Fast Facts of CDC: Surveillance for Foodborne Disease Outbreaks — United States, 2009–2015 Surveillance Summaries / July 27, 2018 / 67(10);1–11:

2009–2015: 5,760 outbreaks that resulted in 100,939 illnesses, 5,699 hospitalizations, and 145 deaths.

Among 2,953 outbreaks with a single confirmed etiology:

  1. Norovirus was the most common cause of outbreaks (1,130 outbreaks [38%]) and outbreak-associated illnesses (27,623 illnesses [41%]).
  2. Salmonella with 896 outbreaks (30%) and 23,662 illnesses (35%).
  3. Outbreaks caused by ListeriaSalmonella, and Shiga toxin-producing Escherichia coli (STEC) were responsible for 82% of all hospitalizations and 82% of deaths reported.

Among 1,281 outbreaks in which the food reported could be classified into a single food category:

  1. Fish were the most commonly implicated category (222 outbreaks [17%]).
  2. Dairy (136 [11%]).
  3. Chicken (123 [10%]).

The food categories responsible for the most outbreak-associated illnesses were:

  1. Chicken (3,114 illnesses [12%]).
  2. Pork (2,670 [10%]).
  3. Seeded vegetables (2,572 [10%]).

Multistate outbreaks comprised only 3% of all outbreaks reported but accounted for 11% of illnesses, 34% of hospitalizations, and 54% of deaths.

Problem/Condition: Known foodborne disease agents are estimated to cause approximately 9.4 million illnesses each year in the United States. Although only a small subset of illnesses are associated with recognized outbreaks, data from outbreak investigations provide insight into the foods and pathogens that cause illnesses and the settings and conditions in which they occur.

Description of System: The Foodborne Disease Outbreak Surveillance System (FDOSS) collects data on foodborne disease outbreaks, which are defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Since the early 1960s, foodborne outbreaks have been reported voluntarily to CDC by state, local, and territorial health departments using a standard form. Beginning in 2009, FDOSS reporting was made through the National Outbreak Reporting System, a web-based platform launched that year.

Results: During 2009–2015, FDOSS received reports of 5,760 outbreaks that resulted in 100,939 illnesses, 5,699 hospitalizations, and 145 deaths. All 50 states, the District of Columbia, Puerto Rico, and CDC reported outbreaks. Among 2,953 outbreaks with a single confirmed etiology, norovirus was the most common cause of outbreaks (1,130 outbreaks [38%]) and outbreak-associated illnesses (27,623 illnesses [41%]), followed by Salmonella with 896 outbreaks (30%) and 23,662 illnesses (35%). Outbreaks caused by ListeriaSalmonella, and Shiga toxin-producing Escherichia coli (STEC) were responsible for 82% of all hospitalizations and 82% of deaths reported. Among 1,281 outbreaks in which the food reported could be classified into a single food category, fish were the most commonly implicated category (222 outbreaks [17%]), followed by dairy (136 [11%]) and chicken (123 [10%]). The food categories responsible for the most outbreak-associated illnesses were chicken (3,114 illnesses [12%]), pork (2,670 [10%]), and seeded vegetables (2,572 [10%]). Multistate outbreaks comprised only 3% of all outbreaks reported but accounted for 11% of illnesses, 34% of hospitalizations, and 54% of deaths.

Location: A location of preparation was provided for 5,022 outbreak reports (87%), with 4,696 (94%) indicating a single location. Among outbreaks reporting a single location of preparation, restaurants were the most common location (2,880 outbreaks [61%]), followed by catering or banquet facilities (636 [14%]) and private homes (561 [12%]). Sit-down dining style restaurants (2,239 [48%]) were the most commonly reported type of restaurant. The locations of food preparation with the most outbreak-associated illnesses were restaurants (33,465 illnesses [43%]), catering or banquet facilities (18,141 [24%]), and institutions, such as schools (9,806 [13%]). The preparation location with the largest average number of illnesses per outbreak was institutions (46.5), whereas restaurants had the smallest (11.6).

Outbreaks: Outbreak investigators identified a food in 2,442 outbreaks (42%). These outbreaks resulted in 51,341 illnesses (51%). The food reported belonged to a single food category in 1,281 outbreaks (22%). The food category most commonly implicated was fish (222 outbreaks [17%]), followed by dairy (136 [11%]) and chicken (123 [10%]). The food categories responsible for the most outbreak-associated illnesses were chicken (3,114 illnesses [12%]), pork (2,670 [10%]), and seeded vegetables (2,572 [10%]). Scombroid toxin in fish was the single confirmed etiology and food category pair responsible for the most outbreaks (85), followed by ciguatoxin in fish (72) and Campylobacter in dairy (60). The pathogen-food category pairs that caused the most outbreak-associated illnesses were Salmonella in eggs (2,422 illnesses), Salmonella in seeded vegetables (2,203), and Salmonella in chicken (1,941). In comparison, scombroid toxin and ciguatoxin outbreaks from fish resulted in 519 outbreak-associated illnesses, an average of three illnesses per outbreak. Outbreaks of Salmonella infections from seeded vegetables resulted in an average of 88 illnesses per outbreak, and outbreaks of Salmonella infections from eggs resulted in an average of 78 illnesses per outbreak.

Food Implicated: Several novel food vehicles caused outbreaks during the study period. In 2011, an outbreak of Salmonella serotype Enteritidis infections linked to pine nuts imported from Turkey resulted in 53 illnesses and two hospitalizations. In 2014, an outbreak of Salmonella serotypes Gaminara, Hartford, and Oranienburg in chia seed powder imported from Canada caused 45 illnesses and seven hospitalizations. An outbreak of STEC serogroups O26 and O121 infections that began in 2015 was linked to raw wheat flour produced in the United States; it resulted in 56 illnesses and 16 hospitalizations in 24 states. An outbreak of Salmonella serotype Virchow infections attributable to moringa leaf powder imported from South Africa began in 2015 and caused 35 illnesses and six hospitalizations in 24 states. It was an ingredient of an organic powdered shake mix branded to be used as a meal replacement.

Multistate Outbreaks: Multistate outbreaks comprised only 3% of outbreaks but were responsible for 11% of illnesses, 34% of hospitalizations, and 54% of deaths. Multistate outbreaks involved a median of seven states with a range of two to 45 states in which exposure occurred. The largest of the 177 multistate outbreaks was caused by Salmonella serotype Enteritidis and due to contaminated shell eggs. An estimated 1,939 persons were infected in 10 states beginning in 2010. An outbreak of Salmonella serotype Poona infections attributed to cucumbers in 2015 had the second highest number of illnesses (907 illnesses in 40 states). This outbreak also had the most outbreak-associated hospitalizations (204 [22% of cases]). An outbreak of Salmonella serotype Heidelberg infections attributed to chicken during 2013–2014 had the second most hospitalizations (200 [32% of cases]) and involved persons from 29 states and Puerto Rico. An outbreak of Listeria monocytogenes infections attributed to cantaloupes in 28 states in 2011 had the most deaths (33 [22% of cases]), followed in 2014 by an outbreak in 12 states of Listeria monocytogenes infections attributed to caramel apples, another novel food vehicle (9), in which seven persons (20% of cases) died.

Daniel Dewey-Mattia, MPH; Karunya Manikonda, MPH; Aron J. Hall, DVM; Matthew E. Wise, PhD; Samuel J. Crowe, PhD.

  1. CDC Annual summaries of foodborne outbreaks. Atlanta, GA: US Department of Health and Human Services, CDC; 2018. https://www.cdc.gov/fdoss/annual-reports/index.html
  2. Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States—major pathogens. Emerg Infect Dis 2011;17:7–15. CrossRefPubMed
  3. National Notifiable Diseases Surveillance System (NNDSS). Foodborne disease outbreak 2011 case definition. Atlanta, GA: US Department of Health and Human Services, CDC; 2013. http://wwwn.cdc.gov/nndss/conditions/foodborne-disease-outbreak/case-definition/2011
  4. PulseNet. Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://www.cdc.gov/pulsenet/index.html
  5. Guide to confirming an etiology in foodborne disease outbreak. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. https://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/confirming_diagnosis.html
  6. Interagency Food Safety Analytics Collaboration (IFSAC) Food Categorization Scheme. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. https://www.cdc.gov/foodsafety/ifsac/projects/food-categorization-scheme.html
  7. Richardson LC, Bazaco MC, Parker CC, et al. An updated scheme for categorizing foods implicated in foodborne disease outbreaks: a tri-agency collaboration. Foodborne Pathog Dis 2017;14:701–10. CrossRefPubMed
  8. US Census Bureau. Population and housing unit estimates. Washington, DC: US Department of Commerce, US Census Bureau; 2016. https://www.census.gov/programs-surveys/popest.html
  9. Angelo KM, Conrad AR, Saupe A, et al. Multistate outbreak of Listeria monocytogenesinfections linked to whole apples used in commercially produced, prepackaged caramel apples: United States, 2014–2015. Epidemiol Infect 2017;145:848–56. CrossRef PubMed
  10. Gould LH, Kline J, Monahan C, Vierk K. Outbreaks of disease associated with food imported into the United States, 1996–2014. Emerg Infect Dis 2017;23:525–8. CrossRefPubMed
  11. Gould LH, Walsh KA, Vieira AR, et al. . Surveillance for foodborne disease outbreaks—United States, 1998–2008. MMWR Surveill Summ 2013;62(No. SS-2):1–34. PubMed
  12. Hall AJ, Wikswo ME, Pringle K, Gould LH, Parashar UD. Vital signs: foodborne norovirus outbreaks—United States, 2009–2012. MMWR Morb Mortal Wkly Rep 2014;63:491–5. PubMed
  13. Food and Drug Administration. Food Code 2017. Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2018. https://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/ucm595139.htm
  14. Tauxe RV. Emerging foodborne diseases: an evolving public health challenge. Emerg Infect Dis 1997;3:425–34. CrossRefPubMed
  15. Food and Drug Administration. Egg safety final rule. Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2017. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Eggs/ucm170615.htm
  16. Food and Drug Administration. FDA Food Safety Modernization Act (FSMA). Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2017. https://www.fda.gov/Food/GuidanceRegulation/FSMA
  17. Food Safety and Inspection Service. Salmonella action plan. Washington, DC: US Department of Agriculture, Food Safety and Inspection Service; 2015. https://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/foodborne-illness-and-disease/salmonella/sap

As of June 27, 2018, the CDC reported 210 people infected with the outbreak strain of E. coli O157:H7 were reported from 36 states.  Canada reported 8 sickened.

Illnesses started on dates ranging from March 13, 2018 to June 6, 2018. Ill people ranged in age from 1 to 88 years, with a median age of 28.

Sixty-seven percent of ill people were female.

Of 201 people with information available, 96 (48%) were hospitalized, including 27 people who developed hemolytic uremic syndrome, a type of kidney failure.

Five deaths were reported from Arkansas, California, Minnesota (2), and New York.

Here is what the FDA has told us all as of May 31, 2018:

Epidemiologic, laboratory, and traceback evidence indicated that romaine lettuce from the Yuma growing region was the likely source of this outbreak.

The FDA and state and local regulatory officials traced the romaine lettuce to many farms in the Yuma growing region. The FDA, along with CDC and state partners, started an environmental assessment in the Yuma growing region and collected samples of water, soil, and manure. CDC laboratory testing identified the outbreak strain of E. coli O157:H7 in water samples taken from a canal in the Yuma growing region.

Here is what we have figured out through litigation to date.  More information will be added in the coming weeks:

We are now investigating the following outbreak that seemed to fall a bit below the radar.

Authors: Amelia Keaton, R. Hassan, S. Luna, I. Lee, R. Magalhaes, M. Bidlack, L. Smith, R. Maves, D. Freer, K. Flinn, G. Monk, P. Graf, K. Trinh, J. Crandall, D. Noveroske, G. Fortenberry, L. Ramos, R. Recio, C. Peak, E. McDonald, T. Waltz, K. Patel, D. Wagner, J. Espiritu, L. Christensen, L. Gieraltowski

Background: Shiga toxin-producing Escherichia coli (STEC) infections are a substantial cause of foodborne illness and a cause of hemolytic-uremic syndrome (HUS). In November 2017, CDC assisted the US Navy in a response to an outbreak of STEC illnesses in recruits at a Marine Corps Recruit Depot in San Diego (MCRD). We investigated to determine the source of this outbreak and identify prevention and mitigation measures.

Methods: In October 2017, medical providers identified a high number of gastrointestinal (GI) illnesses at MCRD. Recruits with diarrhea submitted stool specimens for culture and/or culture-independent diagnostic testing (CIDT) for GI pathogens. We performed pulsed-field gel electrophoresis (PFGE) on culture isolates. Case-patients were then defined as follows: confirmed (PFGE-confirmed STEC infection matching outbreak strains), probable (diagnosis of HUS and/or CIDT evidence of STEC), and suspected (bloody diarrhea). We conducted environmental evaluations of facilities, training areas, and barracks. A case-control study was performed using PFGE-confirmed case-patients and platoon-matched controls. We performed product traceback for foods identified as exposure risks by interview or case-control study.

Results: We identified 62 confirmed, 62 probable, and 120 suspected case-patients. Thirty case-patients required hospitalization and 15 had HUS. Case-patient ages ranged from 17-28 years (median: 18 years). Poor hygiene practices among recruits and inconsistent cooking temperatures within dining facilities were noted. Forty-three case-patients and 135 controls were interviewed about food, hygiene, and environmental exposures. Consumption of undercooked beef was found to be significantly associated with illness, (mOR 2.40, CI 1.04-5.72, p=0.04). We identified a single ground beef supplier for MCRD, but MCRD records did not document which specific lots of ground beef were used.

Conclusions: Case-control analysis and environmental observations suggested undercooked ground beef as a potential source for this outbreak. We recommended the Navy and Marine Corps retain lot information, address food handling concerns, and improve hygiene among recruits.

REF:  https://www.cdc.gov/eis/downloads/eis-conference-2018-508.pdf, page 117

Pepperidge Farm has been notified by one of its ingredient suppliers that whey powder in a seasoning that is applied to four varieties of crackers has been the subject of a recall by the whey powder manufacturer due to the potential presence of Salmonella.  Pepperidge Farm initiated an investigation and, out of an abundance of caution, is voluntarily recalling four varieties of Goldfish crackers. The products were distributed throughout the United States. No illnesses have been reported. No other Pepperidge Farm products in the U.S. are subject to this recall.

The following four varieties with the indicated codes are subject to this recall:

  • Flavor Blasted® Xtra Cheddar
  • Flavor Blasted® Sour Cream & Onion
  • Goldfish® Baked with Whole Grain Xtra Cheddar
  • Goldfish® Mix Xtra Cheddar + Pretzel

As a precautionary measure, Flowers Foods, Inc. (NYSE: FLO) is voluntarily recalling Swiss Rolls sold under the brand names Mrs. Freshley’s, Food Lion, H-E-B, Baker’s Treat, Market Square, and Great Value, distributed nationwide, and Captain John Derst’s Old Fashioned Bread distributed in Alabama, Florida, Georgia, North Carolina, and South Carolina, due to the potential presence of Salmonella in an ingredient, whey powder. The ingredient recall was initiated by a third-party whey powder manufacturer and supplier. No illnesses have been reported in connection with the recalled items. See below for list of UPC #s and “best by” dates.

The recalled products are:

BRAND UPC # BEST BY / ENJOY BY DATES
Mrs. Freshley’s – 4 ct./7.2 oz. 072250011907 10/09/18 through 10/19/18 309 8187 A 75 D
309 8187 B 75 D
309 8190 C 75 D
309 8194 B 75 D
309 8194 C 75 D
Mrs. Freshley’s – 6 ct./12 oz. 072250903233 10/14/18
309 8194 B 75 D
Food Lion – 6 ct./13 oz. 035826092779 10/16/18
H-E-B – 6 ct./12 oz. 041220296583 09/19/18
Baker’s Treat – 6 ct./13 oz. 041498188382 09/21/18 through 09/28/18
Market Square – 6 ct./12 oz. 087381760556 309 8194 B
Great Value – 6 ct./13 oz. 078742147550 Sep 17 2018 Through Sep 25 2018
309 8191 B
Captain John Derst’s
Old Fashioned Bread
071316001180 07/16/18 through 7/28/18

Mondelēz Global LLC announced today a voluntary recall in the United States, including Puerto Rico & the U.S. Virgin Islands, of certain Ritz Cracker Sandwiches and Ritz Bits productThese products contain whey powder as an ingredient, which the whey powder supplier has recalled due to the potential presence of Salmonella.

This recall is limited exclusively to the products listed in the grid below, available at retail stores nationwide. No other Mondelēz Global LLC product is included in this recall.

Description Retail UPC Best When Used By Dates Package Image
RITZ BITS CHEESE
BIG BAG
3 OZ
0 44000 00677 8 07 MAR 19
Thru
13 APR 19
SEE IMAGE BELOW
RITZ BITS CHEESE
1 OZ
0 44000 02025 5 07 MAR 19
Thru
13 APR 19
SEE IMAGE BELOW
RITZ BITS CHEESE
12 PACK CARTON
0 44000 02032 3 08 MAR 19
thru
13 APR 19
SEE IMAGE BELOW
RITZ BITS CHEESE
30 PACK CARTON
0 44000 01309 7 03 MAR 19
thru
13 APR 19
SEE IMAGE BELOW
RITZ BITS CHEESE
1.5 OZ
0 44000 00929 8 03 MAR 19
thru
13 APR 19
SEE IMAGE BELOW
RITZ BITS CHEESE
3 OZ GO PACKS
0 44000 03215 9 07 MAR 19
thru
12 APR 19
SEE IMAGE BELOW
10.8 OZ RITZ CHEESE CRACKER SANDWICHES 0 44000 88211 2 14 JAN 19
thru
11 FEB 19
SEE IMAGE BELOW
1.35 OZ RITZ CHEESE CRACKER SANDWICHES 0 44000 00211 4 14 JAN 19
thru
11 FEB 19
SEE IMAGE BELOW
10.8 OZ RITZ BACON CRACKER SANDWICHES
WITH CHEESE
0 44000 04566 1 05 FEB 19
06 FEB 19
SEE IMAGE BELOW
1.35 OZ RITZ BACON CRACKER SANDWICHES
WITH CHEESE
0 44000 04567 8 05 FEB 19
thru
06 FEB 19
SEE IMAGE BELOW
10.8 OZ RITZ WHOLE WHEAT CRACKER
SANDWICHES WITH WHITE CHEDDAR CHEESE
0 44000 04577 7 04 FEB 19
05 FEB 19
SEE IMAGE BELOW
1.35 OZ RITZ WHOLE WHEAT CRACKER
SANDWICHES WITH CREAM CHEESE
0 44000 04580 7 06 FEB 19 07 FEB 19
08 FEB 19
SEE IMAGE BELOW
1.35 OZ RITZ EVERYTHING CRACKER
SANDWICHES WITH CREAM CHEESE
0 44000 04580 7 06 FEB 19
07 FEB 19
08 FEB 19
SEE IMAGE BELOW
MIXED COOKIE CRACKER VARIETY
20 PACK
0 44000 04100 7 01 FEB 19
thru
04 FEB 19
SEE IMAGE BELOW
MIXED COOKIE CRACKER VARIETY
40 PACK
0 44000 04221 0 31 JAN 19
thru
05 FEB 19
SEE IMAGE BELOW

As of July 13, 2018, 212 people infected with the outbreak strains of Salmonella have been reported from 44 states.

  • Illnesses started from February 15, 2018 to June 21, 2018.
  • 34 ill people have been hospitalized, and no deaths have been reported.
  • 26% of ill people are children younger than 5 years.

Epidemiologic, traceback, and laboratory findings link these outbreaks to contact with live poultry, such as chicks and ducklings, which come from multiple hatcheries.

  • In interviews, 100 (72%) of 138 ill people with information available reported contact with chicks or ducklings in the week before their illness started.
  • People reported obtaining chicks and ducklings from several sources, including feed supply stores, websites, hatcheries, and from relatives.

WGS analysis to identify antibiotic resistance was performed for 118 isolates from ill people in this outbreak. Twenty-two isolates from ill people contained genes expected to cause resistance or decreased susceptibility to all or some of the following antibiotics: ampicillin, streptomycin, sulfamethoxazole, tetracycline, gentamicin, ceftriaxone, amoxicillin-clavulanic acid, cefoxitin, ciprofloxacin, and fosfomycin. Ninety-six isolates did not identify predicted resistance. Testing of 5 outbreak isolates using standard antibiotic susceptibility testing by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory confirmed these results. Some infections may be difficult to treat with commonly recommended antibiotics, and may require another kind of antibiotic.

Here is a good reminder:

This year’s FoodNet report summarizes 2017 preliminary surveillance data and describes trends since 2006 for infections caused by the following pathogens monitored by FoodNet: Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC), Shigella, Vibrio, Yersinia. The report also summarizes cases of hemolytic uremic syndrome (HUS) for 2016, the most recent year for which those data are available.

  • In 2017, FoodNet received reports of 24,484 illnesses, 5,677 hospitalizations, and 122 deaths in its surveillance area, which includes 15% of the U.S. population.
  • The incidence of infections per 100,000 people was highest for Campylobacter and Salmonella, which is similar to previous years.
  • The number of infections diagnosed by CIDT, a newer type of test, is increasing. The overall number of Campylobacter, Listeria, Salmonella, Shigella, Vibrio, and Yersinia infections diagnosed by CIDT increased 96% in 2017 compared with the 2014–2016 average.
  • CIDTs are revealing many infections – such as those caused by Cyclospora, Yersinia, Vibrio, and STEC non-O157 – that would not have been diagnosed before because of limited testing. CIDTs are fast and easy to use, and they detect some illnesses that would have otherwise been missed. However, CIDTs also challenge our ability to find outbreaks and monitor disease trends, because they do not provide certain information needed to characterize organisms that cause infections. For example, some information about the bacteria that cause infections, such as subtype and antimicrobial susceptibility, can be obtained only if a CIDT-positive specimen is cultured. FoodNet is gathering information to better understand the effect of CIDTs on surveillance.
  • The incidence of Salmonella infections overall did not change significantly, but there were significant changes among serotypes:
  • The incidence of infections caused by serotypes Typhimurium and Heidelberg has been decreasing since 2006–2008, with overall declines of more than 40% for both. Infections cause by serotypes Javiana, Thompson, and Infantis have all increased by more than 50% since 2006–2008.
  • Infections caused by STEC O157 have decreased in the past 10 years. The increasing use of CIDTs makes interpretation of trends in STEC infections difficult because CIDTs do not indicate which STEC serogroup caused the infection. The incidence of HUS among children younger than 5 years decreased during 2016 compared with 2006–2008. Because most cases of HUS are caused by STEC O157, the decline in HUS provides evidence that supports the finding of the decline in STEC O157 cases.

 

Ninety people infected with the outbreak strain of Salmonella Reading have been reported from 26 states. Forty people have been hospitalized. The outbreak strain of Salmonella Reading has been identified in samples from raw turkey pet food in Minnesota, from raw turkey products from 19 slaughter and 6 processing establishments, and from live turkeys from several states.

The samples collected by FSIS at these slaughter and processing establishments were part of FSIS’ routine testing under the Salmonella performance standards. Furthermore, WGS showed that the Salmonella strain from these samples is closely related genetically to the Salmonella strain from ill people.  This result provides more evidence that people in this outbreak got sick from preparing raw turkey products.

Yesterday I suggested that the FDA’s Dr. Scott Gottlieb should be a bit more transparent on who produced, processed, transported and sold the E. coli tainted romaine.  Today, the FDA notes that retailers are still selling Salmonella tainted Kellogg’s Honey Smacks cereal (See below)

The FDA has become aware that recalled Kellogg’s Honey Smacks cereal are still being offered for sale. All Honey Smacks cereal was recalled in June 2018. Retailers cannot legally offer the cereal for sale and consumers should not purchase Kellogg’s Honey Smacks cereal. The FDA has learned that some retailers are still selling this product. The FDA will continue to monitor this situation closely and follow up with retailers as we become aware of recalled products being offered for sale.

As of July 12, 2018, 100 people infected with the outbreak strain of Salmonella Mbandaka have been reported from 33 states.

Illnesses started on dates from March 3, 2018, to July 2, 2018. Ill people range in age from less than one year to 95, with a median age of 57. Of ill people, 68% are female. Out of 77 people with information available, 30 (39%) have been hospitalized. No deaths have been reported.

Illnesses that occurred after June 19, 2018, might not yet be reported due to the time it takes between when a person becomes ill and when their illness is reported. This takes an average of 2 to 4 weeks.

State and local health officials continue to interview ill people and ask questions about the foods they ate and other exposures in the week before they became ill. Fifty-five (85%) of 65 people interviewed reported eating cold cereal. In interviews, 43 people specifically reported eating Kellogg’s Honey Smacks cereal. Ill people in this outbreak reported this cereal more often than any other cereals or food items.

Health officials in several states collected Kellogg’s Honey Smacks cereal from retail locations and ill people’s homes for testing. Laboratory testing identified the outbreak strain of Salmonella Mbandaka in a sample of unopened Kellogg’s Honey Smacks cereal collected from a retail location in California. Laboratory testing also identified the outbreak strain in samples of leftover Kellogg’s Honey Smacks cereal collected from the homes of ill people in Montana, New York, and Utah.

The Kellogg Company recalled all Honey Smacks products that were on the market within the cereal’s one-year shelf-life. However, Honey Smacks products with earlier dates could also potentially be contaminated. Do not eat Kellogg’s Honey Smacks cereal of any size package or with any “best if used by” date.

Dr. Gottlieb it is past time for the FDA – especially during an outbreak and recall situation – to make the supply chain transparent.

Here is what the FDA has told the public thus far about the source of the 2018 Yuma Romaine Lettuce Outbreak that has sickened over 200 in the US and Canada and killed 5 in the US:

Eventually, at least for the 105 people who have hired us, we will fill in all the blanks.  I must admit as someone interested in food safety and transparency, having a lawyer in Seattle fill in the blanks that the FDA should is not how it should be.  The time has come for the FDA to reassess what are considered “trade secrets” or “confidential.”  FSIS did it a decade ago and the sky did not fall.