The Centers for Disease Control and Prevention (CDC) today reported that 45 more people in 19 states have fallen ill with Salmonella poisoning since the CDC's last update on Mar 15.
The agency has now confirmed 132 cases in 32 states tied to the use of kratom, an herbal alternative to opioids. Thirteen states have reported their first infections, bringing the number of affected states to 38.
Forty percent of patients (38 of 96 with available information) have required hospitalization, but no deaths have been reported in this outbreak, the CDC said.
The update comes just days after the US Food and Drug Administration (FDA) issued a mandatory recall for all powdered kratom products from Triangle Pharmanaturals, the first-ever mandatory recalled issued by the FDA for a food product. The FDA issued the recall after the Las Vegas–based company failed to voluntarily recall kratom products.
On Apr 3, FDA Commissioner Scott Gottlieb, MD, said, "This action is based on the imminent health risk posed by the contamination of this product with Salmonella, and the refusal of this company to voluntarily act to protect its customers and issue a recall, despite our repeated requests and actions."
It is not yet known if any Triangle products are involved in the current outbreak.
Outbreak concentrated on West Coast
The CDC said illness start dates ranged from Jan 11, 2017, to Mar 20 of this year, and any cases occurring on or after Mar 14 may still not be reported. The CDC identified multiple strains of Salmonella involved in the 132 cases: Salmonella I 4,,12:b:- (61 cases), Salmonella Javiana (15), Salmonella Okatie (21), and Salmonella Thompson (35).
"Despite the information collected to date about where ill people purchased kratom, a single common brand or supplier of kratom has not been linked to the outbreak. CDC continues to recommend that people not consume kratom in any form because it could be contaminated with Salmonella and could make people sick," the CDC said.
Fifty-seven (73%) of 78 people interviewed reported consuming kratom in pills, powder, or tea in the weeks prior to illness. Kratom is touted as both an herbal stimulant and pain killer, and it is often purchased online and consumed in powder form. Most cases (54%) have occurred in men, with Washington, Oregon, California, and Idaho each reporting eight or more cases. Washington, with 13, has the most cases.
Whole-genome sequencing performed on isolates taken from 60 patients has shown no signs of antibiotic resistance, the CDC said.
Apr 6 CDC update
Apr 3 CIDRAP News story "Tainted kratom prompts first mandatory FDA food product recall"