Press Release

Update Salmonella Agona associated with breakfast cereal

Epidemiology

As of June 8, a total of 211 persons with culture-confirmed Salmonella Agona infections identified in April-May 1998 have been reported by 12 midwestern and northeastern states. The case counts are attached. Among these 211 persons, a total of 47 have been hospitalized. No deaths have been recognized. Among newly identified cases, the most recent date of stool culture was June 2nd.

Among 68 households enrolled in the multistate case-control study to determine risk factors for illness in the 12 involved states, 56 ill persons reported eating Millville Toasted Oats sold by Aldi's Supermarket in the 3-day period before illness onset. Three additional ill persons had this cereal brand in the home but did not specifically report eating it, and four other ill persons shopped at Aldi's but denied purchasing cereal. The five remaining persons have no known risk, but they do not have cereal items in common. It is possible that these represent normal background cases of S. Agona, since this serotype accounts for 2% of all Salmonella strains isolated in the United States in most years. It is also possible they may have been exposed by another plain toasted oat cereal product produced by the same plant (Malt-o-Meal) which makes Millville brand products.

Malt-o-Meal produces a large number of generic brand names of toasted oats, which are distributed nationally. Investigations into cases in other states are critical to determine if another brand of cereal produced by Malt-o-Meal may be responsible for these cases.

Laboratory

Samples of Millville Toasted Oats cereal have been obtained by CDC from homes of ill persons. S. Agona has been identified in an opened box of cereal taken from the home of one of the cases in New York State. This person claims toasted oats from this box were consumed just prior to illness onset. Testing in state public health laboratories and at FDA has to date been negative for growth of Salmonella species.

Molecular subtyping is being performed on all available S. Agona isolates related to the outbreak and from other states now reporting recent increases in cases.

Tracebacks

To date, most of the cereal obtained from homes of ill persons have a "pull by" date of December 3­5, corresponding to production dates of April 3­5. An investigative team from FDA, the Minnesota Department of Health, and CDC has been visiting the plant in Northfield, Minnesota and studying records to determine how the contamination may have occurred.

At present, the company is not producing toasted oat products, and has voluntarily recalled all toasted oats boxed and bagged under the various labels.

Case Counts for April­May 1998

	Cases	Hospitalized
Illinois	49	13
Indiana	30	3
Iowa	8	2
Kansas	4	2
Michigan	15	4
Minnesota	2	0
Missouri	22	2
New York	24	4
Ohio	29	8
Pennsylvania	20	7
West Virginia	2	1
Wisconsin	6	1

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES