Tropical fruit cited in US typhoid fever outbreak

Aug 13, 2010 (CIDRAP News) – Federal and state health agencies say frozen mamey fruit pulp is the probable cause of seven confirmed and two suspected cases of typhoid fever (Salmonella Typhi infections) in California and Nevada.

The Centers for Disease Control and Prevention (CDC) announced the outbreak yesterday and said epidemiologic evidence points to mamey fruit pulp produced by Goya Foods, Inc., Secaucus, N.J. The company recalled 14-ounce packages of the tropical fruit product on Aug 11.

Typhoid fever is common in the developing world, but only about 400 cases occur in the United States annually, with about 75% of them in international travelers, according to the CDC. The infection causes high and sustained fever, headache, constipation, malaise, chills, and myalgia, and it can be severe or fatal if not treated. It typically spreads through contaminated food or water.

The CDC said the outbreak so far includes three confirmed and two probable cases in California and four confirmed cases in Nevada. Confirmation is based on a DNA fingerprint matching the outbreak strain; probable cases have not been genetically matched but have strong epidemiologic links to the outbreak.

For cases with available information, illnesses began between Apr 10 and Jul 23, the CDC said. Patients range from 4 to 31 years old, and all report Hispanic ethnicity. Five of seven patients with clinical information were hospitalized, and 5 of 6 patients who were interviewed reported no international travel in the 2 months before they got sick.

In a case-control study, 5 of 7 patients interviewed said they had consumed frozen mamey fruit pulp in a milkshake or smoothie, while none of 33 healthy people had had the product, the CDC reported. Further investigation showed that 4 of 5 patients had consumed Goya brand frozen mamey and that no other food was associated with illness.

The CDC said mamey, also called zapote or sapote, is mainly grown in Central and South America. Frozen mamey pulp can be bought in grocery stores throughout the United States, and packages have a shelf life of 2 to 3 years.

In its recall announcement, Goya Foods said the mamey fruit pulp comes in 14-ounce plastic packages that are not marked with a lot number or expiration date. The UPC number is 041331090803. The product is distributed in retail stores in Alaska, Arizona, California, Colorado, Hawaii, New Mexico, Nevada, Oregon, Texas, Utah, and Washington.

The company said it issued the recall because one package of mamey pulp collected in Las Vegas and tested by the Food and Drug Administration (FDA) was found to contain Salmonella. A CDC official contacted by CIDRAP News today could not say whether the specific outbreak strain of Salmonella Typhi had been found in any Goya product.

Typhoid vaccines are available and recommended for travelers, according to the CDC. But because the vaccines are not completely effective, travelers also should avoid risky foods and potentially contaminated water, officials said.

See also:

Aug 12 CDC report on outbreak
http://www.cdc.gov/salmonella/typhoidfever/index.html

Aug 13 Goya Foods recall press release posted on FDA site
http://www.fda.gov/Safety/Recalls/ucm222506.htm

CDC information on typhoid fever

http://www.cdc.gov/nczved/divisions/dfbmd/diseases/typhoid_fever/

Aug 12 Southern Nevada Health District press release
http://www.southernnevadahealthdistrict.org/news10/081210.php

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