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Tracking Down a Salmonella Outbreak

CDC report details how health officials first spotted, chased down source and spread of tainted peanut product

FRIDAY, Jan. 30 (HealthDay News) -- The salmonella outbreak that has now sickened 529 people began as a blip on U.S. health-monitoring radar.

Officials with the U.S. Centers of Disease Control and Prevention report that the problem first showed up as a small multi-state cluster of a strain of the bacteria on Nov. 10 of last year. It took the search party until Dec. 28 to narrow the possible target to peanut products being served in institutions.

In between, according to the detailed account in the Jan. 29 early release issue of the CDC publication, Morbidity and Mortality Weekly Report, the problem grew, as reports of illnesses did likewise.

That led to this week, and one of the largest recalls in U.S. history: U.S. Food and Drug Administration officials on Wednesday recalled every single peanut product made in the last two years at a Georgia facility owned by Peanut Corp. of America.

Now, the real search begins.

As of Jan. 28, at least 431 peanut butter containing products had been recalled by 54 companies that had used ingredients produced at the Peanut Corp. facility after July 1, 2008, according to the CDC documents.

Now, FDA inspectors must tackle the monumental task of tracking and removing products that were sent, by their own accounts, to 2,100 different locations.

The problem is compounded by the fact that most of the products are not whole products sitting on store shelves. In fact, jars of plain-old peanut butter are safe to consume, since they were not made at the plant. However, Peanut Corp. supplied institutions and others with product that was used mainly for making other products, everything from candy and cookies to dog biscuits, ice cream and peanut butter crackers.

"There is a lot of work in finding out what is causing an outbreak," CDC epidemiologist and report co-author Dr. Casey Barton Behravesh said.

"Once a cluster or outbreak is identified, we call people and ask a lot of questions about foods they may have eaten or other types of exposures that have been linked to illness in the past," she explained.

In the current outbreak, hundreds of CDC and state health department officials talked with hundreds of people, Barton Behravesh noted: "We were making hundreds and hundreds of phone calls."

CDC officials first noticed on Nov. 10 of last year that there was an uptick in the number of cases of Salmonella Typhimurium; 13 cases in several states, to be exact. On Nov. 25, the CDC began an epidemiological investigation. By Nov. 24, 41 cases had been reported.

In late December, the Minnesota Department of Health had narrowed their investigation to institutions where peanut butter from King Nut was served. On Jan. 9, the Minnesota investigators found the suspected strain in an open container of King Nut peanut butter.

The peanut butter was traced to Peanut Corp. of America and its plant in Blakely, Ga. On Jan. 9, the company stopped production of all peanut products. On Jan. 16, it issued a recall of products produced since July 1, 2008. That recall has now been extended to products produced in the plant going back to Jan. 1, 2007.

Meanwhile, on Jan. 16, Connecticut health officials found the outbreak strain in an unopened can of King Nut peanut butter. In late January, a study by the CDC had determined that contamination was also likely in other foods.

The bad news is that, despite the outbreak appearing to be on the wane, the illnesses haven't ended, even though the death toll still stands at eight victims.

"This was definitely a successful outbreak investigation," Barton Behravesh said. "But we are still working on it. We are still continuing surveillance and identifying new cases, though in not the large numbers we were seeing previously."

And while U.S. health officials expect more victims to surface in the United States and Canada as the search for tainted product continues, the CDC document reveals that the problem may actually be much more widespread than that.

A footnote to the document lays out the full scope: "As of Jan. 27, 2009, FDA was aware of distribution in the following countries and non-U.S. territories: Aruba, Australia, the Bahamas, Bermuda, Canada, the Cayman Islands, Haiti, Italy, Jamaica, Japan, Korea, Malaysia, Mexico, the Netherlands, New Zealand, Norway, St. Maarten, St. Vincent and the Grenadines, Singapore, Slovenia, Spain, the Turks and Caicos Islands, and the United Kingdom."

Meanwhile, the Associated Press reported Friday that peanuts exported by Peanut Corp. were found in Canada to be contaminated and returned to the United States several weeks before the current outbreak began.

The rejected shipment, from the now-shuttered plant, came across a bridge from Canada to New York state in mid-September. The shipment was "logged by the Food and Drug Administration but never was tested by federal inspectors, according to the government's own records," the AP reported.

The chopped peanuts were prevented by the FDA from being allowed back into the United States because the nuts contained an unspecified "filthy, putrid or decomposed substance, or is otherwise unfit for food," according to an FDA report of the incident, the news service said.

More information

The U.S. Food and Drug Administration Web site lists these recalled products.

And there is a growing list of products determined to be safe at the American Peanut Council.

SOURCES: Casey Barton Behravesh, epidemiologist, U.S. Centers for Disease Control and Prevention, Atlanta; Jan. 29, 2009, Morbidity and Mortality Weekly Report

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