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SPECIAL EDITION XII —
Salmonella Saintpaul Outbreak…
Let The Hearings Begin

Will Colorado Salmonella Sickness Case Lead To Texas Pepper?

Jim Prevor’s Perishable Pundit, July 30, 2008

High profile food safety attorney Bill Marler has sent along word that one of his clients was the first person to fall ill of Salmonella Saintpaul after having eaten jalapenos. This person actually had jalapenos left over from his purchase and the jalapenos and the client’s illness were a genetic match — two enzymes — for Salmonella Saintpaul. In addition, the tainted peppers were purchased at a local Wal-Mart.

We asked Pundit Investigator and Special Projects Editor Mira Slott to find out more:

Alicia Cronquist
Epidemiologist
Colorado Department of Public Health and Environment

Q: I’m told you were integrally involved in the epidemiological study linking a human case of Salmonella Saintpaul from jalapenos. How did it unfold?

A: It was a team effort. Let me start by talking generally, rather than about this individual case. Salmonella is a reportable condition in Colorado. When someone is diagnosed with salmonella, the lab and health care provider must report it to the health department, local or state in our case. The average time is about five days from the sample to the reporting.

We hear someone is ill with Salmonella. We call and ask them what they ate, when, where, etc.

Q: As far as a time line, your state release says the pepper was purchased at a local Wal-Mart, likely on June 24, and the individual became ill on July 4.

A: In this instance, we learned the individual had leftover peppers in his refrigerator and we arranged to have them shipped to a lab and tested them. I’m not sure of the exact date when the lab received them; it was sometime last week. The state lab did the culture, grew the bacteria and then did additional testing to determine if it was the same strain that made people ill in the outbreak. Those results were final on Monday, July 28.

Q: How many peppers did the individual have in his refrigerator? How many were tested in the lab? Were they tested separately or was it a composite? There have been many references to “the pepper” and a single pepper, first by FDA’s Dr. Acheson in regards to the pepper sample that tested positive from the Agricola Zaragoza produce distributor, and now in the Colorado release.

A: I don’t have details of the FDA tested pepper sample. In Colorado, the individual had two peppers left in the fridge. We obtained both. They arrived in the same box, shipped from the patient, and both were tested together. There was no separation because they were sitting together in the box. It wasn’t a whole group of peppers tested. There were just the two in the fridge.

Q: In a wide spread outbreak, couldn’t you have sick people touching and contaminating produce, in turn falsely implicating that produce? Hypothetically, the Colorado individual could have contracted Salmonella Saintpaul eating salsa at a restaurant, and then upon hearing news of the outbreak remembered he had peppers in his refrigerator, picking them up and in the process and contaminating them. Is that possible?

A: It’s possible, but highly unlikely. There is pretty good evidence the pepper is the likely source of the illness. When people get ill, they do shed it in their stool — the bacteria is in your feces. At some point, it came from some animal. It’s impossible to know.

We conducted a lengthy interview. We have all different types of investigating methods for ill patients. If we have a group of people sick, we try to interview both sick and well people. Other times, in nationwide outbreaks like this Salmonella Saintpaul, we pull all states and interview controls on a national level. So Colorado did participate in that.

Q: Are you involved in the trace back investigation of the Colorado case? How far along is the state on the trace back? Wal-Mart, where the patient purchased the peppers that tested positive for the Saintpaul strain, has a dedicated distribution center system. This usually means there is only one supplier to a given distribution center. Then you would need to trace back from there to the actual farm…

A: The state health department is working with the government. The trace back is ongoing. Trace back activities are underway. When we have more information, the state will probably issue another release, which I’ll arrange to have sent to you. In the mean time, feel free to check back with me.

Q: The significance of this finding seems to depend in part on the trace back investigation. For example, if the positive pepper in Colorado and the positive pepper in Texas both link back to that same Mexican farm, versus the pepper in Colorado tracing back to a completely unrelated location and origin.

A: The important thing is Salmonella doesn’t belong on produce. FDA works really hard to make sure there is no Salmonella in produce at all. I do think this is an important step in the investigation — the first time linking a specific pepper to a specific person that has been ill with the same DNA fingerprint of the Saintpaul outbreak.

There is pretty good evidence that jalapeno pepper is the likely source of this Colorado patient’s illness. After all, 1,300 people getting ill from this same strain is extremely unusual. This is a large outbreak.

Q: When states report test results, CDC says there is a process that takes place to determine whether it accepts that certification. How does that work? Does CDC have to do a separate confirmation test? Is there any possibility that CDC would not accept this testing?

A: This relates to DNA fingerprinting — pulsed field gel electrophoresis, the official term. People at CDC can better describe the process. There is a nationwide data base called Pulsenet. Our molecular scientists at each laboratory do tests and post an electronic image on a web board. CDC checks and determines whether they agree with the markings. This is a process used very successfully for over 10 years.

Q: Has CDC checked Colorado’s results yet?

A: It’s complete. CDC has confirmed Colorado’s lab results. We are very confident the isolate we have from this pepper matches that of the nationwide outbreak.

What we don’t know now:

  1. Did the pepper give Salmonella to the ill person or did the ill person pick up the illness elsewhere — say a restaurant — and contaminate the pepper?
  2. Does the strain match that found in the warehouse in Texas?
  3. Will the traceback lead to the warehouse in Texas?
  4. Will the traceback of the Texas and Colorado peppers lead to a common farm?

If there is a match between the Salmonella Saintpaul on the pepper in Colorado and the one in Texas and the peppers have a common origin, the odds become overwhelming that we have found the source. If, and it is a big if, there was only one source.

Many thanks to Alicia Cronquist and the Colorado Department of Public Health and Environment for helping the industry to better understand the findings in Colorado.

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