Friday, September 3, 2010

Salmonella Egg Outbreak: The State Of The States

A state-by-state report of Salmonella Enteritidis outbreak cases
(Original post August 25; updated September 3 with additional states reporting)

When a food-borne disease outbreak is caused by a rare strain of Salmonella – or any other pathogen – a relatively small cluster of illnesses is relatively easy to spot. But when a common strain is behind the outbreak, it can be much more difficult to detect an unusual pattern of illness reports. This, in fact, is what has happened in the egg outbreak.

Salmonella is a reportable disease When a doctor or a hospital encounters a patient who is infected with Salmonella, the illness must be reported to the appropriate agency – usually the state department of health – which transmits the report to CDC. It can easily take 2-3 weeks between the time that a person consumes a contaminated food until the time that CDC receives a report. Consider this:
  1. The incubation period between the time that someone consumes Salmonella-contaminated food and the time he or she begins to experience symptoms can be as short as one day or as long as a week.
  2. The ill person may wait several days before visiting a doctor or a hospital emergency room (if they do so at all).
  3. It takes at least a couple of days for a stool sample to be processed in the lab and for Salmonella to be recovered.
  4. It takes additional time for the Salmonella to be identified (ie., Salmonella Enteritidis, Salmonella Infantis, or one of some 2500+ other types)
  5. Once the Salmonella has been identified, the next step is genetic profiling – the so-called PFGE (pulsed field gel electrophoresis) typing.
  6. Only after all of this is done, can useful information be transmitted to CDC's PulseNet data base.
A small number of reports of an unusual Salmonella strain can be spotted with relative ease (as occurred with the Salmonella Newport alfalfa sprout outbreak earlier this year). But it takes a larger number of cases – enough to rise about the background "noise" level – for an outbreak to be recognized when a very common Salmonella strain is the culprit.

There is a very good reason why CDC has not yet reported a total of confirmed and suspect cases – it doesn't know what that total is. The agency is trying to differentiate between outbreak cases and background cases by taking genetic profiling of the Salmonella isolates to a more advanced level.

Until (and unless) CDC can pin down a specific genetic fingerprint for the outbreak strain, it will not know for certain which illnesses are related to this egg outbreak. Meanwhile, it will divulge only the total number of reported Salmonella Enteritidis illnesses nationwide, compared to the number that would be expected (based on the past five years).

As a result, the public has been left wondering which states are involved in this outbreak, and which ones have managed to dodge the dodgy eggs. To fill the knowledge gap, I have been canvassing state health departments for information. Here is what I've learned so far, either from a search of state web sites (indicated with live links), or from direct email contact with state representatives:

Alaska (from Elizabeth Funk, Alaska Department of Health and Social Services)
Three cases of Salmonella Enteritidis (PFGE #JEGX01.0004) so far this year; at least one case has a link to eggs, and the others are still under investigation. None of the three were hospitalized. CDC is doing additional genetic testing of the three isolates. Alaska has not found any eggs from either Wright County Egg or Hillandale Farms distributed in the state.

Eggs from Wright County Egg have been shipped to Arizona, and the number of Salmonella Enteritidis cases in the state is significantly higher than in 2009; however, ADHS has not been able to connect any of the Salmonella Enteritidis cases to the egg recall.

California (From Ronald Owens, California Department of Public Health)

Investigation of illness clusters in San Diego, Santa Clara and Los Angeles Counties led CDPH to the theory that Wright County Eggs were involved in the outbreak. The first breakthrough came in Santa Clara, when eggs in a custard pastry were linked to eggs recalled by Wright County Egg. California has recorded more than 200 Salmonella Enteritidis illnesses; however, not all of them are necessarily linked to contaminated eggs.

Separately, Los Angeles County Department of Public Health reports that as many as 60 people in LA County have been infected with the strain of Salmonella Enteritidis that is associated with the recalled eggs.

Colorado (from Shaun Cosgrove, Colorado Department of Public Health and Environment)
Twenty-eight cases of Salmonella Enteritidis reported in June and July, versus an average of seven cases during this two-month period in past years. Some of the cases are "likely linked to the egg recall, including cases from a recent outbreak involving The Fort restaurant in Jefferson County.

District of Columbia (from the DC web site)
There is no evidence of recall-related illnesses in DC.

Hawaii (from Janice Okubo, Hawaii Department of Health)
No cases reported.

Idaho (from Thomas Shanahan, Idaho Department of Health and Welfare)
Nothing "out of the ordinary" in Idaho, and no indications of recalled product having been distributed in the state.

Illinois (from Illinois Department of Public Health web site)
There are no confirmed cases of Salmonella Enteritidis in the state that have been linked to recalled eggs.

Indiana (from Jennifer Dunlap, Indiana State Department of Health)
There has been no unusual incidence of Salmonella Enteritidis reports and no PFGE matches associated with the recalled shell eggs.

Iowa (from press release)
No illnesses in Iowa have been linked directly to the egg recall. Nevertheless, there have been 86 cases of Salmonella Enteritidis in Iowa so far this year, as compared to 84 cases in all of 2009.

Maine (from Amy Robbins, Maine Center for Disease Control)
Maine has not seen an increase in Salmonella Enteritidis cases.

Maryland (from Karen Black, Maryland Department of Health and Mental Hygiene)
Maryland experiences on average 800-900 confirmed cases of Salmonella annually, approximately 1/3 of them Salmonella Enteritidis. None of the Salmonella Enteritidis cases in Maryland. Companies packing eggs for Maryland – either directly or via third-party egg shipments (such as supermarket brands) must register with the Maryland Department of Agriculture. No evidence of such direct or indirect shipments of recalled eggs have been found.

Massachusetts (from Massachusetts Department of Public Health web site)
The egg recalls have not impacted any eggs distributed in Massachusetts.

Michigan (from Michigan Department of Agriculture web site)
Michigan Department of Agriculture reports that eggs associated with the nationwide egg recall were distributed in Michigan.

Minnesota (from Joshua Rounds, Minnesota Department of Health)
Minnesota has seen an unusual number of Salmonella Enteritidis (outbreak strain) cases in 2010 – approximately 70 cases so far this year, as compared to 55 in all of 2009 and 75 in 2008. Fourteen cases have been linked to the consumption of shell eggs: seven each to Wright County Egg and Hillandale Farms. Two people have been hospitalized. Of the 14 egg-related patients, five are male and 9 female; victims range in age from 5 years to more than 50 years old, with 10 of them in the 20-49 year age range. Minnesota was one of the first three states to participate in the investigation of illness clusters that led to the identification of eggs from Wright County Egg as a probable source of infections.

Mississippi (from Mississippi Department of Health web site)
A limited number of recalled eggs may have been shipped to Mississippi; however, there are no reported cases of illness in Mississippi that are linked to the recalled eggs.

Missouri (from Eden Dietle, Missouri Department of Health and Senior Services)
Missouri has not had any reported cases linked to the recalled eggs.

Nebraska (from Marla Augustine, Nebraska Department of Health and Human Services)
Eight cases of Salmonella Enteritidis appear to be connected to recalled eggs. Victims range in age from 21 to 93 years old; two are male, six are female. Five of the 8 confirmed outbreak patients were hospitalized; all have been discharged.

Nevada (from Southern Nevada Health District web site)
The Southern Nevada Health District has recorded 30 cases of Salmonella Enteritidis so far in 2010 – four times the number usually reported.

New Mexico (from Deborah Busemeyer, New Mexico Department of Health)
No unusual number of cases in the state, and none that are linked to eggs.

New York State (from New York Department of Health web site)
None of the recalled eggs have been found in New York State, nor have there been any recall-related cases of Salmonella Enteritidis reported to the Department of Health. Eggs produced in New York are not part of the national recall.

North Carolina (from Durham County, NC News Release)
Sixty-five patrons of Bullock's Bar-B-Que Restaurant in Durham were infected with the outbreak strain of Salmonella Enteritidis in April. The illnesses were linked to the consumption of a meringue that was present on certain desserts. The outbreak investigation report stated that CDC had identified similar outbreaks in other parts of the country, involving commercially distributed pasteurized egg whites sold by the same restaurant supplier and manufactured in the same plant as the product delivered to Bullocks. Testing conducted by the North Carolina Department of Agriculture could not definitively prove that this ingredient was contaminated with Salmonella.

North Dakota (from Sarah Weninger, North Dakota Department of Health)
North Dakota has not experienced an unusual number of Salmonella Enteritidis cases. The state has not recorded any cases that are linked to the recalled shell eggs.

South Dakota (from Lon Kightlinger, South Dakota Department of Health)
There have been 13 Salmonella Enteritids cases matching the PFGE pattern identified in the egg outbreak (median annual rate of 24 cases over the past five years). None of the 13 cases recall having eaten raw or undercooked eggs.

Texas (from Christine Mann, Texas Department of State Health Services)
There have been 165 cases of Salmonella Enteritidis illnesses in 41 Texas counties since mid-May (versus an average of approximately 28 cases during the same period over the last five years). A definitive link between the illnesses and the egg recalls has not yet been established.

Utah (from Julia Hall, Utah Department of Health)
Utah was originally put on the FDA recall list because Capital Trading Company (West Jordan) was once a customer of Wright County Egg. After further conversations with FDA and the owner of Capital Trading, Utah DOH believes that Capital Trading received no recalled eggs. Utah hopes that FDA will eventually remove the state from the recall list.

Vermont (from Erica Berl, Vermont Department of Health and from Vermont Agency of Agriculture)
No human cases of Salmonella Enteritidis linked to recalled eggs have been reported to the Vermont Department of Health, and there has been no increase in the reported incidence of the Salmonella Enteritidis strain. None of the recalled eggs have been found in Vermont to date.

Virginia (from Michelle Peregoy, Virginia Department of Health)
Virginia is seeing about double the number of this strain of Salmonella Enteritidis in 2010 compared to 2009; however, there were more cases in 2008 than there have been this year. Currently no cases have been linked to the consumption of shell eggs involved in the recall. The state is continuing to monitor reports for evidence of any clusters involving restaurants or events.

Washington State (from Gordon MacCracken, Washington Department of Health)
No cases reported.

West Virginia (from Toby Wagoner, Bureau for Public Health and the WV Department of Agriculture web page)
No cases of Salmonella Enteritidis linked to the outbreak investigation and no increase in incidence compared to previous years. Recalled eggs have been found at 18 locations in the state.

Wisconsin (reported in the Milwaukee Journal Sentinal on August 18th)
Twenty-one patrons of the Baker Street Restaurant and Pub in Kenosha experienced infections with Salmonella Enteritidis that were linked to the recalled eggs. Additional isolated cases are still under investigation.

Wyoming (from Kelly Weidenbach, Wyoming Department of Health)
There have not been an unusual number of Salmonella Enteritidis cases in the state this year. No cases in Wyoming have been linked to the consumption of shell eggs. No suspect outbreak cases are currently under investigation.

This outbreak is a reminder to all that eggs must be handled with the same respect given to other raw foods. The California Department of Public Health offers the following warning:
Salmonella is a bacterium that may cause serious health problems, including fever, abdominal cramps and diarrhea. Most infected people recover within a week; however, some may develop complications that require hospitalization. Infants, the elderly, and people with weakened immune systems are at the highest risk for more severe illness. Consumers are advised to use all eggs carefully, and cook them thoroughly until whites and yolks harden. Broken or cracked eggs should be discarded.

This state-by-state status report will be updated as more information becomes available.

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  1. So, if a state is not included, it's because you haven't recieved the informtion yet?
    ~Stephanie, N.C.

  2. That's correct Stephanie. I will be adding more states as I receive replies or when information is posted on the Internet.


  3. Wow. That's alot of work. Thanks!


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