Global & Disaster Medicine

Multistate Outbreak of Salmonella Infections Linked to Coconut Tree Brand Frozen Shredded Coconut

 Image of Coconut Tree Brand Frozen Shredded Coconut

Posted January 16, 2018 3:45 PM ET

Multistate Outbreak of Salmonella Infections Linked to Coconut Tree Brand Frozen Shredded Coconut

People infected with the outbreak strains of Salmonella I,4,[5],12:b:- or Salmonella Newport, by state of residence, as of January 12, 2018

Highlights

  • CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Salmonella infections.
  • Twenty-five people infected with the outbreak strains of Salmonella I 4,[5],12:b:- or Salmonella Newport have been reported from nine states.
    • Six ill people have been hospitalized. No deaths have been reported.
  • Epidemiologic, laboratory, and traceback evidence(https://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/index.html) indicates that Coconut Tree Brand Frozen Shredded Coconut, distributed by Evershing International Trading Company, is the likely source of this multistate outbreak.
    • On January 3, 2018, Evershing International Trading Company recalled all 16 oz. Coconut Tree Brand Frozen Shredded Coconut after Salmonella was identified in the product by officials in Massachusetts.
  • CDC recommends that retailers not sell, restaurants not serve, and consumers not eat recalled frozen shredded coconut.
    • The recalled product was packaged in 16-ounce plastic bags labeled as Coconut Tree Brand Shredded Coconut.
    • If you have recalled frozen shredded coconut in your home, you can return it to the place of purchase for a refund.
    • If you aren’t sure if the frozen coconut you bought is Coconut Tree Brand frozen Shredded Coconut, you can ask the place of purchase. Restaurants and retailers can ask their supplier.
    • When in doubt, don’t eat, sell, or serve it. Throw it out.
    • Wash and sanitize countertops as well as drawers or shelves in freezers or refrigerators(https://www.cdc.gov/foodsafety/communication/clean-refrigerator-steps.html) where frozen shredded coconut was stored.
  • This investigation is ongoing. CDC will provide updates when more information is available.

Initial Announcement

January 16, 2018

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Salmonella infections.

Public health investigators are using the PulseNet(https://www.cdc.gov/pulsenet/index.html) system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is performed on Salmonella bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis(https://www.cdc.gov/pulsenet/pathogens/pfge.html) (PFGE) and whole genome sequencing(https://www.cdc.gov/ncezid/dfwed/keyprograms/tracking-foodborne-illness-wgs.html) (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE.

As of January 12, 2018, 25 people infected with the outbreak strains of Salmonella I 4,[5],12:b:- (24 people) or Salmonella Newport (1 person) have been reported from 9 states. A list of the states and the number of cases in each can be found on the Case Count Map(https://www.cdc.gov/salmonella/coconut-01-18/map.html) page. One more ill person infected with the outbreak strain of Salmonella I 4,[5],12:b:- has been reported from Canada.

Signs & Symptoms

What are the signs and symptoms of Salmonella infection?

Most people infected with Salmonella develop the following signs and symptoms 12-72 hours after being exposed to the bacteria:

  • Diarrhea
  • Fever
  • Abdominal cramps

How long does the illness last?

  • The illness usually lasts 4 to 7 days, and most people recover without treatment.
  • In some people, the diarrhea may be so severe that the patient needs to be hospitalized. Salmonella infection may spread from the intestines to the bloodstream and then to other places in the body.
  • In rare cases, Salmonella infection can cause death unless the person is treated promptly with antibiotics.

Who is more likely to have a severe illness?

  • Children younger than 5 years
  • Adults older than 65
  • People with weakened immune systems

More information about Salmonella and steps people can take to reduce their risk of infection with Salmonella in general can be found on the CDCSalmonella(https://www.cdc.gov/salmonella/general/index.html) website.

WGS showed that isolates from people infected with Salmonella I 4,[5],12:b:- are closely related genetically. This close genetic relationship means that people in this outbreak are more likely to share a common source of infection.

Illnesses started on dates ranging from May 11, 2017 to November 4, 2017. Ill people range in age from 1 year to 82, with a median age of 19. Among ill people, 19 (76%) are male. Six people (24%) report being hospitalized. 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(https://www.cdc.gov/salmonella/coconut-01-18/epi.html).

Investigation of the Outbreak

Epidemiologic, laboratory, and traceback evidence(https://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/index.html) indicates that Coconut Tree Brand frozen Shredded Coconut is the likely source of this multistate outbreak. This investigation is ongoing.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Ten (63%) of 16 people interviewed reported eating or maybe eating coconut. Of these 10 people, 8 (80%) reported having an Asian-style dessert drink that contained frozen shredded coconut.

Throughout the outbreak investigation, state and local health officials have collected different food items from restaurants where ill people consumed Asian-style dessert drinks. In November 2017, laboratory testing of a sample from coconut milk made in one restaurant in New York did not identify the outbreak strain of Salmonella I 4,[5],12:b:-, but did identify a strain of Salmonella Newport. This sample was from coconut milk made with Coconut Tree Brand frozen Shredded Coconut, as well as other ingredients. WGS showed that the Salmonella Newport isolated from the coconut milk was closely related genetically to a Salmonella Newport isolate from an ill person from Massachusetts who had consumed an Asian-style dessert drink.

In December 2017, officials in Massachusetts collected food items from a restaurant where that ill person had consumed Asian-style dessert drinks. One sample from frozen shredded coconut identified a strain of Salmonella that was new to the PulseNet database and has not been linked to any illnesses. This sample was from an unopened package of Coconut Tree Brand Frozen Shredded Coconut. As a result, on January 3, 2018, Evershing International Trading Company recalled all Coconut Tree Brand Frozen Shredded Coconut. The recalled product was packaged in 16-ounce plastic bags.

Officials in Massachusetts returned to the restaurant and collected more Coconut Tree Brand frozen Shredded Coconut in January 2018. On January 12, laboratory testing confirmed that samples from that frozen shredded coconut identified the outbreak strain of Salmonella I 4,[5],12:b:-. Laboratory testing of other samples identified several types of Salmonella bacteria, including Salmonella Javiana, Salmonella Rissen, and Salmonella Thompson. These samples were from unopened packages of Coconut Tree Brand Frozen Shredded Coconut sold before January 3, 2018. CDC is reviewing the PulseNet database to determine if the other Salmonella isolates from the frozen shredded coconut are linked to any illnesses.

The frozen shredded coconut linked to this outbreak was used as an ingredient in Asian-style dessert drinks served at restaurants. The product was also sold in grocery stores and markets in several states. Frozen shredded coconut can last for several months if kept frozen and may still be in retail stores or in people’s homes. CDC recommends that retailers not sell, restaurants not serve, and consumers not eat recalled Coconut Tree Brand frozen Shredded Coconut.

This investigation is ongoing and we will provide updates when they are available.


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