Multistate Outbreak of Salmonella Typhimurium Linked to Chicken Salad (Final Update)
Posted April 16, 2018 4:45 PM ET
This outbreak appears to be over. However, Salmonella is an important cause of illness in the United States. For more information about Salmonella and steps that people can take to reduce their risk of infection, visit CDC’s Salmonella webpage.
- Read the Recall and Advice to Consumers, Retailers, and Restaurants>>
- This outbreak appears to be over.
- On February 21, 2018, Triple T Specialty Meats, Inc. recalledExternal all chicken salad produced from January 2, 2018 to February 7, 2018. The recalled chicken salad was sold in containers of various weights from the deli at Fareway grocery stores in Illinois, Iowa, Minnesota, Nebraska, and South Dakota from January 4, 2018, to February 9, 2018.
- CDC recommends people do not eat any remaining recalled chicken salad sold at Fareway grocery stores, including any that has been frozen. Throw it away or return it to the place of purchase.
- Even if some of the chicken salad was eaten or served and no one got sick, throw the rest of it away, including any chicken salad in your freezer. Put it in a sealed bag in the trash so that children, pets or other animals can’t eat it.
- Wash and sanitize countertops as well as drawers or shelves in refrigerators or freezers where recalled chicken salad was stored.
- If you don’t remember the date when you purchased chicken salad from Fareway, don’t eat it. Throw it away or return it to the place of purchase.
- CDC, public health and regulatory officials in several states, and the U.S. Department of Agriculture’s Food Safety and Inspection Service investigated a multistate outbreak of Salmonella Typhimurium infections.
- 265 people infected with the outbreak strains of Salmonella Typhimurium were reported from 8 states.
- 94 hospitalizations were reported, including one person from Iowa who died.
- Epidemiologic, laboratory, and traceback evidence indicated that chicken salad produced by Triple T Specialty Meats, Inc. and sold at Fareway grocery stores was the likely source of this multistate outbreak.
Introduction
CDC collaborated with public health and regulatory officials in several state and the U.S. Department of Agriculture’s Food Safety and Inspection Service to investigate a multistate outbreak of Salmonella Typhimurium infections.
Public health investigators used the PulseNet system to identify illnesses that were part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting was performed on Salmonella bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE.
A total of 265 people infected with the outbreak strains of Salmonella Typhimurium were reported from 8 states. A list of the states and the number of cases in each can be found on the Case Count Map page. WGS performed on bacteria isolated from ill people showed that they were closely related genetically. This means that people in this outbreak were more likely to share a common source of infection.
Illnesses started on dates ranging from January 8, 2018, to March 20, 2018. Ill people ranged in age from less than 1 year to 89 years, with a median age of 57. Sixty-seven percent of people were female. Ninety-four hospitalizations were reported, including one person from Iowa who died.
WGS analysis did not identify predicted antibiotic resistance in 112 of 127 isolates (110 samples from ill people and 2 from food). Fifteen isolates from ill people contained genes for resistance to all or some of the following antibiotics: amoxicillin-clavulanic acid, ampicillin, cefoxitin, ceftriaxone, gentamicin, streptomycin, sulfamethoxazole, and tetracycline. This resistance is unlikely to affect the treatment of most people, but some infections might be difficult to treat with antibiotics usually prescribed and may require a different antibiotic. Standard antibiotic resistance testing methods were used by CDC’s National Antimicrobial Resistance Monitoring System laboratory on clinical isolates from three ill people in this outbreak. These isolates were not resistant to any antibiotics tested.
Investigation of the Outbreak
Epidemiologic, laboratory, and traceback evidence indicated that chicken salad produced by Triple T Specialty Meats, Inc. and sold at Fareway grocery stores was the likely source of this multistate outbreak.
Public health officials in IowaExternal first detected this outbreak and linked the illnesses to chicken salad sold at Fareway grocery stores. CDC searched the PulseNet database and identified illnesses in other states, and those illnesses were added to this outbreak. In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Of 222 people interviewed, 194 (87%) reported eating chicken salad purchased from Fareway grocery stores. Triple T Specialty Meats, Inc. produced the chicken salad that ill people reported eating.
On February 9, 2018, Fareway stopped selling chicken salad in all of its stores after the Iowa Department of Inspections and Appeals contacted the company about the illnesses. The Iowa Department of Public Health and the Iowa Department of Inspections and Appeals issued a consumer advisory on February 13, 2018 warning that chicken salad sold at Fareway may be contaminated with Salmonella.
Investigators in Iowa collected chicken salad from two Fareway grocery store locations in Iowa for laboratory testing. An outbreak strain of Salmonella Typhimurium was identified in both samples.
On February 21, 2018, Triple T Specialty Meats, Inc. recalledExternal all chicken salad produced from January 2, 2018 to February 7, 2018. The recalled chicken salad was sold in containers of various weights from the deli at Fareway grocery stores in Iowa, Illinois, Minnesota, Nebraska, and South Dakota from January 4, 2018 to February 9, 2018.
As of April 6, 2018, this outbreak appears to be over.
Previous Announcements
Case Count Update
105 more ill people from 6 states were added to this investigation since the last update on February 22, 2018.
As of March 6, 2018, 170 people infected with the outbreak strains of Salmonella Typhimurium have been reported from 7 states. A list of the states and the number of cases in each can be found on the Case Count Map page.
Illnesses started on dates ranging from January 8, 2018, to February 18, 2018. Ill people range in age from 7 to 89 years, with a median age of 59. Sixty-six percent of ill people are female. 62 hospitalizations and no deaths have been reported.
Illnesses that occurred after February 12, 2018, might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of two to four weeks.
WGS analysis did not identify predicted antibiotic resistance in 67 of 72 isolates (70 ill people and 2 food samples). Five isolates from ill people contained genes for resistance to all or some of the following antibiotics: amoxicillin-clavulanic acid, ampicillin, cefoxitin, ceftriaxone, gentamicin, streptomycin, sulfamethoxazole, and tetracycline. This resistance is unlikely to affect the treatment of most people, but some infections might be difficult to treat with antibiotics usually prescribed and may require a different antibiotic. Testing of outbreak isolates using standard antibiotic susceptibility testing methods is currently underway in CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory.
Investigation Update
State and local health officials continue to interview ill people to ask about the foods they ate and other exposures in the week before they became ill. Of 159 people interviewed, 131 (82%) reported eating chicken salad from Fareway stores. Triple T Specialty Meats, Inc. produced the chicken salad that ill people reported eating.
It takes an average of two to four weeks from when a person becomes ill with Salmonella to when the illness is reported to CDC or health officials. Because of this reporting lag, the additional 105 people added to this investigation likely became ill from eating chicken salad recalledExternal by Triple T Specialty Meats, Inc. which is no longer available for purchase. The last reported illness began on February 18, 2018.
CDC recommends that people do not eat recalled chicken salad. Throw it away or return it to the place of purchase. This investigation is ongoing and we will provide updates when more information is available.
February 22, 2018
CDC, public health and regulatory officials in several states, and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS)External are investigating a multistate outbreak of Salmonella Typhimurium infections.
Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is performed on Salmonella bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE.
As of February 21, 2018, 65 people infected with the outbreak strain of Salmonella Typhimurium have been reported from 5 states. A list of the states and the number of cases in each can be found on the Case Count Map page. WGS performed on bacterial isolates from ill people showed that they were closely relatedly genetically. This means that people in this outbreak are more likely to share a common source of infection.
Illnesses reported by investigators in Iowa also included ill people who reported eating chicken salad from a Fareway store and who had a diagnostic test showing they were infected with Salmonella bacteria. CDC is not including these people in the outbreak case count until DNA fingerprinting can link their illnesses to the outbreak. Some people may not be included because no bacterial isolates are available for DNA fingerprinting.
Illnesses started on dates ranging from January 8, 2018 to February 10, 2018. Ill people range in age from 11 to 89 years, with a median age of 57. Forty-two people are female. Twenty-eight hospitalizations have been reported. No deaths have been reported.
This outbreak can be illustrated with a chart showing the number of people who became ill each day. This chart is called an epidemic curve, or epi curve. Illnesses that occurred after February 5, 2018, might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 4 weeks. Please see the Timeline for Reporting Cases of Salmonella Infection for more details.
WGS analysis did not identify predicted antibiotic resistance in 19 isolates from 20 ill people. One isolate contained a gene for resistance to tetracycline, an antibiotic which is not commonly used to treat patients with Salmonella infection. Testing of outbreak isolates using standard antibiotic susceptibility testing methods is currently underway in CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory.
Investigation of the Outbreak
Epidemiologic and laboratory evidence indicates that chicken salad produced by Triple T Specialty Meats, Inc. and sold at Fareway grocery stores is the likely source of this multistate outbreak.
Public health officials in IowaExternal first detected this outbreak and linked the illnesses to chicken salad sold at Fareway grocery stores. CDC searched the PulseNet database and identified illnesses in other states, and those illnesses have been added to this outbreak. In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Forty-five (78%) of 58 people interviewed reported eating chicken salad from Fareway stores. Triple T Specialty Meats, Inc. produced the chicken salad that ill people reported eating. Public health officials continue to interview ill people in other states to learn more about what they ate in the week before becoming sick.
On February 9, 2018, Fareway stopped selling chicken salad in all of its stores after the Iowa Department of Inspections and Appeals contacted the company about the illnesses. Iowa Department of Public Health and the Iowa Department of Inspections and Appeals then issued a consumer advisory on February 13, 2018 warning that chicken salad sold at Fareway may be contaminated with Salmonella.
Investigators in Iowa collected chicken salad from two Fareway grocery store locations in Iowa for laboratory testing. The outbreak strain of Salmonella Typhimurium was identified in both samples.
On February 21, 2018, Triple T Specialty Meats, Inc. recalledExternal all chicken salad produced from January 2, 2018 to February 7, 2018. The recalled chicken salad was sold in containers of various weights from the deli at Fareway grocery stores in Iowa, Illinois, Minnesota, Nebraska, and South Dakota from January 4, 2018 to February 9, 2018. CDC recommends that people do not eat recalled chicken salad. Throw it away or return it to the place of purchase. This investigation is ongoing and we will provide updates when more information is available.