title: 2008 outbreak of Salmonella Saintpaul infections associated with raw produce.
abstract: BACKGROUND
  Raw produce is an increasingly recognized vehicle for salmonellosis. We investigated a nationwide outbreak that occurred in the United States in 2008.
  
  
  METHODS
  We defined a case as diarrhea in a person with laboratory-confirmed infection with the outbreak strain of Salmonella enterica serotype Saintpaul. Epidemiologic, traceback, and environmental studies were conducted.
  
  
  RESULTS
  Among the 1500 case subjects, 21% were hospitalized, and 2 died. In three case-control studies of cases not linked to restaurant clusters, illness was significantly associated with eating raw tomatoes (matched odds ratio, 5.6; 95% confidence interval [CI], 1.6 to 30.3); eating at a Mexican-style restaurant (matched odds ratio, 4.6; 95% CI, 2.1 to ∞) and eating pico de gallo salsa (matched odds ratio, 4.0; 95% CI, 1.5 to 17.8), corn tortillas (matched odds ratio, 2.3; 95% CI, 1.2 to 5.0), or salsa (matched odds ratio, 2.1; 95% CI, 1.1 to 3.9); and having a raw jalapeño pepper in the household (matched odds ratio, 2.9; 95% CI, 1.2 to 7.6). In nine analyses of clusters associated with restaurants or events, jalapeño peppers were implicated in all three clusters with implicated ingredients, and jalapeño or serrano peppers were an ingredient in an implicated item in the other three clusters. Raw tomatoes were an ingredient in an implicated item in three clusters. The outbreak strain was identified in jalapeño peppers collected in Texas and in agricultural water and serrano peppers on a Mexican farm. Tomato tracebacks did not converge on a source.
  
  
  CONCLUSIONS
  Although an epidemiologic association with raw tomatoes was identified early in this investigation, subsequent epidemiologic and microbiologic evidence implicated jalapeño and serrano peppers. This outbreak highlights the importance of preventing raw-produce contamination.
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. cbartonbehravesh@cdc.gov
authors.forename: Casey
authors.initials: C
authors.lastname: Barton Behravesh
authors.forename: Rajal K
authors.initials: RK
authors.lastname: Mody
authors.forename: Jessica
authors.initials: J
authors.lastname: Jungk
authors.forename: Linda
authors.initials: L
authors.lastname: Gaul
authors.forename: John T
authors.initials: JT
authors.lastname: Redd
authors.forename: Sanny
authors.initials: S
authors.lastname: Chen
authors.forename: Shaun
authors.initials: S
authors.lastname: Cosgrove
authors.forename: Erin
authors.initials: E
authors.lastname: Hedican
authors.forename: David
authors.initials: D
authors.lastname: Sweat
authors.forename: Lina
authors.initials: L
authors.lastname: Chávez-Hauser
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Snow
authors.forename: Heather
authors.initials: H
authors.lastname: Hanson
authors.forename: Thai-An
authors.initials: TA
authors.lastname: Nguyen
authors.forename: Samir V
authors.initials: SV
authors.lastname: Sodha
authors.forename: Amy L
authors.initials: AL
authors.lastname: Boore
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Russo
authors.forename: Matthew
authors.initials: M
authors.lastname: Mikoleit
authors.forename: Lisa
authors.initials: L
authors.lastname: Theobald
authors.forename: Peter
authors.initials: P
authors.lastname: Gerner-Smidt
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hoekstra
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Angulo
authors.forename: David L
authors.initials: DL
authors.lastname: Swerdlow
authors.forename: Robert V
authors.initials: RV
authors.lastname: Tauxe
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Griffin
authors.forename: Ian T
authors.initials: IT
authors.lastname: Williams
mesh_terms: D002212:Capsicum / Q000382:microbiology*; D016022:Case-Control Studies; D016000:Cluster Analysis; D028526:Coriandrum / Q000382:microbiology; D004196:Disease Outbreaks / Q000517:prevention & control; D005506:Food Contamination / Q000517:prevention & control; D005516:Food Microbiology; D006801:Humans; D018551:Solanum lycopersicum / Q000382:microbiology*; D016017:Odds Ratio; D012147:Restaurants; D012478:Salmonella Food Poisoning / Q000453:epidemiology* / Q000382:microbiology; D019779:Salmonella enterica / Q000145:classification / Q000302:isolation & purification; D012703:Serotyping; D014481:United States / Q000453:epidemiology