U.S. health officials perplexed 7 weeks into salmonella probe

7/11/2008

WASHINGTON - Think of your favorite recipe for salsa. Three common ingredients now are suspects in the salmonella poisonings that have become the nation's largest foodborne outbreak in at least a decade.

And therein lies the frustration. Seven weeks into their investigation, federal health officials aren't shortening the list of potential culprits but adding to it.

Now jalapeno pepper producers are being probed alongside tomato distributors, and fresh cilantro is under suspicion.

"I wish I could have a crystal ball and say it's one of those three things," Dr. David Acheson, the Food and Drug Administration's food safety chief, said yesterday.

"This has gone on longer and has been more complicated than anything I've worked on at FDA," he said.

It's quite a departure from the 2006 E. coli outbreak in spinach, a mystery solved in about two weeks.

"We really got spoiled, if you will, with the spinach outbreak," said Dr. Robert Tauxe, food safety chief at the Centers for Disease Control and Prevention.

There aren't as many spinach lovers as tomato lovers. And the spinach that consumers remembered eating came in bags, often still left in their refrigerators, that bore bar codes that were as good a clue as a fingerprint in helping investigators race to the field that had been contaminated.

This time around, the suspects seldom are left over in the refrigerator or bear bar codes.

Victims are having a harder time remembering.

They say, "Well, I'm not sure. I may have had guacamole, or a garnish," Dr. Tauxe said.

But this outbreak is lasting an unusually long time, with a record 1,065 cases confirmed yesterday - the first of whom fell sick April 10 and the latest so far on June 26.

That makes the toll of the current salmonella outbreak far surpass recent large outbreaks of any foodborne disease: salmonella linked to peanut butter in 2006 and hepatitis A from green onions in 2003.

It's not quite as big as one caused by cyclospora-tainted raspberries in the mid-1990s.

The scope is bad both for public health and a battered tomato industry that estimates losses at $100 million. Yet it is giving federal investigators some apparently valuable new clues.

Early on, lots of individuals got sick, not clusters of people who all ate at the same restaurant or catered picnic. But by mid-May and well into last month, those clusters of a few people sickened in the same spot were appearing. That's helpful for disease detectives, who find it easier to trace suppliers for a few restaurants than hundreds of stores and markets.

Plus, the CDC just finished comparing 144 people who got sick in June with 287 people who live near them but didn't fall ill.

That study of the June cases shows the sick are far more likely than the well to have eaten either raw tomatoes, raw jalapeno peppers, or fresh cilantro.

In one of the largest clusters, those sickened had consumed fresh tomatoes and fresh jalapenos mixed together. In two other large clusters, illnesses were linked only to a dish with fresh jalapenos but no tomatoes.

What does that mean?

"We are quite sure that neither tomatoes nor jalapenos explain the entire outbreak at this point. ... We're presuming both have caused illness," Dr. Tauxe said.

That has the FDA looking furiously for intersections between peppers and tomatoes. Perhaps there are farms that grew tomatoes earlier in the spring and then switched to pepper harvesting, or distribution centers that handled both types of produce and contaminated incoming produce, Dr. Acheson said.

The government's advice is to avoid certain raw tomatoes - red round, plum, and Roma - unless they were grown in areas cleared of suspicion. Plus, people at highest risk of severe illness from salmonella should not eat raw jalapeno and serrano peppers, the CDC advised. The most vulnerable are the elderly, people with weak immune systems, and infants. Serranos are on the list because they're hard to distinguish from jalapenos.