The US Centers for Disease Control and Prevention (CDC) said 50 more ill people had been reported from 16 states since an update in November, bringing the total to 888.
“The number of reported illnesses has declined substantially since the peak of illnesses in August and September; however, it has not returned to the number…that we would expect to see,” said the agency.
“A series of events occurs between the time a person is infected and the time public health officials can determine that the person is part of an outbreak. This means that there will be a delay between when a person gets sick and confirmation that he or she is part of an outbreak. This takes an average of two to four weeks.”
Tennessee was added to the list of states with ill people, bringing the total number to 39.
A&W: We have brought in outside food safety experts
Last month, Dave Murray, of Andrew & Williamson Fresh Produce, told us that only one farm and one facility were associated with the outbreak and cucumbers are not being grown there and the facility remains closed as it has since it learned of the outbreak and made the product recall on September 4.
“A&W continues to grow and ship produce from other farms and facilities in California and Mexico that were not implicated in the outbreak,” he said.
“We have already reviewed our food safety procedures and protocols throughout all our operations and remain committed to continuous food safety improvements to protect consumers and ensure this never happens again.”
Murray said in an effort to help determine the cause of the outbreak, A&W opened fields and facilities to government inspectors from the US and Mexico.
Among people for whom information is available, illness dates range from July 3, 2015 to January 6, 2016. Ill people range in age from less than 1 to 99 and 49% are children younger than 18 years.
Among 686 people with available information, 191 (28%) report being hospitalized.
“We have also brought in outside food safety experts to conduct a thorough review of our farms and packing operations to help identify any possible source of contamination as well as evaluate our food safety procedures and protocols. As we move through this process, A&W remains committed to also sharing what we learn with industry to ensure all consumers, not just those that buy our fresh products, are protected.
“To every victim, I have something important to say here and I know this comes from every A&W employee and partner. We are so sorry for your suffering. Please know that we have learned from this outbreak and will continue to learn through more research and better science.
“And, that is our company’s focus right now - learning how this could have happened, fixing the problem and sharing what we have learned with others in the industry so that consumers are protected.”
Murray said many people don’t understand that much of the produce in US grocery stores today comes from Mexico.
“We have a long time relationship with our farming partner in Mexico. They are also a family business and are just as committed to food safety as we are. In fact, they have been a leader in making positive improvements in farming and food safety activities in Mexico.
“As part of our goal of continuous improvements in food safety, we always encourage our customers to visit our operations at any time – unannounced, if they wish.”
Almost 20 years ago, there was a Hepatitis A outbreak associated with frozen strawberries from A&W.
Murray said it is a different company than it was in the 1990s and learned a ‘great deal from that experience’.
Possible cross contamination
Investigations are looking to see if cross-contamination within the distribution chain for the recalled cucumbers could explain recent illnesses.
“One hundred and six illnesses started after September 24, 2015, when recalled cucumbers should have no longer been available in stores or restaurants. If any of the recalled cucumbers were still available, they would have spoiled by that time,” said CDC.
“State and local public health officials have interviewed 38 of these ill people. 63% of them reported eating cucumbers in the week before their illness started. Interviews have not identified any additional food items potentially linked with illness.”
A CDC spokeswoman told FQN that it does not have evidence at this time to suggest there is another food item causing illness.
“Interviews have not identified any additional food items potentially linked with illness. Additionally, whole genome sequencing of more recent illnesses was found to be highly related genetically to the cucumbers recalled by Andrew & Williamson in September 2015,” she said.
“The source of contamination for cucumbers distributed by Andrew & Williamson has not been identified.”
The FDA told us it is an ongoing investigation and it cannot speculate at this time on the reason for the newer illnesses.
“But cross contamination can occur through many ways, including using the same utensils to handle contaminated and uncontaminated produce or if different foods are handled on the same surface.
“For example, in a previous outbreak, cross-contamination from a recalled cheese, Frescolina Marte brand ricotta salata cheese, to other cheeses may explain several illnesses in this outbreak. This cross-contamination may have occurred when another cheese was cut with the same knife or on the same surface as the recalled cheese.
“We do not speculate on the possibility of future regulatory action. However, you should be aware that FDA has already placed Rancho Don Juanito on two Import Alerts.”
Closely related isolates
WGS of isolates from people who became ill in October and November are closely related genetically to isolates from people ill during the peak of the outbreak and to isolates from contaminated cucumbers.
The spokeswoman said foodborne disease outbreak investigations can take varying amounts of time, and it cannot be predicted how long an investigation will take.
“In this investigation, the number of reported illnesses has not returned to the level we would expect for this strain of Salmonella Poona, which is about five illnesses per month overall, and about one illness per month during winter months. If we saw illnesses return to this expected baseline, we would feel more confident that the outbreak was over.”
Health departments from Nevada Arizona and Montana isolated one of the outbreak strains of Salmonella Poona from cucumbers at retail locations around September and October last year.
The San Diego County Health and Human Services Agency isolated one of the outbreak strains in cucumbers collected during a visit to the Andrew & Williamson Fresh Produce facility.
The FDA traceback investigation determined that Rancho Don Juanito de R.L. de C.V. in Baja, Mexico was the primary source of cucumbers shipped to Andrew & Williamson.