Investigation Update: Outbreak of Salmonella Typhimurium Infections, 2008–2009

Update for January 14, 2009

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CDC is collaborating with public health officials in many states and the United States Food and Drug Administration (FDA) to investigate a multistate outbreak of human infections due to Salmonella serotype Typhimurium.

As of Wednesday, January 14, 2009, 434 persons infected with the outbreak strain of Salmonella Typhimurium have been reported from 43 states. The number of ill persons identified in each state is as follows: Alabama (1), Arizona (8), Arkansas (4), California (57), Colorado (9), Connecticut (8), Georgia (6), Hawaii (1), Idaho (10), Illinois (5), Indiana (3), Iowa (1), Kansas (2), Kentucky (3), Maine (4), Maryland (7), Massachusetts (40), Michigan (20), Minnesota (33), Missouri (8), Mississippi (1), Nebraska (1), New Hampshire (10), New Jersey (16), New York (17), Nevada (5), North Carolina (1), North Dakota (10), Ohio (57), Oklahoma (2), Oregon (5), Pennsylvania (13), Rhode Island (4), South Dakota (2), Tennessee (8), Texas (6), Utah (3), Vermont (4), Virginia (19), Washington (13), West Virginia (2), Wisconsin (3), and Wyoming (2).  Among the 388 persons with dates available, illnesses began between September 8 and December 31, 2008, with most illnesses beginning after October 1, 2008. Patients range in age from <1 to 98 years; 49% are female. Among persons with available information, 28% were hospitalized and the infection may have contributed to five deaths.

The outbreak can be visually described with a chart showing the number of persons who became ill each day.  This chart is called an epidemic curve or epi curve. The epi curve and information about interpreting it may be found here. It shows that illnesses began between September 8 and December 31, 2008, with most illnesses beginning after October 1, 2008. Illnesses that occurred after December 14, 2008 may not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported.  This takes an average of 2-3 weeks. Please see the Salmonella Outbreak Investigations: Timeline for Reporting Cases for more details.

Outbreak Investigation

Preliminary analysis of an epidemiologic study conducted by CDC and public health officials in multiple states comparing foods eaten by ill and well persons has suggested peanut butter as a likely source of the bacteria causing the infections. To date, no association has been found with common brand names of peanut butter sold in grocery stores. The investigation is ongoing, and exposures to peanut butter and peanut butter-containing products are being examined.

An epidemiologic investigation by the Minnesota Department of Health suggested King Nut creamy peanut butter as a likely source of Salmonella infections among many ill persons in Minnesota. The Minnesota Department of Agriculture Laboratory isolated the outbreak strains of Salmonella Typhimurium from an open 5-pound container of King Nut brand creamy peanut butter. The product is distributed in Minnesota to establishments such as long-term care facilities, hospitals, schools, universities, restaurants, delis, cafeterias, and bakeries. It is not sold directly to consumers and is not known to be distributed for retail sale in grocery stores.

Clusters of infections in several states have been reported in schools and other institutions, such as long-term care facilities and hospitals. King Nut is the only brand of peanut butter used in those facilities for which we have information.

CDC and other public health officials are continuing to conduct surveillance for cases of infection with the outbreak strains, and to gather and analyze data on exposures to peanut butter and peanut butter-containing products that may be associated with illness.

Advice to Consumers

To date, common brands of peanut butter sold in grocery stores do not appear to be associated with the outbreak. Public health officials will advise the public if more products are identified as being associated with the outbreak. Persons who think they may have become ill from eating peanut butter are advised to consult their health care providers.

On January 10, 2009, King Nut Companies, a distributor of peanut butter manufactured by Peanut Corporation of America (PCA), issued a voluntary recall of peanut butter distributed under the King Nut label. In addition, King Nut Companies issued a voluntary recall of Parnell’s Pride peanut butter, which they also distributed and which is produced by the same manufacturer. The recalled products have lot codes beginning with “8”. No other King Nut products are included in this voluntary recall. More information about this recall can be found on the FDA website.

On January 13, 2009, Peanut Corporation of America (PCA), the manufacturer of King Nut peanut butter, announced a voluntary recall of peanut butter produced in its Blakely, Georgia processing facility produced on or after July 1, 2008, that had specific lot numbers and descriptions. More information regarding the recall is available on the FDA website.  The peanut butter being recalled is sold in bulk and distributed to institutions, food service industries, and private label food companies, under the brand names Parnell’s Pride and King Nut. None of the peanut butter being recalled is sold directly to consumers through retail grocery stores.

Clinical Features

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 to 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 unless the person is treated promptly with antibiotics.

More general information about Salmonella can be found here under Salmonella FAQs.

More information on this investigation can be found below.

• Minnesota Department of Health and Minnesota Department of Agriculture press release
• FDA – Salmonella Typhimurium Outbreak
• More information on Salmonella

The next web posting is expected on Friday, January 16, 2009.

Previous Updates on this Outbreak

• January 12, 2009
• January 9, 2009
• January 8, 2009

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