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228 People in 22 States Sickened in Ongoing Salmonella-Tomato Outbreak

Meanwhile, Congressional report faults FDA on food safety

THURSDAY, June 12 (HealthDay News) -- The number of people sickened in the ongoing outbreak of salmonella-contaminated tomatoes has risen to 228 in 22 states, with 25 hospitalizations, U.S. health officials reported Thursday.

Also Thursday, Congressional investigators said the U.S. Food and Drug Administration has failed to meet its own stated goals of protecting the nation's food supply.

The investigators for the Government Accountability Office (GAO) were scheduled to tell the House of Representatives' Energy and Commerce Committee that the FDA has done little to implement its "food protection plan," which the agency released in November, The New York Times reported.

"In March 2008, FDA officials indicated that a progress report on actions taken to implement the 'food protection plan' would be issued in April 2008. In May, FDA officials told us that they had prepared a draft progress report, but as of June 4, 2008, FDA had not made this report public.

The food protection plan calls for establishing a risk-based inspection system of food plants, "which is particularly important as the numbers of food firms have increased while inspections have decreased," the accountability office report said, according to the Times.

The release of the GAO report came at the same time that federal health officials said they were zeroing in on a source for the recent outbreak of salmonella from contaminated tomatoes, while the number of cases continues to mount.

"The question is where specifically did these tomatoes come from," Dr. David Acheson, associate commissioner for foods at the U.S. Food and Drug Administration, said during a teleconference Wednesday. "We're getting very close, but at this point, today, we don't know for sure where they did come from."

Parts of Florida are still under investigation, although northern Florida, which was not harvesting at the time the outbreaks began, has been ruled out as a source for the contamination.

Several other states have been excluded but, beyond that, Acheson said, "anywhere else is essentially open for question in terms of whether that is the source."

On Thursday, FDA officials said the number of people sickened during the outbreak had risen to 228 in 22 states, with 25 people hospitalized.

The death of a man in Texas who died is still being investigated, Dr. Ian Williams, chief of the OutbreakNet Team at the U.S. Centers for Disease Control and Prevention, said during Wednesday's teleconference. The man had cancer and consumed pico de gallo, which is made with tomatoes.

The actual number of people infected is likely to be many more, Williams said. "Many people with salmonella infection don't have stool specimen tests," he said.

On Tuesday, the warning about salmonella-contaminated tomatoes was expanded to include the entire country.

The outbreak was first identified in May with a cluster of approximately 20 people in New Mexico infected with salmonella which had the same genetic footprint. Another cluster was then identified in Texas.

Officials were then able to trace the outbreak to contaminated tomatoes.

The particular type of salmonella involved, Salmonella Saintpaul, is virulent and relatively rare, accounting for only about 400 reported cases annually in the United States, Williams said.

Acheson reiterated that the outbreak of salmonella contamination seems to be linked with certain types of raw, red tomatoes and products containing these tomatoes. In particular, the agency said, raw, red plum tomatoes, raw, red Roma tomatoes and raw, round red tomatoes should be avoided at this time.

Cherry tomatoes, grape tomatoes, homegrown tomatoes and tomatoes sold with the vine still attached appear to be safe. But all tomatoes should be washed before eating, officials advised.

And, until a source for the outbreak is identified, consumers need to employ a little detective work before consuming tomatoes or tomato products.

"The best advice right now is to be extremely careful in trying to find out exactly where the tomatoes they're purchasing are from," said Tony Corbo, legislative representative for Food & Water Watch, a Washington, D.C.-based nonprofit consumer group that works to ensure clean water and safe food.

"The other problem with tomatoes is that they have shown up in restaurants and in salsa. So, maybe for the time being, consumers should stay away from anything that is processed," Corbo said.

On Tuesday, FDA officials also recommended that retailers, restaurants and other food service operators not offer raw, red Roma, raw, red plum, and raw, red round tomatoes unless they are from sources that have not been associated with the outbreak. If unsure of where tomatoes were grown or harvested, consumers are encouraged to contact the store where the tomato purchase was made, the agency said.

Several large fast food, restaurant and grocery chains, including McDonald's, Wal-Mart, Burger King, Kroger and Outback Steakhouse, have voluntarily withdrawn red plum, red Roma or round red tomatoes not grown in certain states and countries. Also, the Los Angeles Unified School District has suspended serving raw tomatoes, the AP said.

The FDA recommends consuming raw, red plum, raw, red Roma or raw, red round tomatoes only if grown and harvested from these areas: Alabama, Arkansas, California, Georgia, Hawaii, Louisiana, Maine, Maryland, Minnesota, Mississippi, New York, Nebraska, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, West Virginia, Belgium, Canada, the Dominican Republic, Guatemala, Israel, the Netherlands and Puerto Rico.

States reporting illnesses linked to the outbreak include: Arizona, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, New Mexico, Missouri, New York, Oklahoma, Oregon, Tennesse, Texas, Utah, Vermont, Virginia, Washington, and Wisconsin, the FDA said.

Salmonella is a bacteria that can cause bloody diarrhea in humans. Some 40,000 cases of salmonellosis are reported in the United States each year, although the CDC estimates that because milder cases are not diagnosed or reported, the actual number of infections may be 30 or more times greater. Approximately 600 people die each year after being infected.

Also Thursday, a poll released by the Harvard School of Public Health's Project on the Public and Biological Security found that, despite the number of food safety incidents in recent years, most Americans are confident that the food produced in the United States is safe. However, many have concerns about the safety of imported food produced in some other countries. They also do not have high levels of confidence in parts of the U.S. food safety system and some of the organizations involved.

The poll found that a majority of Americans believe that the food produced in the United States is either very (37 percent) or somewhat (58 percent) safe. Only 4 percent thought U.S.-produced foods were unsafe. When asked about foods available in the United States but produced in other countries, fewer than one in 10 (6 percent) considered foods from Canada to be unsafe. Conversely, almost half of Americans (47 percent) thought food from Mexico was unsafe, and 56 percent thought the same about food from China.

Although most Americans see U.S.-produced food as relatively safe, they do have some reservations about the groups involved in food production and provision. Majorities have only some or very little confidence in meat producers (58 percent) or restaurants (55 percent) to keep food safe, while substantial minorities say this about grocery stores (41 percent) and fruit and vegetable growers (39 percent). Also, Americans have some concerns about the government food inspection system: 52 percent have only some or very little confidence in the inspection system to keep food safe, the poll found.

More information

Visit the U.S. Centers for Disease Control and Prevention for more on the current salmonella outbreak.

SOURCES: Tony Corbo, legislative representative, Food & Water Watch, Washington, D.C.; June 11, 2008 teleconference with David Acheson, M.D., associate commissioner for foods, U.S. Food and Drug Administration, and Ian Williams, M.D., chief, OutbreakNet Team, U.S. Centers for Disease Control and Prevention; June 12, 2008, news release, Harvard School of Public Health, Boston

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