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. 2018 Aug 31;67(6):890-896.
doi: 10.1093/cid/ciy195.

Multistate Outbreak of Salmonella Virchow Infections Linked to a Powdered Meal Replacement Product-United States, 2015-2016

Kelly J Gambino-Shirley  1   2 , Adiam Tesfai  3 , Colin A Schwensohn  2 , Cindy Burnett  4 , Lori Smith  5 , Jennifer M Wagner  5 , Dana Eikmeier  6 , Kirk Smith  6 , Jolianne P Stone  7 , Dawn Updike  8 , Jonas Hines  1   9 , Lauren N Shade  3 , Beth Tolar  2 , Tong-Jen Fu  10 , Stelios Viazis  3 , Sharon L Seelman  3 , Kathryn Blackshear  11 , Matthew E Wise  2 , Karen P Neil  2
Affiliations

Multistate Outbreak of Salmonella Virchow Infections Linked to a Powdered Meal Replacement Product-United States, 2015-2016

Kelly J Gambino-Shirley et al. Clin Infect Dis. .

Abstract

Background: Nontyphoidal Salmonella is the leading cause of bacterial gastroenteritis in the United States. Meal replacement products containing raw and "superfood" ingredients have gained increasing popularity among consumers in recent years. In January 2016, we investigated a multistate outbreak of infections with a novel strain of Salmonella Virchow.

Methods: Cases were defined using molecular subtyping procedures. Commonly reported exposures were compared with responses from healthy people interviewed in the 2006-2007 FoodNet Population Survey. Firm inspections and product traceback and testing were performed.

Results: Thirty-five cases from 24 states were identified; 6 hospitalizations and no deaths were reported. Thirty-one of 33 (94%) ill people interviewed reported consuming a powdered supplement in the week before illness; of these, 30 (97%) reported consuming product A, a raw organic powdered shake product consumed as a meal replacement. Laboratory testing isolated the outbreak strain of Salmonella Virchow from leftover product A collected from ill people's homes, organic moringa leaf powder (an ingredient in product A), and finished product retained by the firm. Firm inspections at 3 facilities linked to product A production did not reveal contamination at the facilities. Traceback investigation identified that the contaminated moringa leaf powder was imported from South Africa.

Conclusions: This investigation identified a novel outbreak vehicle and highlighted the potential risk with similar products not intended to be cooked by consumers before consuming. The company issued a voluntary recall of all implicated products. As this product has a long shelf life, the recall likely prevented additional illnesses.

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Conflict of interest statement

Conflicts of Interest: There are no conflicts of interest.

Figures

Figure 1.
Figure 1.
Outbreak-associated Salmonella Virchow cases by state of residence, United States, December 5, 2015–April 26, 2016 (n=35)
Figure 2.
Figure 2.
Outbreak-associated cases of Salmonella Virchow by date of illness onset, United States, December 5, 2015–April 12, 2016 (n=35)
Figure 3.
Figure 3.
Informational Traceback Diagram, Product A January 2016. Points of Service included in the traceback had cases with the most complete and available purchasing and product information as of 7/26/2016. *The raw ingredient, moringa leaf, yielded the outbreak strain of Salmonella Virchow.
See this image and copyright information in PMC

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