NEWS SCAN: Salmonella in Mexican food and in tomatoes, anti-infective shortages

Jan 20, 2012

Salmonella sickened 68 in multistate outbreak tied to Mexican restaurant chain
Salmonella Enteritidis infections linked to eating at an unnamed Mexican restaurant chain sickened at least 68 people in 10 states in October and November 2011, the Centers for Disease Control and Prevention (CDC) said in a first and final notice yesterday about the outbreak. Investigators were unable to implicate a specific food but said the epidemiologic curve of cases resembled those of past outbreaks in produce. The report also said ground beef was unlikely to blame because of the handling and cooking processes used. It also said contamination likely occurred before the product reached the restaurants. Twenty-one patients (31%) were hospitalized, but no deaths were reported. The median age was 25, and 54% of patients were women. Texas had 43 cases, Oklahoma 16, and Kansas 2, while seven states had 1 case each: Iowa, Michigan, Missouri, Nebraska, New Mexico, Ohio, and Tennessee.
Jan 19 CDC report

Study: Source tracing critical in tomato Salmonella outbreak
A re-analysis of data from a 2006 Salmonella Typhimurium outbreak involving tomatoes underscored the importance of source tracing and reiterated the role that tomatoes have played in recent foodborne disease outbreaks, according to a study in Epidemiology and Infection. Public health scientists from the CDC and multiple states examined PulseNet data on 190 lab-confirmed cases and found that eating raw, large tomatoes in restaurants was associated with the outbreak (matched odds ratio, 3.1; 95% confidence interval, 1.3-7.3). Officials traced the source to Ohio tomato fields, a growing area not previously implicated. The authors said their findings are consistent with 11 other recent multistate outbreaks linked to tomatoes, in which cases have occurred over a 6- to 8-week period, median patient age has been in the 30s (in this case, 34), and cases have occurred slightly more often in females than males (58% in this case). They conclude, "Public health professionals should be aware that tomatoes are a possible vehicle when investigating outbreaks of Salmonella infections."
Jan 20 Epidemiol Infect abstract

Shortages of anti-infective drugs a public health emergency, review says
Increasing shortages of anti-infective drugs represent a public health emergency and can put patients at risk, according to a review in Clinical Infectious Diseases today. A group of Chicago researchers noted that 25 (13%) of 193 medications currently not available in the United States are anti-infectives. They also noted 17 shortages of anti-infective drugs in 2010, compared with 11 in 2009 and 5 or 6 annually from 2005 through 2008. Over the same period, new anti-infectives dropped from 4 to 1 per year. First-line treatments for certain pneumonia, herpes encephalitis, neurosyphilis, tuberculosis, and enterococcal infections, among others, have been affected by shortages, the group found. Although the cause of shortages can be hard to determine because the law does not require manufacturers to disclose such details, the authors highlighted several supply-side issues: raw material availability, processing, distributing, regulatory compliance, market shortages due to outbreaks, and new therapeutic indications. The authors conclude, "Enhanced oversight by governmental agencies may be necessary to identify and correct shortages of these life-saving anti-infectives" and say that bills such as the Preserving Access to Life-Saving Medications Act introduced in 2011 could give the Food and Drug Administration authority to minimize the impact of shortages.
Jan 20 Clin Infect Dis review
Jan 20 Clin Infect Dis accompanying commentary
Jan 20 news release on the review

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