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Published Date: 2004-07-15 23:50:00
Subject: PRO/AH/EDR> Salmonellosis, tomatoes, convenience stores - USA (Multistate)
Archive Number: 20040715.1911

SALMONELLOSIS, TOMATOES, CONVENIENCE STORES - USA (MULTISTATE)
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[1]
Date: Thu 15 Jul 2004
From: ProMED-mail <promed@promedmail.org>
Source: Pittsburgh Post-Gazette [edited]
<http://www.post-gazette.com/pg/04197/346668.stm>

Salmonellosis outbreak tied to produce sold at Sheetz
----------------------------------------------
State health officials said yesterday, Wed 14 Jul 2004, that the source of
the bacteria that has sickened more than 30 people, in southwestern
Pennsylvania, with salmonellosis, appears to be contaminated produce sold
at Sheetz convenience stores. At a news conference, Sheetz officials said
34 illnesses were linked to 16 of the company's stores in Pennsylvania.
Most of the stores are located around Pittsburgh and east along the
Pennsylvania Turnpike, they said. 3 other cases have been connected to 3
Sheetz stores in Maryland, the company said, and, regulatory agencies were
investigating whether more people were affected in other states.
Steve Sheetz, chairman of Sheetz Inc., said the company has taken steps to
ensure the safety of the food in its stores. "The well-being and safety of
our customers, and employees, is our absolute priority," he said.
Sheetz, based in Altoona, operates more than 300 stores in Ohio,
Pennsylvania, Maryland, West Virginia, Virginia, and North Carolina,
company officials said.
After interviewing victims of the outbreak, Pennsylvania health officials
concluded yesterday [Wed 14 Jul 2004] that many had eaten food from Sheetz
stores shortly before they became ill, said Richard McGarvey, spokesman for
the state Department of Health. The fact that the contaminated food came
from a number of stores suggested that it originated with an outside
supplier, McGarvey said.
State officials believe the outbreak began through food consumed early this
month [July 2004], he said. Health officials were conducting additional
interviews, and tests, to pinpoint the contaminated food, a process that
could take days or weeks, McGarvey said. He said Sheetz has cooperated
fully with health officials.
Sheetz officials said that they replaced all lettuce and tomatoes in stores
linked to the illnesses on Mon 12 Jul 2004.
Based on additional information, which suggests that the type of salmonella
that caused the outbreak might be linked to Roma tomatoes, Sheetz officials
said they removed all Roma tomatoes from stores on Fri 9 Jul 2004, and,
switched to a different supplier.
McGarvey said state officials had not conclusively linked the outbreak to
Roma tomatoes, but said that that variety had been associated with other
outbreaks. Lab tests confirmed that a majority of the 34 cases in
Pennsylvania were caused by a type of salmonella bacteria known as javiana,
McGarvey said. The outbreak is relatively small. The largest U.S. outbreak
involved several hundred thousand people, he said.
In Pennsylvania, cases have been reported in 11 counties ranging from
Beaver, in the west, to Dauphin, in the east, and Bradford, in the north.
That distribution made investigators think contamination occurred somewhere
in the chain of distribution of the produce.
No deaths have been reported in the current outbreak, McGarvey said, but,
there seems to have been a concentration of patients in Westmoreland
County. Mercy Jeannette Hospital reported treating 14 patients for
salmonella in the past 4 weeks, including 4 new cases in the last 2 days
[Wed 14, Thu 15 Jul 2004], according to a spokeswoman.
[Byline: Joe Fahy and Christopher Snowbeck]
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[2]
Date: Thu 15 Jul 2004
From: ProMED-mail <promed@promedmail.org>
Source: Penn Live [edited]
<http://www.pennlive.com/newsflash/pa/index.ssf?/base/news-
18/1089890640188890.xml&storylist=>

Salmonellosis cases traced to convenience store chain
-----------------------------------------------
Nearly 3 dozen cases of salmonellosis, in 11 Pennsylvania counties, have
been traced to a convenience store chain, state health officials said.
The cases are linked to Sheetz stores, where all those who became sick ate
deli sandwiches, with lettuce and tomatoes, between 2-8 Jul 2004, said
Richard McGarvey, spokesman for the state Department of Health.
Sheetz officials said that those who got sick ate at 16 of the company's
stores, mostly in the Pittsburgh area, but, also, eastward along the
Pennsylvania Turnpike.
Department of Health officials haven't identified the source of the
vegetables that they believe caused the outbreak, but said that Sheetz, and
its employees, didn't do anything to contaminate the items.
"We didn't find any problems with cooking or hygiene in the stores,"
McGarvey said.
Sheetz operates more than 300 stores in Pennsylvania, Ohio, Maryland, West
Virginia, Virginia, and North Carolina. Some salmonellosis cases have been
reported in Maryland and West Virginia, but they've not been conclusively
linked to the Pennsylvania outbreak, McGarvey said.
The U.S. Centers for Disease Control and Prevention have tied Roma tomatoes
to salmonellosis outbreaks in the past. More than 140 people were sickened
after eating Roma tomatoes at Walt Disney World in Orlando, FL 2 years ago
[2002].
The Pennsylvania cases have been reported by doctors, or hospitals, mainly
in western Pennsylvania, including some in Allegheny, Beaver, Butler, and
Westmoreland counties, though cases have also been found in Bedford,
Clearfield, Dauphin, Franklin, Fulton, Indiana, and Washington counties,
McGarvey said.
Each year, about 2000 cases of salmonellosis are reported statewide.
Nationally, there are 40 000 cases reported, including about 600 deaths.
The U.S. Centers for Disease Control and Prevention said the actual total
number of cases may be 30 times as high, however, because milder cases may
not be diagnosed.
[Byline: Joe Mandak]
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[3]
Date: 15 Jul 2004
From: ProMED-mail <promed@promedmail.org>
Source: WPXi
<http://www.wpxi.com/health/3533827/detail.html>

More Salmonella Cases Reported
16 new cases were confirmed, bringing the total salmonella cases to 50.
--------------------------
The Centers for Disease Control and Prevention arrived in Greensburg
Thursday to investigate the outbreak. And the State Agriculture Department
is doing tests to confirm the link that identify lettuce and tomatoes from
Sheetz stores as the likely cause.
Salmonella has historically been associated with high protein foods like
eggs, meat and dairy products. Now, the focus is on raw commodities like
raw fruits and vegetables.
The Food and Drug Administration has begun the search for the source of the
salmonella. Among the produce suppliers, the FDA is investigating Coronet
Foods in Wheeling, W.Va. It supplies fresh produce to Sheetz. In addition
to Wheeling, the company has facilities in Yuma, Az., and Salinas, Cal.
After investigators linked the outbreak to Sheetz earlier this week, the
company voluntarily pulled all of the lettuce and tomatoes from the stores
in question, sanitized the kitchens and restocked them with new produce.
The company also stopped using Roma tomatoes and hired a new supplier.
In the meantime, the number of confirmed cases jumped from 34 to 50
Thursday and because the incubation period is 3 days, a spokesman for the
state health department said cases could continue coming in over the weekend.
Heath Department spokesman Richard McGarvey said, "Especially with the
publicity, anybody that's ill is going to go to the doctors and get tested.
So, I expect the number to rise for a while."
The State Agriculture Department hope to have some test results Friday.
This isn't the first time a food-borne illness has hit western
Pennsylvania. Contaminated green onions from Mexico were blamed for a
hepatitis A outbreak that sickened 660 people and killed 4 last year.
[By: Rick Earle]
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[_Salmonella javiana_ has been implicated in foodborne outbreaks associated
with contaminated cheese (ref 1), watermelon (ref 2) and tomatoes (ref 3,
4, 5). It has also been associated with contaminated frozen chicken in
Norway leading to a recall of imported frozen chicken from Brazil
<http://europa.eu.int/comm/food/food/rapidalert/reports/week25-2004_en.pdf>
In a multistate outbreak of _Salmonella javiana_ involving 176 individuals,
tomatoes were implicated as the source, most likely contaminated at the
packing shed, where field grown tomatoes were dumped into a common
waterbath (ref 3). In the multistate outbreak of _S. javiana_ among
transplant recipients, infection was associated with eating diced Roma
tomatos (ref 4 and Salmonellosis, theme park - USA (Multistate):alert
20020809.5005). While tomatoes had not traditionally been seen as vehicles
for salmonella transmission, this may be the 3rd major outbreak associated
with tomatoes. We await further information on the results of the
investigation into this outbreak.
1. Hedberg CW, Korlath JA, D'Aoust JY, White KE, Schell WL, Miller MR,
Cameron DN, MacDonald KL, Osterholm MT. A multistate outbreak of
Salmonella javiana and Salmonella oranienburg infections due to consumption
of contaminated cheese. JAMA. 1992 Dec 9;268(22):3203-7.
2. Blostein J. An outbreak of salmonella javiana associated with
consumption of watermelon. J. Environ. Health. 1993 Jul 1;56:2931.
3. Hedberg CW, Angulo FJ, White KE, Langkop CW, Schell WL, Stobierski MG,
Schuchat A, Besser JM, Dietrich S, Helsel L, Griffin PM, McFarland JW,
Osterholm MT. Outbreaks of salmonellosis associated with eating uncooked
tomatoes: implications for public health. The Investigation Team. Epidemiol
Infect. 1999 Jun;122(3):385-93.
4. Outbreak of _Salmonella Serotype Javiana_ Infections -- Orlando,
Florida, June 2002. MMWR 2002 Aug 9:683-684
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5131a2.htm>
5. Hedberg CW, Angulo FJ, White KE, et al. Outbreaks of salmonellosis
associated with eating uncooked tomatoes: implications for public health.
Epidemiol Infect 1999;122:385--93. - Mod.MPP]

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