Multistate Outbreak of Salmonella Agona Infections Linked to Rice and Wheat Puff Cereal (FINAL UPDATE)

Posted May 13, 2008

Outbreak Summary

CDC is collaborating with public health officials in multiple states across the United States and with the U.S. Food and Drug Administration (FDA) to investigate a multi-state outbreak of Salmonella Agona infections. An investigation that includes interviews of persons with Salmonella Agona infections and comparison of the DNA fingerprints suggests that cereal from Malt-O-Meal unsweetened Puffed Rice Cereals and unsweetened Puffed Wheat Cereals is likely related to these illnesses.

As of May 13, 2008, state and city health departments from 15 states have identified 28 ill persons infected with same genetic fingerprint of Salmonella Agona. Ill persons with the outbreak strain have been identified from Colorado (1), Delaware (2), Illinois (1), Maine (4), Massachusetts (2), Michigan (1), Minnesota (1), North Dakota (1), New Hampshire (2), New Jersey (5), New York (3), Ohio (1), Pennsylvania (2), Rhode Island (1), and Vermont (1). Onset dates, which are known for 23 patients, ranged from January 1 to April 10, 2008.  Patients’ ages ranged from 4 months to 95 years with a median age of 65 years. Eight hospitalizations and no deaths have been reported.

Investigation of the Outbreak

On April 5, 2008 Malt-O-Meal Company received results of routine food testing performed on March 24, 2008 that detected the presence of Salmonella in a Minnesota plant that produces and packages dry cereals.  On April 5, 2008, Malt-O-Meal issued a recall of unsweetened Puffed Rice cereals and unsweetened Puffed Wheat cereals produced during the previous 12 months at the plant in Minnesota. The recall products have "Best If Used By" dates of April 8, 2008 to March 18, 2009. On April 7, 2008, PulseNet, the molecular subtyping network for foodborne disease surveillance, independently notified CDC's OutbreakNet Team of a cluster of human Salmonella Agona isolates with an indistinguishable PFGE pattern (outbreak pattern) in multiple states. On April 10, 2008, CDC was informed by several state health departments that patients infected with Salmonella Agona with the outbreak pattern had eaten Malt-O-Meal cereal products. On April 11, the Minnesota State Public Health Department confirmed that the Salmonella isolate isolated from the Minnesota plant was Salmonella Agona and had the same indistinguishable PFGE pattern as the isolates from ill humans. Additionally, both the Delaware and New York State Public Health Laboratories isolated Salmonella Agona with matching PFGE patterns from two bags of Puffed Rice cereal produced by the same company. CDC, multiple state health departments, and FDA are working collaboratively to identify additional cases and determine the source and factors that contribute to this outbreak.

More information can be found in the MMWR article Multistate Outbreak of Salmonella Serotype Agona Infections Linked to Toasted Oats Cereal.

Final Case Count Map

Persons infected with the outbreak strain of Salmonella Agona, by state of residence, as of May 13, 2008 (n=28)

As of May 13, 2008, state and city health departments from 15 states have identified 28 ill persons infected with same genetic fingerprint of Salmonella Agona. Ill persons with the outbreak strain have been identified from Colorado (1), Delaware (2), Illinois (1), Maine (4), Massachusetts (2), Michigan (1), Minnesota (1), North Dakota (1), New Hampshire (2), New Jersey (5), New York (3), Ohio (1), Pennsylvania (2), Rhode Island (1), and Vermont (1).

Clinical Features

Most persons 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 to 7 days. Although most people recover without treatment, severe infections may occur. Infants, elderly persons, and those with impaired immune systems are more likely than others to develop severe illness. When severe infection occurs, Salmonella may spread from the intestines to the bloodstream and then to other body sites, and can cause death unless the person is treated promptly with antibiotics.

Advice to Consumers

Recalled Malt-O-Meal products may still be in grocery stores and in consumers' homes. Consumers who have unsweetened Puffed Rice or unsweetened Puffed Wheat cereals should check the "Best If Used By" dates printed on the product. Any cereals with a "Best If Used By" date of April 8, 2008 to March 29, 2009 should not be consumed. Consumers who have a recalled product should contact their local health department.