Announcement

**Shiloh** · August 7, 2017, 04:27 PM

Source: https://www.cdc.gov/salmonella/kiambu-07-17/index.html Multistate Outbreak of Salmonella Kiambu and Salmonella Thompson Infections Linked to Imported Maradol Papayas

Posted August 7, 2017 9:30 AM ET

What's New?

The outbreak investigation has expanded to include another strain of Salmonella.
Sixty-four more ill people from 15 states were added to this investigation since the last update on July 21, 2017.
Six more states have reported ill people: Connecticut, Delaware, Michigan, North Carolina, Oklahoma, and Wisconsin
Laboratory tests showed that the strain of Salmonella Thompson isolated from papayas collected in Maryland is closely related genetically to clinical isolates from ill people.
FDA tested other papayas imported from Mexico and found they were contaminated with several types of Salmonella.

Highlights

Read the Advice to Consumers, Restaurants, and Retailers >>
CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Salmonella Kiambu and Salmonella Thompson infections.
A total of 109 people infected with the outbreak strains of Salmonella Kiambu (48) or Salmonella Thompson (61) have been reported from 16 states.
- Thirty-five ill people have been hospitalized. One death has been reported from New York City.
Epidemiologic and laboratory evidence indicates that Maradol papayas imported from Mexico are the likely source of this multistate outbreak.
- At this time, Caribe?a brand papayas from Mexico have been identified as one brand linked to the outbreak. On July 26, Grande Produce recalled Caribe?a brand Maradol papayas that were distributed between July 10 and July 19, 2017.
- Through testing, the FDA has also identified Maradol papayas from the Carica de Campeche papaya farm in Mexico as a likely source of the outbreak. On August 5, Agroson?s LLC recalled certain Cavi brand Maradol papayas grown and packed by Carica de Campeche. The agency is working to identify other brands of papayas that may have originated from Carica de Campeche and facilitate recalls.
CDC recommends that consumers not eat, restaurants not serve, and retailers not sell Maradol papayas from Mexico until we learn more.
- If you aren?t sure if the papaya you bought is a Maradol papaya from Mexico, you can ask the place of purchase. Restaurants and retailers can ask their supplier.
- When in doubt, don?t eat, sell, or serve them and throw them out.
- Wash and sanitize countertops as well as drawers or shelves in refrigerators where papayas were stored.
This investigation is ongoing. CDC will provide updates when more information is available.

August 4, 2017

Introduction

Since the last update on July 21, 2017, 64 more ill people were added to this investigation from 15 states.
As of August 3, 2017, 109 people infected with the outbreak strains of Salmonella Kiambu (48) and Salmonella Thompson (61) have been reported from 16 states. A list of the states and the number of cases in each can be found on the Case Count Map page.
Illnesses started on dates ranging from May 17, 2017 to July 22, 2017. Ill people range in age from less than 1 year to 95, with a median age of 36. Among ill people, 63% are female. Among 74 people with available information, 50 (68%) are of Hispanic ethnicity. Among 76 people with available information, 35 (46%) were hospitalized. One death was reported from New York City.
This outbreak can be illustrated with a chart showing the number of people who became ill each day. This chart is called an epidemic curve or epi curve. Illnesses that occurred after July 10, 2017 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 4 weeks. Please see the Timeline for Reporting Cases of Salmonella Infection for more details.
Investigation Update

In ongoing interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Of the 59 interviewed, 28 (47%) reported eating papayas. This proportion was significantly higher than results from a survey[PDF ? 29 pages] of healthy Hispanic people in which 16% reported eating papayas in the months of May and June in the week before they were interviewed.
Investigators used whole genome sequencing (WGS) to learn more about the DNA fingerprint of the strains of Salmonella isolated from Maradol papayas that Maryland health officials collected from a grocery store in that state. Samples from these papayas yielded outbreak strains of Salmonella Kiambu and Salmonella Thompson. Both samples were from Caribe?a brand Maradol papayas imported from Mexico. Investigators compared WGS results of Salmonella isolates from the papayas to clinical isolates from ill people in the PulseNet database.
WGS showed that the Salmonella Kiambu papaya isolate is closely related genetically to Salmonella Kiambu isolates from ill people. WGS also showed that the Salmonella Thompson papaya isolate is closely related genetically to Salmonella Thompson isolates from ill people. This result provides more evidence that people in this outbreak got sick from eating contaminated Maradol papayas imported from Mexico.
FDA tested other papayas imported from Mexico and isolated several types of Salmonella, including Salmonella Agona, Salmonella Kiambu, Salmonella Gaminara, Salmonella Thompson, and Salmonella Senftenberg. Through this testing, the FDA has also identified Maradol papayas from the Carica de Campeche papaya farm in Mexico as a likely source of the outbreak.
On August 5, Agroson?s LLC recalled certain Cavi brand Maradol papayas grown and packed by Carica de Campeche. The Cavi brand carries a purple, green and black sticker with the words ?cavi MEXICO 4395? in white. Only certain lot codes of Cavi brand Maradol papayas were recalled, because they were known to come from Carica de Campeche. Boxes provided to wholesalers are stamped with CARICA DE CAMPECHE on the upper left side of the box. Other Cavi papayas, sourced from other farms, were not recalled.
FDA is working to identify other brands of papayas that may have originated from Carica de Campeche and facilitate recalls. More information is available on FDA?s website.
CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill people and to interview them. Further investigation by FDA and regulatory officials is under way to determine the point in the supply chain where the papayas were contaminated. Updates will be provided when more information is available.

**Pathfinder** · August 21, 2017, 11:44 AM

FDA Investigates Multiple Salmonella Outbreak Strains Linked to Papayas

Spanish (En espa?ol)
August 18, 2017
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The U.S. Food and Drug Administration, along with the Centers for Disease Control and Prevention (CDC), the Maryland Department of Health (MDH), and other state and local partners, is investigating multiple Salmonella illnesses that are linked to papayas from Mexico.
Update

The FDA is now advising that consumers avoid Caribe?a, Cavi and Valery brands of Maradol papayas, and all varieties of papayas from the Carica de Campeche farm located in Campeche, MX, as a result of the FDA?s traceback investigation and testing. The FDA is working to identify additional brand(s) that these papayas are sold under and facilitate recall(s). Meanwhile, consumers should ask their retailers about the source of their papayas.

Fast Facts

The FDA is advising consumers not to eat Maradol papayas from the Carica de Campeche farm in Mexico because they are linked to an outbreak of salmonellosis.
Three brands of Maradol papayas have been recalled: Caribe?a brand, distributed by Grande Produce; certain Cavi brand papayas distributed by Agroson?s; and Valery brand papayas, distributed by Freshtex Produce, LLC. If anyone has these papayas in their home, they should dispose of them immediately.
The agency is working to ensure that there are no other brand(s) of papayas on the market that may have originated from the Carica de Campeche farm. Meanwhile, consumers should ask their retailers where their papayas came from.
The FDA has also added the Carica de Campeche farm to Import Alert (IA) 99-35, after testing found multiple strains of Salmonella present in the fruit.
Thus far, Salmonella strains matching the outbreak patterns by PFGE were only isolated from papayas from the Carica de Campeche farm.
CDC reports 173 cases, 58 hospitalizations and one death from 21 states in the Salmonella Kiambu and Salmonella Thompson outbreak . The states involved are CT, DE, IA, IL, KY, LA, MA, MD, MI, MN, MO, NC, NJ, NY, OH, OK, PA, TN, TX, VA, and WI.

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What is the Problem and What is Being Done About It?

The FDA, CDC, MDH and other state and local officials are investigating Salmonella Kiambu and SalmonellaThompson illnesses linked to papayas from the Carica de Campeche farm in Mexico.
Three brands of Maradol papayas have been recalled:

Caribe?a brand, distributed between July 10 and 19. The Caribe?a brand can be identified by a red, green, and yellow sticker.
Cavi brand, distributed to wholesalers in New York, Connecticut and New Jersey from July 16-19 and available to consumers until July 31.The Cavi brand carries a purple, green, and black sticker with the words ?cavi MEXICO 4395? in white. Only certain lot codes of Cavi papayas were recalled that were known to come from Carica de Campeche. Boxes provided to wholesalers are stamped with CARICA DE CAMPECHE on the upper left side of the box. Other Cavi papayas, sourced from other farms, are not being recalled.
Valery brand, distributed from July 10-13. Valery Maradol papayas have a red, yellow, and green sticker with ?Valery? in yellow letters.

Consumers who have any of these papayas in their homes should throw them away.
The FDA and state partners continue to investigate the distribution of the papayas involved in this outbreak and are working to ensure that there are no other brand(s) that these papayas may have been sold under.
Papayas from the Carica de Campeche farm tested positive for Salmonella Kiambu, Salmonella Thompson, Salmonella Agona, Salmonella Senftenberg, and Salmonella Gaminara. On 8/3/2017, CDC announced it has added illnesses of Salmonella Thompson to this outbreak investigation based on epidemiological and laboratory evidence. Whole genome sequencing (WGS) is pending for these samples. The Carica de Campeche farm has been added to Import Alert (IA) 99-35.
The FDA increased testing of papayas from Mexico in an effort to see if fruit from other farms could be contaminated. If the FDA finds Salmonella in other shipments, those farms will also be added to IA 99-35.
Since 2011, papayas from Mexico have been screened at the border for Salmonella by third-party laboratories, and these shipments have not been allowed to enter the country without documentation of testing demonstrating the products test negative for Salmonella. Farms/companies have been able to request addition onto the ?green? list of IA 21-17when they have had five consecutive shipments test negative for Salmonella. In contrast, farms/companies that want to request removal from the ?red? list of IA 99-35 must present substantive documentation demonstrating that they have made corrections to prevent contamination, including, for example, a root cause analysis to identify potential sources and routes of contamination.
The FDA is closely communicating with Mexican food safety authorities, Servicio Nacional de Sanidad, Inocuidad y Calidad Agroalimentaria (SENASICA), and Comisi?n Federal para la Protecci?n contra Riesgos Sanitarios (COFEPRIS), on the outbreak investigation and the FDA?s regulatory activities on implicated Mexican firms. Mexican food safety authorities are conducting inspections and other follow up activities at firms of interest.
CDC reports 173 cases, 58 hospitalizations and one death from 21 states in the Salmonella Kiambu and Salmonella Thompson outbreak. The states involved are CT, DE, IA, IL, KY, LA, MA, MD, MI, MN, MO, NC, NJ, NY, OH, OK, PA, TN, TX, VA, and WI.
Timeline

On June 26, 2017, the CDC notified the FDA about a Salmonella Kiambu cluster detected by PulseNet. All 47 cases have the same pattern by pulsed-field gel electrophoresis (PFGE). Whole Genome Sequencing (WGS) analysis was conducted on ten patient samples in the outbreak cluster and all were highly related. This indicates that the patients were likely sickened by the same type of food.
MDH informed the FDA, CDC, and state partners that several ill people shopped at the same Baltimore retail location and purchased papayas. Records and samples of green and yellow papaya were collected. On July 17, 2017, Maryland reported that three of ten samples had preliminarily tested positive for Salmonella. All positive samples were Caribe?a brand yellow Maradol papayas from Mexico; none of the green papayas were positive. Further WGS testing linked one of the papaya samples to the Salmonella Kiambu outbreak and another to Salmonella Thompson. However, Maradol papayas are green before they ripen and turn yellow, so consumers should not eat Caribe?a brand papayas regardless of the color.
On July 19, 2017, MDH issued an advisory warning consumers not to eat Caribe?a brand yellow Maradol papayas. Further WGS testing linked one of the papaya samples to the Salmonella Kiambu outbreak and another to Salmonella Thompson.
On July 26, 2017, Grande Produce issued a press release to notify consumers that it had conducted a limited recall of Caribe?a brand Maradol papayas distributed during the dates of July 10 to July 19, 2017
On July 27, 2017, the FDA issued an outbreak posting advising consumers to avoid all Caribe?a brand Maradol papayas, regardless of color or date of distribution.
On August 3, 2017, following extensive traceback and testing, the FDA added papaya farm Carica de Campeche to Import Alert (IA) 99-35. Papayas from the Carica de Campeche farm tested positive for Salmonella Kiambu, Salmonella Thompson, Salmonella Agona, Salmonella Senftenberg, and Salmonella Gaminara.
On August 4, 2017, Agroson?s, LLC, issued a press release announcing the recall of certain Cavi brand Maradol papayas. Agroson?s states that the papayas were distributed on July 16-19, and available to consumers until July 31.
Also on August 4, 2017, CDC announced it is adding Salmonella Thompson illness to this outbreak investigation because of epidemiological evidence. Also, FDA and Maryland state testing has indicated that both serotypes of Salmonella were present in a single fruit.
On August 7, 2017, Freshtex Produce, LLC, issued a press release announcing the recall of Valery brand Maradol papayas that were distributed in the state of Illinois from July 10-13. These papayas may have been further distributed outside of Illinois.
Also on August 18, 2017, CDC announced it is adding Salmonella Agona and Salmonella Gaminara illness to this outbreak investigation because of epidemiological evidence.
FDA, CDC, state, and local health officials continue to actively investigate the cases with papaya exposure and will provide updates as additional information becomes available.
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What are the Symptoms of Salmonella Infection?

Most people infected with Salmonella develop diarrhea, fever, and abdominal cramps. The illness usually lasts 4 to 7 days, and most people recover without treatment.
How Soon After Exposure do Symptoms Appear?

Most people infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection.
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What are the Complications of Salmonella Infections?

In some people, the diarrhea may be so severe that the patient needs to be hospitalized. In these patients, the Salmonella infection may spread from the intestines to the blood stream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics.
Who is at Risk?

Children are the most likely to get salmonellosis. Children younger than five, the elderly, and those people with weakened immune systems are more likely to have severe infections.
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What Do Restaurants and Retailers Need To Do?

Retailers, restaurants, and other food service operators who have served any potentially contaminated papayas need to be concerned about cross contamination of cutting surfaces and utensils. They should follow the steps below:

Wash and sanitize display cases and refrigerators where potentially contaminated products were stored.
Wash and sanitize cutting boards, surfaces, and utensils used to prepare, serve, or store potentially contaminated products.
Wash hands with hot water and soap following the cleaning and sanitation process.
Regular frequent cleaning and sanitizing of food contact surfaces and utensils used in food preparation may help to minimize the likelihood of cross-contamination.

Avoid cross contamination through contact with crates or other containers where potentially contaminated products were held or shipped. Wash and sanitize such containers as appropriate.
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What Do Consumers Need To Do?

Consumers should ask restaurants and retailers whether they use Caribe?a or Cavi brands of Maradol papayas and/or whether their distributors receive product from the Carica de Campeche farm in Mexico. If so, consumers should not consume or purchase those products and throw away any such products they have in their home. At this time, CDC is advising consumers not to eat any Maradol papayas regardless of their origin while the traceback investigation is ongoing.
For refrigerators and other food preparation surfaces and food cutting utensils that may have come in contact with potentially contaminated papayas, it is very important that the consumers thoroughly clean and sanitize these areas and items.
Consumers should follow these simple steps:

Wash the inside walls and shelves of the refrigerator, cutting boards and countertops; then sanitize them with a solution of one tablespoon of chlorine bleach to one gallon of hot water; dry with a clean cloth or new paper towel.
Wash hands with warm water and soap for at least 20 seconds before and after handling food.
Wipe up spills in the refrigerator immediately and clean the refrigerator regularly.
Always wash hands with warm water and soap following the cleaning and sanitization process.

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Who Should be Contacted?

If you think you might have become ill from eating potentially contaminated papayas, talk to your health care provider. Contact your health care provider if you have diarrhea that lasts for more than 3 days, or is accompanied by high fever, blood in the stool, or so much vomiting that you cannot keep liquids down and you pass very little urine.
The FDA encourages consumers with questions about food safety to call 1-888-SAFEFOOD Monday through Friday between 10 a.m. and 4 p.m. Eastern Time, or to consult the fda.gov website: http://www.fda.gov.
Additional Information

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Page Last Updated: 08/18/2017

Announcement

US: Multistate Outbreak of Salmonella Kiambu Infections Linked to Yellow Maradol Papayas

US: Multistate Outbreak of Salmonella Kiambu Infections Linked to Yellow Maradol Papayas

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