The CDC has reported that a total of 99 individuals infected with the outbreak strain of Salmonella Agona have been reported from 23 states between January 1 and July 22, 2011. The number of ill persons identified in each state with the outbreak strain is as follows: Arkansas (1), Arizona (3), California (7), Colorado (1), Georgia (8), Illinois (17), Louisiana (2), Massachusetts (1), Minnesota (3), Missouri (3), Nebraska (2), Nevada (1), New Jersey (1), New Mexico (3), New York (7), Ohio (1), Oklahoma (1), Pennsylvania (2), Tennessee (1), Texas (25), Virginia (2), Washington (5), and Wisconsin (2). Among persons for whom information is available, illnesses began on or after January 17, 2011. Ill persons range in age from less than 1 year old to 91 years old, and the median age is 19 years old. Forty-one percent of patients are younger than 5 years old. Sixty percent are female. Eleven persons reported travel to Mexico in the week before they became ill. Ten patients were hospitalized.
Interestingly, the CDC also reports that the strain of Salmonella Agona associated with the 2011 outbreak is comprised of four closely related PFGE patterns that have been rarely identified before in PulseNet. Three of these four PFGE patterns were first identified beginning in 2010. A total of 119 cases from 14 states were reported between May 28, 2010, and September 10, 2010. Distribution of age, sex, ethnicity, and state of residence among ill persons was similar to the distribution seen in the current outbreak. Despite an intensive investigation during the summer of 2010 by local, state, and federal public health agencies that focused on fresh fruit, including papaya, the source of the outbreak was not determined.
Sometimes outbreaks are never determined – to the frustration of state, local and federal health officials – and to the victims in the outbreaks. Active surveillance of foodborne disease is key to catching outbreaks early, stopping them, and accurately determining how the outbreak happened in the first place.
One interesting proposal for a more rapid outbreak response is the Council to Improve Foodborne Outbreak Response (CIFOR). It is a multidisciplinary working group convened to increase collaboration across the country and across relevant areas of expertise in order to reduce the burden of foodborne illness in the United States. The Council of State and Territorial Epidemiologists (CSTE) and the National Association of County and City Health Officials (NACCHO) co-chair CIFOR with support from the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).