  Persons who believer they have signs or symptoms of foodborne illness should consult a healthcare provider.

For Immediate Release:  June 13, 2008                                              
Contact: Jennifer Holton, 517-241-2485 or holtonj@michigan.gov
                                                                                             
Michigan–Grown Tomatoes Declared Safe to Eat by FDA
 
LANSING – Michigan Department of Agriculture (MDA) Director Don Koivisto today announced that Michigan-grown tomatoes are not associated with the current Salmonella Saintpaul outbreak and have been declared safe to eat by the Food and Drug Administration (FDA).  Michigan has been added to the FDA’s “safe to consume” list available online.

Michigan is second in the nation in terms of agricultural diversity and is home to approximately 500 open-field tomato farms and 15 hydroponic/greenhouse tomato operations with locally focused distribution.

“Although Michigan’s open field tomato harvest doesn’t begin until July, it’s important for consumers to know that our growers are producing safe, wholesome products for Michigan families to enjoy,” said Koivisto.  “Now is the perfect time to ask for locally grown and processed Michigan products at your area retail markets.

Purchasing local food and agriculture products throughout the year has a huge impact on the state’s economy. In fact, for every dollar spent locally, three to seven different local businesses are impacted before that dollar leaves the local economy. If every household spends just $10 per week of their current grocery budget on local foods, it would keep more than $37 million circulating weekly within Michigan.

Consumers can locate Michigan-grown produce by looking for the “Select Michigan” label at area grocery stores, visiting local farmer’s markets, or online through Michigan State University’s “MI MarketMaker” program.

MI MarketMaker is a web-based resource providing a link between producers, processors, wholesalers, retailers, farmers' markets, food service providers and end-consumers within the food supply chain.  It allows a consumer to find local producers who sell at their farm or at farmers markets.  It also allows retailers such as grocery stores and restaurants to find producers who can supply their wholesale needs.  It is available on the web at http://mimarketmaker.msu.edu/.

For more information about the Select Michigan program or a listing of Michigan specialty food companies, visit www.selectmichigan.org.

For more information on the “safe to consume” list, please visit FDA’s Web site at http://www.fda.gov/oc/opacom/hottopics/tomatoes.html#retailers.

Antibiotic Resistant Skin Infection Prevention

"MRSA has been featured in the news and on television programs a great deal recently. MRSA stands for Methicillin-resistant Staphylococcus aureus. This type of bacteria causes “staph” infections that are resistant to treatment with usual antibiotics."(CDC Web site) For more information on MRSA, visit the links below.

Methicillin-Resistant Staphylococcus Aureus (MRSA) Facts

MRSA Questions and Answers