According to the CDC, for every one person who is a stool-culture positive victim of salmonella in the United States, there a multiple of 38.5 who are also sick, but remain uncounted.  (See, AC Voetsch, “FoodNet estimate of the burden of illness caused by nontyphoidal Salmonella infections in the United States,”Clinical Infectious Diseases 2004;38 (Suppl 3):S127-34).  This means that in this salmonella Saintpaul tomato outbreak of 228 (this number is bound to rise), we are missing 8,550 people so far.  (By the way, I am still in London and visited Saint Paul’s Cathedral yesterday).

So, how does such a miscount actually happen?  Frankly, some people who became ill simply suffer in silence or were not sick enough to seek medical treatment.  Those that do seek medical attention are also not that likely to have a doctor order a stool culture for salmonella.  Without a stool culture they do not get counted in the “official” CDC numbers (to date 228).

On where in the world is tainted tomato?  The U.S. Food and Drug Administration added New Mexico, Indiana and one Mexican state to its list of places that are cleared of being the source of the salmonella outbreak.  The FDA has now cleared 37 states, Puerto Rico and parts of Florida as the source of the outbreak.

Thus far we have been contacted by over 50 people in the US who either are stool-culture positive salmonella Saintpaul or who believe that they became ill after eating tomatoes in April or May.  Several have identified the same restaurant chain. Because we have not see the health department documentation of the illnesses, we will not divulge that name of the chain – yet.  Interestingly, on June 13, the FDA said that nine people fell ill at two restaurants that were part of the same chain.  The agency also declined to name the chain or its locations. Hmm, wonder if I beat the FDA to the punch?

Anyway, I still hope someone answers my questions:

1. Why does it take CDC so long to figure out an outbreak is going on?*

2. Why does it take so long for FDA to figure out where the tainted tomatoes came from?*

3. What if this was a bio-terrorism act instead of a likely food handling error?

*  Note – I think this more has to do with resources than it does will or ability.