Outbreak of Salmonella Poona Infections in Mexican Imported Cucumbers in the United States

Nutritional poisoning results to illnesses commonly referred to as foodborne diseases, foodborne infections, or food poisoning. Statistically, at least 16% of Americans suffer illnesses related to diet and beverage contamination caused by pathogens, chemicals, and microbes. The Centre for Disease and Control Prevention (CDC) estimates that almost 50 million people get infected with foodborne diseases annually. Hospitals admit 128,000 people and 3,000 of them pass away due to these infections. According to their 2011 report, the most common diseases are caused by Campylobacter, Clostridium, and Salmonella. This report reviews the Salmonella Poona outbreak that affected several states found in cucumbers imported from Mexico.

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Outbreak Description and Summary

The CDC and the U.S Food and Drug Administration unit (FDA) first launched an investigation to review a collection of 32 cases of the S. Poon infection recorded in various states like Alaska, California, Arizona, and Tennessee. After isolation and field gel electrophoresis (PFGE) matching, CDC linked the outbreak to the ingestion of raw cucumbers also known as slicer or American cucumbers. They were grown and imported from Baja in Mexico. The disease had spread out to 39 different states in a report published in December 2015, and the count stood at 888 people affected. By the end of February 2016, reports indicated a total of 907 people affected, with six deaths in three different states. Renowned retail brands such as the Red Lobster, Whole Foods, Walmart, and In-N-Out Burger were affected the most.

The initial illness date recorded was 3rd July 2015, and the last update is done at the end of February 2016. Within this period, the people affected ranged from infants as young as 5months to adults of 99 years. However, almost 50% of the recorded cases were of children below 18 years, and 56% of individuals affected were female. 28% of those with data available were admitted in hospitals due to the poisoning. The CDC and FDA conducted a series of laboratory, epidemiological, and traceback investigations that eventually identified the imported cucumbers from Baja as the source of the infection. The signs and symptoms for people exposed to the bacteria within 12 to 72 hours include diarrhea, vomiting, and abdominal cramps, with the illness lasting between 4 to 7 days. The company responsible for importing the cucumbers was known as Andrew and Williamson Fresh Produce and almost faced legal suits for the incidents.

The Causative Agent: Salmonella Poona

Salmonella Poona is one of the rare strains of Salmonella bacteria. A Salmonella infection is a bacterial infection that affects and lives in both human and animal intestinal tracts and shed through fecal matter. It is a genus of Bacillus gram-negative bacteria found in the Enterobacteriaceae family. It is divided into two species namely Enterica found in warm-blooded animals, and Bongori found in cold-blooded animals especially reptiles. Salmonella Enterica is further subdivided into six groups or subspecies that have over 2000 serovars and serotypes. Salmonella Poona is one of the several strains in this family responsible for typhoid, paratyphoid, and salmonellosis. The bacteria can be categorized as either being invasive or non-invasive depending on its host and the manifestation of the disease.

Common sources of salmonellosis include eating food contaminated during the processing or handling stage, contamination from an infected food handler, fecal matter of pets especially those that have diarrhea, and from animals carrying the disease. The primary source is usually in animal products such as meat, poultry, unpasteurized milk, and eggs. However, all other forms of food including vegetables can be easily contaminated. Contamination and infection occur mostly due to poor hygiene and sanitary conditions. Common symptoms include diarrhea, fever, abdominal pains, headaches, and vomiting. Most people recover without specific treatment, but in other cases, it may develop into a life-threatening condition. The bacteria multiply rapidly in humid and warm conditions with the possibility of cross-contamination between tools and surfaces used in cooking or handling food. Even though heat destroys these bacteria, some of the strains can survive extreme heat from roasting when food is not properly defrosted.

Salmonella is managed by both drugs and non-drug interventions. Under drugs use, most doctors prescribe antibiotics that shorten the illness and prolong the carrier stage. The only disadvantage is when a person becomes resistant to antibiotics. Other medicinal interventions include using antidiarrheal and antispasmodic drugs. Non-medicinal remedies include using oral rehydration liquids, maintaining hygiene to avoid spreading the disease, and cleaning or cooking food well before consumption.

Presence of Salmonella Poona in Imported Cucumbers: Incident Analysis

After noticing the trend in infection, the federal government and state authorities identified groups of affected individuals according to geographic location. They used the traceback, epidemiological, and investigative laboratory methods to determine the food that was eaten and as a result, the investigation led them to Andrew & Williamson Fresh Produce. The company supplied cucumbers for residents in the areas that had recorded high infections of the illness. After this discovery, several health and agricultural departments, for example, the Nevada, Arizona, Montana and San Diego departments of Health and Human Services, tested cucumbers from retailers for the presence of Salmonella.

In the epidemiologic investigation, the government and public health personnel interviews affected people about food was eaten and other exposures that were occurring before their infection began. 75% of the group reported consuming cucumbers. They were also categorized in illness clusters which provided critical information about the source of the outbreak. According to the feedback from the groups, most of them regularly ate cucumbers and shopped at specific areas for them suggesting that the contaminated item was sold in these regions. The research identified 11 illness clusters of unrelated people in seven states and studied the food eaten by both the sick and the healthy groups. The CDC also conducted a laboratory investigation through the National Antimicrobial Resistance Monitoring System (NARMS) center. The test was meant to determine the level of antibiotic resistance in clinical isolates from a study population of 30 infected people. Out of them, 7% were resistant to some antibiotics, and the rest were non-resistant. The drugs used were tetracycline, nalidixic acid, and ciprofloxacin mostly used to treat bacterial infections. One of the test subjects was resistant to tetracycline while the other was non-susceptible to ciprofloxacin and resistant to nalidixic acid. The latter is used to treat acute Salmonella diseases, meaning the subject had a severe case of the condition.

Independent industry experts were consulted to get information regarding fresh food harvest and supply in the affected cluster areas. They gave insightful information that assessed the plausibility of cucumbers as the primary source. The health experts announced two recalls of garden cucumbers grown in Mexico and distributed to the United States.

The FDA then issued an import alert on the Mexican cucumbers after they were identified as containing Salmonella. FDA investigators were accompanied by Mexican authorities further conducted an inspection of the farm, named Rancho Don Juanito, in which the cucumbers were grown. They made observations such as an inadequate waste water management, a flawed equipment design of the farms pre-wash area, and improper storage of materials used in packing. This discovery led them to halting cucumber harvests, correcting the hardware layout, and issued another import alert of the produce based on the unsanitary conditions in which the cucumbers were prepared, held, and packed.

The FDA also increased surveillance on cucumber imports from the region and tested subsequent recalls afterward to ensure there was no contamination. They also investigated the issue of cross-contamination. The FDA reviewed records within the distribution chain to check for cross-contamination. The results showed that there was a high level of contagion in the cucumbers found at the main ports of entry and retail locations. They wanted to figure out whether the shipping containers and food-contact surfaces were affected. Most of the results from this investigation became inconclusive.

Technical and Performance Standards Application for Salmonella Poona

The FDA has handed out separate guidance on environmental and egg testing for Salmonella. They are titled Guidance for Industry: Prevention of Salmonella Enteretidis in Shell Eggs During Production, Storage, and Transportation, and Draft Guidance for Industry: Questions and Answers Regarding the Final Rule, Prevention of Salmonella Enteretidis During Production, Storage, and Transportation. The guidance documents address testing processes in human and direct-animal-human contact foods, and how the results are interpreted when the bacteria presence renders the food harmful to people's health.

To conduct a study on food that is implicated as the cause of an outbreak, the parties involved are required to make observations and perform tests on the case. They should consider the sample condition about its color, odor, and consistency. The microbiologists should also evaluate the causes associated with the status of the illness and the signs and symptoms observed. The physicians should obtain clinical blood serum and biochemical testing microbial isolates from the victims.

The United States has finalized its Food Safety Modernization Act (FSMA). It is a set of rules that establish basic standards for the safe breeding, harvesting, holding, and packing of food produce meant for human consumption. The initial rule was proposed at the beginning of 2013 and revisions were made till its finalization in late 2014. The final one is a compilation of reviews, and additional changes in the supplemental proposal to form the Preventive Controls for Human Food law. They are also meant to establish safety standards for human food production and consumption.

All firms, industries, or companies that manufacture, pack, hold, or process human or direct-animal-human- contact food are recommended to test for the presence of Salmonella by the FDA. Under testing, they are required to:

Maintain regulation of the food being tested pending the final result, and to make sure the food is reconditioned, diverted, or destroyed. For example, by feeding it to animals. The company is in charge of the food before its transfer to another place or person.

Apply the use of cultural methods is the FDAs Bacteriological Analytical Manual or an authenticated non-BAM procedure in conducting Salmonella tests in food and the proper handling of samples.

Portray awareness in the expected three results of any Salmonella BAM test. These are a presumptive positive one, confirmed positive, or a negative effect. The initial one is a preliminary result and has the possibility of turning out to be either positive or negative. Researchers may perform additional tests on the specimen to prompt a conclusive stem from the presumptive one. However, it is deemed unnecessary to conduct another test or get cultural isolates when the food sample is not intended for shipping. Negative ones are obtained when additional testing fails to confirm the presence of Salmonella, and the first stage is not presumptive.

d) Reflect upon...