Multistate outbreak of Salmonella Mbandaka infections linked to sweetened puffed wheat cereal – United States, 2018

Abstract

In May of 2018, PulseNet, the national molecular subtyping network for enteric pathogens, detected a multistate cluster of illnesses caused by an uncommon molecular subtype of Salmonella serovar Mbandaka. A case was defined as an illness in a person infected with the outbreak strain of Salmonella Mbandaka with illness onset on or after 3 March 2018 and before 1 September 2018. One-hundred thirty-six cases from 36 states were identified; 35 hospitalisations and no deaths were reported. Ill people ranged in age from <1 year to 95 years (median: 57 years). When standardised questionnaires did not generate a strong hypothesis, opened-ended interviews were performed. Sixty-three of 84 (75%) ultimately reported consuming or possibly consuming a specific sweetened puffed wheat cereal in the week before illness onset. Environmental sampling performed at the cereal manufacturing facility yielded the outbreak strain. The outbreak strain was also isolated from open cereal samples from ill people's homes and from a sealed retail sample. Due to these findings, the brand owner of the product issued a voluntary recall of the cereal on 14 June 2018. Additional investigation of the manufacturing facility identified persistent environmental contamination with Salmonella Mbandaka that was closely genetically related to other isolates in the outbreak. This investigation highlights the ability of Salmonella to survive in low-moisture environments, and the potential for prolonged outbreaks linked to products with long shelf lives and large distribution areas.

Persistence of microbiological hazards in food and feed production and processing environments

“…The hygiene level of NFCS is also critical for preventing persistence, because persistent strains from NFCS have been linked to foodborne outbreaks. A typical example is the 2018 sweetened puffed wheat cereal outbreak in Illinois, caused by S. Mbandaka that originated from drains and the external surfaces of food processing equipment (Keaton et al, 2022).…”

“…A drying tower was identified as the source of contamination (Jones et al, 2019). Also, a S. Mbandaka outbreak (2018), linked to sweetened puffed wheat cereal, where the thorough investigation of the manufacturing facility identified persistent environmental contamination with strains closely related genetically to the outbreak strain (Keaton et al, 2022). At last, a S. Agona outbreak (2008), associated with toasted oats cereal, where the outbreak isolates were linked by PFGE and WGS to a 1998 S. Agona outbreak associated with cereal manufactured in the same facility, indicating a persistent source of contamination (Hoffmann et al, 2020;Russo et al, 2013).…”

“…The numbers indicate the cases of persistence being identified from the experimental studies retrieved in the literature search for each serotype and sector. Note : Based on (Arguello, Carvajal, et al., 2013; Bersot et al., 2021; Bertrand et al., 2010; Boubendir et al., 2021; Bridier et al., 2019; Corcoran et al., 2013; Dantas et al., 2020; Davies et al., 1997; Duggan et al., 2010; Eriksson et al., 2005; Friesema et al., 2014; Gantzhom et al., 2014; Gosling et al., 2022; Grasso et al., 2015; Gu et al., 2020; Häggblom, 2012; Hiko et al., 2016; Hoffmann et al., 2020; Jakociune et al., 2014; Jones et al., 2019; Kawakami et al., 2019; Keaton et al., 2022; Kim et al., 2015; Kinross et al., 2014; Kuhn et al., 2013; Labska et al., 2021; Lienemann et al., 2011; Löfström et al., 2006; Mannion et al., 2012; Medina‐Santana et al., 2022; Moffatt et al., 2017; Monte et al., 2020; Monte et al., 2022; Moretro et al., 2003; Morganti et al., 2018; Morita et al., 2022; Nesse et al., 2003; Nesse et al., 2005; Parker et al., 2019; Parker et al., 2022; Pellegrini et al., 2015; Piras et al., 2011; Piras et al., 2015; Prasertsee et al., 2019; Prendergast et al., 2011; Ren et al., 2016; Russo et al., 2013; Schroeder et al., 2016; Tadee et al., 2015; Trinetta et al., 2020; van Hoek et al., 2012; Viazis et al., 2015; Vinueza‐Burgos et al., 2019; Wang et al., …”

“…A typical example is the 2018 sweetened puffed wheat cereal outbreak in Illinois, caused by S . Mbandaka that originated from drains and the external surfaces of food processing equipment (Keaton et al., 2022).…”

“…Also, a S . Mbandaka outbreak (2018), linked to sweetened puffed wheat cereal, where the thorough investigation of the manufacturing facility identified persistent environmental contamination with strains closely related genetically to the outbreak strain (Keaton et al., 2022). At last, a S .…”