December 3, 2015
CDC is collaborating with public health officials in multiple states and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Salmonella Paratyphi B variant L(+) tartrate(+) infections.
This outbreak is caused by Salmonella Paratyphi B variant L(+) tartrate(+) bacteria, formerly known as Salmonella Java. People with illness caused by this bacteria typically experience diarrhea, fever, and abdominal cramps 12-72 hours after an exposure. Salmonella Paratyphi B variant L(+) tartrate(+) does not cause paratyphoid fever, enteric fever, or typhoid fever.
Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. PulseNet, the national subtyping network of public health and food regulatory agency laboratories, is coordinated by CDC. DNA ‘fingerprinting’ is performed on Salmonella bacteria isolated from ill people by using a technique called pulsed-field gel electrophoresis, or PFGE. PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. One DNA fingerprint (outbreak strain) is included in this outbreak investigation. The outbreak strain is new to the PulseNet database.
A total of 11 people infected with the outbreak strain of Salmonella Paratyphi B variant L(+) tartrate(+) have been reported from nine states as of December 2, 2015. The number of ill people identified in each state is as follows: California (1), Colorado (1), Georgia (1), Hawaii (1), Idaho (1), Illinois (1), North Carolina (1), New Jersey (1), and Oregon (3).
Illnesses started on dates ranging from July 18, 2015, to October 15, 2015. Ill people range in age from 1 year to 79, with a median age of 48. Sixty-four percent of ill people are male. Among nine ill people with available information, none reported being hospitalized, and no deaths have been reported.
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 October 30, 2015, might not yet be reported 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. The recalled nut butter products have a long shelf life and may still be in people’s homes, restaurants, and grocery stores, and illnesses may continue to be reported.
Investigation of the Outbreak
The epidemiologic evidence available at this time indicates that JEM Raw brand sprouted nut butter spreads are the likely source of this outbreak.
In interviews, ill people answered questions about foods eaten and other exposures in the week before they became ill. All eight ill people interviewed (100%) reported exposure to a nut butter or nut butter spread in the week before illness onset, and six (75%) of these people specifically reported exposure to a JEM Raw brand sprouted nut spread.
On December 2, 2015, JEM Raw Chocolate, LLC of Bend, Oregon, voluntarily recalled its entire line of sprouted nut butter spreads because of potential contamination with Salmonella. The nut butter spreads were distributed nationwide in retail stores and through mail order. The recall affects all flavors of sprouted nut butter spreads sold by JEM Raw. The products were sold in glass jars in sizes ranging from 1.25 ounces to 16 ounces.
CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill persons and to interview ill persons about foods they ate before they become ill.