Salami implicated in 38-state Salmonella outbreak

Robert Roos

Jan 25, 2010 (CIDRAP News) – An epidemiologic investigation has implicated pepper-coated salami products from a Rhode Island company as the source of a multistate Salmonella outbreak that dates back to July, prompting a recall of 1.2 million pounds of sausage products.

The outbreak so far involves 184 cases in 38 states with a matching strain of Salmonella Montevideo, the Centers for Disease Control and Prevention (CDC) announced on Jan 23. But because the outbreak strain is common, investigators may eventually determine that some of those cases were not part of the outbreak, the CDC said.

No deaths have been reported in the outbreak, but among 125 patients with available information, 35 were hospitalized, the CDC said.

Daniele International Inc., based in Pascoag, R.I., announced Jan 23 the recall of 1,240,000 pounds of ready-to-eat Italian sausage products, including salami. The US Department of Agriculture (USDA) posted a long list of items covered by the recall; all bear the establishment number "EST. 9992" or "EST. 54" inside the USDA mark of inspection. The products were distributed to retail stores nationwide and internationally as well, USDA officials said.

The CDC said evidence linking the cases to the products came from a case-control investigation in which 51% of the patients reported eating salami, versus only 15% of healthy people. In addition, there were 11 patients who had eaten products from the "Daniele Italian Brand Gourmet Pack" before getting sick, the company and federal officials said.

Also, Salmonella has been found in a retail sample of a Daniele salami product, but it is not the outbreak strain, according to the CDC and USDA. Federal officials and the company said the outbreak strain of Salmonella Montevideo has not been found in any of the company's products.

The USDA said Daniele believes black pepper used in its products is a possible source of contamination and consequently recalled all products associated with black pepper.

A Daniele official said the company plans to start irradiating its black pepper to kill pathogens, according to a Jan 24 report from the Portland Oregonian.

The Rhode Island Department of Health is waiting for further lab test results on some ingredients in Daniele products, department spokeswoman Annemarie Beardsworth told CIDRAP News today.

"We do not have anything definitive enough to say this is the source of the outbreak. Within 48 to 72 hours we should be able to say something more definite one way or another," she said.

William E. Keene, PhD, MPH, Oregon state epidemiologist, said the outbreak has been under investigation since his department noted it in July, making it one of the longest, if not the longest, foodborne outbreak investigations he can recall.

"Usually when you get beyond several months, they just kind of peter out; the outbreak ends and we get up in disgust," he said. "This time we tried to give up in disgust a number of times, but someone kept it alive in one state or another and eventually it got cracked."

"It's not clear why this one took so long," he said. "It's not for lack of effort." He said that in the investigation, only about a quarter of the people who were asked if they had eaten some kind of salami said yes, which he found surprisingly low.

The break in the case, Keene said, was a finding by Washington state investigators that a relatively high proportion of their cases were in people who shopped at the Costco retail chain. Costco tracks "everything people buy," so the investigators got the patients' permission to let Costco provide their shopping records to Washington and Oregon officials, he said.

Oregon got the records for only one patient, but Washington got a stack of records and found that the product the patients had in common was the Daniele gourmet pack, Keene reported.

Keene said it was unclear why the outbreak strain has not been found in any Daniele products, but added that it's not uncommon to find two, three, or four different strains of a pathogen in the same outbreak. He noted that in an E coli O157:H7 outbreak associated with Nestle cookie dough last summer, the outbreak strain was never found in the dough, though other E coli O157 strains were found.

If pepper turns out to be the contamination source in this case, it won't be the first time pepper has been tied to an outbreak, Keene said. Last year a Salmonella Rissen outbreak in western states was tied to white pepper, which is black pepper with the husks removed, he explained

The US Food and Drug Administration permits irradiation of spices for pathogen control, and, unlike some other foods that can be irradiated, they don't have to be labeled as such, Keene observed. But he said he didn't know to what extent spices sold in the United States actually are irradiated.