title: Nationwide outbreak of Salmonella Montevideo infections associated with contaminated imported black and red pepper: warehouse membership cards provide critical clues to identify the source.
abstract: In November 2009, we initiated a multistate investigation of Salmonella Montevideo infections with pulsed-field gel electrophoresis pattern JIXX01.0011. We identified 272 cases in 44 states with illness onset dates ranging from 1 July 2009 to 14 April 2010. To help generate hypotheses, warehouse store membership card information was collected to identify products consumed by cases. These records identified 19 ill persons who purchased company A salami products before onset of illness. A case-control study was conducted. Ready-to-eat salami consumption was significantly associated with illness (matched odds ratio 8·5, 95% confidence interval 2·1-75·9). The outbreak strain was isolated from company A salami products from an environmental sample from one manufacturing plant, and sealed containers of black and red pepper at the facility. This outbreak illustrates the importance of using membership card information to assist in identifying suspect vehicles, the potential for spices to contaminate ready-to-eat products, and preventing raw ingredient contamination of these products.
authors.affiliation: Epidemic Intelligence Service assigned to the Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. lax2@cdc.gov
authors.forename: L
authors.initials: L
authors.lastname: Gieraltowski
authors.forename: E
authors.initials: E
authors.lastname: Julian
authors.forename: J
authors.initials: J
authors.lastname: Pringle
authors.forename: K
authors.initials: K
authors.lastname: Macdonald
authors.forename: D
authors.initials: D
authors.lastname: Quilliam
authors.forename: N
authors.initials: N
authors.lastname: Marsden-Haug
authors.forename: L
authors.initials: L
authors.lastname: Saathoff-Huber
authors.forename: D
authors.initials: D
authors.lastname: Von Stein
authors.forename: B
authors.initials: B
authors.lastname: Kissler
authors.forename: M
authors.initials: M
authors.lastname: Parish
authors.forename: D
authors.initials: D
authors.lastname: Elder
authors.forename: V
authors.initials: V
authors.lastname: Howard-King
authors.forename: J
authors.initials: J
authors.lastname: Besser
authors.forename: S
authors.initials: S
authors.lastname: Sodha
authors.forename: A
authors.initials: A
authors.lastname: Loharikar
authors.forename: S
authors.initials: S
authors.lastname: Dalton
authors.forename: I
authors.initials: I
authors.lastname: Williams
authors.forename: C
authors.initials: C
authors.lastname: Barton Behravesh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002212:Capsicum / Q000382:microbiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003132:Commerce; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005516:Food Microbiology; D005523:Food Supply; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D029222:Piper nigrum / Q000382:microbiology*; D012475:Salmonella / Q000145:classification; D012478:Salmonella Food Poisoning / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D012703:Serotyping; D014481:United States / Q000453:epidemiology; D055815:Young Adult