Multistate Outbreak of Salmonella I 4,[5],12:i- Infections Linked to Pot Pies (FINAL UPDATE)

Posted October 29, 2007

Outbreak Summary

CDC is collaborating with public health officials in multiple states across the United States and with the U.S. Department of Agriculture’s Food Safety and Inspection Service to investigate an ongoing multi-state outbreak of Salmonella I 4,[5],12:i:- (pronounced "four five twelve eye minus") infections in humans. An investigation that used interviews comparing foods eaten by ill and well persons is showing that eating Banquet brand pot pies produced by the ConAgra Foods Company is the likely source of the illness.

Between January 1, 2007 and October 29, 2007, at least 272 isolates of Salmonella I 4,[5],12:i:- with an indistinguishable genetic fingerprint have been collected from ill persons in 35 states. Ill persons whose Salmonella strain has this genetic fingerprint have been reported from Arizona (1 person), Arkansas (4), California (18), Colorado (9), Connecticut (7), Delaware (5), Florida (2), Georgia (2), Idaho (11), Illinois (7), Indiana (3), Iowa (1), Kansas (4), Kentucky (9), Massachusetts (7), Maryland (7), Maine (2), Michigan (3), Minnesota (7), Missouri (18), Montana (6), Nevada (6), New York (10), North Carolina (2), Ohio (11), Oklahoma (1), Oregon (4), Pennsylvania (18), Tennessee (6), Texas (4), Utah (12), Virginia (9), Vermont (2), Washington (27), Wisconsin (24), Wyoming (3). Their ages range from <1 to 89 years with a median age of 18 years; 51% of ill persons are female. At least 65 people have been hospitalized. No deaths have been reported.

Investigation of the Outbreak

CDC coordinated a case-control study designed to identify the source of these infections. For this study, a case was defined as Salmonella infection on or after August 1, 2007, with a strain that had the outbreak genetic fingerprint. Eating a Banquet brand pot pie was significantly associated with illness. State health departments are collecting and testing pot pie products recovered from patients’ homes. To date, three patients’ pot pies have yielded Salmonella I 4,[5],12:i:- isolates with a genetic fingerprint indistinguishable from the outbreak pattern.

Final Case Count Map

Persons infected with the outbreak strain of Salmonella I 4,[5],12:i-, by state of residence, as of October 29, 2007 (n=272)

Between January 1, 2007 and October 29, 2007, at least 272 isolates of Salmonella I 4,[5],12:i:- with an indistinguishable genetic fingerprint have been collected from ill persons in 35 states. Ill persons whose Salmonella strain has this genetic fingerprint have been reported from Arizona (1 person), Arkansas (4), California (18), Colorado (9), Connecticut (7), Delaware (5), Florida (2), Georgia (2), Idaho (11), Illinois (7), Indiana (3), Iowa (1), Kansas (4), Kentucky (9), Massachusetts (7), Maryland (7), Maine (2), Michigan (3), Minnesota (7), Missouri (18), Montana (6), Nevada (6), New York (10), North Carolina (2), Ohio (11), Oklahoma (1), Oregon (4), Pennsylvania (18), Tennessee (6), Texas (4), Utah (12), Virginia (9), Vermont (2), Washington (27), Wisconsin (24), Wyoming (3).

More information can be found in the MMWR article Multistate Outbreak of Salmonella Infections Associated with Frozen Pot Pies.

Clinical Features

Most people infected with Salmonella develop diarrhea, fever, and abdominal cramps 12–72 hours after infection. Infection is usually diagnosed by culture of a stool sample. The illness usually lasts 4 – 7 days. Although most people recover without treatment, severe infections may occur. Infants, elderly persons, and people with impaired immune systems are more likely than others to develop severe illness. In severe infection, Salmonella spreads from the intestines to the bloodstream and then to other body sites, and death can occur if the person is not treated promptly with antibiotics.

Advice to Consumers

On October 11, 2007, ConAgra Foods issued a voluntary recall of frozen pot pies that may be linked to this outbreak. The following brands of frozen pot pie products are subject to this recall:

• Banquet
• Albertson’s (sold at Albertson’s)
• Food Lion (sold at Food Lion)
• Great Value (sold at Wal-Mart)
• Hill Country Fare (sold at HEB)
• Kirkwood (sold at Aldi)
• Kroger (sold at Kroger)
• Meijer (sold at Meijer)
• Western Family (now discontinued; previously sold at a variety of small retailers)

These frozen pot pies include all varieties in 7 oz. single serving packages bearing an establishment number "P-9" or "Est. 1059" printed on the side of the package. These frozen pot pie products were distributed to retail establishments throughout the United States, Puerto Rico, and the Caribbean islands. These products could still be in consumers’ freezers, so it is important that consumers look for and return or discard these products.

Consumers should not eat these products.

Questions and Answers Related to the Outbreak of Salmonella Infections from Banquet Pot Pies

What is salmonellosis? What are the symptoms?

Salmonellosis is an infection caused by bacteria called Salmonella. Most people infected with Salmonella develop fever, diarrhea, and abdominal cramps 12–72 hours after exposure. Although illness usually lasts 4–7 days and most people recover without treatment, severe illness may occur that requires medical attention and hospitalization. In these patients, the Salmonella infection can spread from the intestines to the bloodstream and then to other body sites. In this situation, the infection can cause death unless the patient is treated promptly with antibiotics. Infants, elderly people, and people with impaired immune systems are more likely than other people to become severely ill.

How do people get infected with Salmonella?

Salmonella live in the intestinal tracts of animals, including birds and reptiles. Salmonella usually are transmitted to humans when we eat food contaminated with animal feces or food contaminated by a food handler who forgot to wash his or her hands with soap after handling raw meat, poultry or eggs, or after using the bathroom. Salmonella is also transmitted when contaminated objects or fingers are put into the mouth. The feces of some pets, especially reptiles, can contain Salmonella, and people can be infected if they do not wash their hands after contact with reptiles or their environment. Contaminated food, for example, beef, poultry, milk, and eggs, often originates from animals. However, many foods, including fruits, vegetables, and even flour can become contaminated.

How is salmonellosis diagnosed?

Salmonella infection is usually diagnosed by culture of a stool sample. In some instances, it can also be cultured from other body sources such as blood.

Does Salmonella make foods taste or look different?

Most products contaminated with Salmonella do not taste or look any different than normal. Some taste bad because they contain other contaminants.

I/my household member ate a Banquet Pot pies or a pot pie made by ConAgra Foods product code beginning in “5009” and ending in “P9” or “Est 1059” and I/my household member is ill with diarrhea. What should I do?

Do not eat any more of these pot pies. If the diarrheal illness is severe, with bloody diarrhea, fever, or symptoms lasting more than three days, you should consult a healthcare provider. Salmonella infection is diagnosed by culture of a stool specimen. Call your local health department as well, as they may wish to investigate your case further.

I have a Banquet pot pie or pot pie made by ConAgra Foods with a product code beginning in “5009” and ending in “P9” or “Est 1059” in my freezer at home. What should I do?

Until further information is available, CDC and United States Department of Agriculture – Food Safety and Inspection Service (USDA-FSIS) are advising the public to not eat any Banquet pot pies or pot pies made by ConAgra Foods that have a printed product code beginning in “5009” and ending in “P9” or “Est 1059.” Other brands of pot pies made in the ConAgra Foods factory that makes Banquet brand pot pies and sold under other brand names may also be contaminated with Salmonella. These other pot pie boxes also have a printed code beginning in “5009” and ending in “P9” or “Est 1059.” If you have any of these products at home, the safest thing to do is to discard them.

How did Salmonella get into the Banquet pot pies made by ConAgra Foods?

It is not known how Salmonella contaminated these products. An investigation is underway to determine how contamination might have occurred.

Have pot pies made by ConAgra Foods that neither are Banquet brand pot pies nor have a printed code beginning in “5009” and ending in “P9” or “Est 1059” been associated with illness?

CDC is not aware of any human illness associated with brands of pot pies made by ConAgra Foods other than Banquet brand. However, ConAgra Foods has placed a market hold on these products as a precautionary measure.

Have pot pies made by companies other than ConAgra Foods been associated with illness?

CDC is not aware of any human illness associated with pot pies made by companies other than ConAgra Foods.

What other advice does CDC have about Salmonella?

Because foods of animal origin may be contaminated with Salmonella, people should not eat raw or undercooked eggs, poultry, or meat, or drink raw (unpasteurized) milk. Raw eggs may be unrecognized in some foods such as homemade Hollandaise sauce, Caesar and other homemade salad dressings, tiramisu, homemade ice cream, homemade mayonnaise, cookie dough, and frostings. To keep your food safe, remember to Clean, Separate, Cook, and Chill. For more food safety information visit www.BeFoodSafe.gov.