2021 Salmonella Outbreak Linked to Italian-Style Meats – Investigation Details
In August 2021, CDC, public health and regulatory officials in several states, and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) investigated a multistate outbreak of Salmonella Infantis and Salmonella Typhimurium infections.
Epidemiologic data showed that Fratelli Beretta brand prepackaged Uncured Antipasto trays made people sick.
As of October 26, 2021, this outbreak is over.
Epidemiologic Data
A total of 40 people infected with the outbreak strains of Salmonella Infantis (14) or Salmonella Typhimurium (26) were reported from 17 states (see map). The true number of sick people in the outbreak was likely much higher than the number reported, and the outbreak may not be limited to the states with known illnesses. This is because many infected people recover without medical care and are not tested for Salmonella.
Illnesses started on dates ranging from May 9, 2021, to August 16, 2021 (see timeline). Sick people ranged in age from 1 to 91 years, with a median age of 41, and 51% were male. Of 35 people with information available, 12 were hospitalized. No deaths were reported.
State and local public health officials interviewed people about the foods they ate in the week before they got sick. Of the 28 people interviewed, 26 (93%) reported eating a variety of Italian-style meats. Among 15 people who remembered the specific product or had shopper card records showing a purchase, 14 had Fratelli Beretta brand prepackaged Uncured Antipasto trays.
Laboratory Data
Public health investigators used the PulseNet system to identify illnesses that were part of this outbreak. CDC PulseNet manages a national database of DNA fingerprints of bacteria that cause foodborne illnesses. DNA fingerprinting is performed on bacteria using a method called whole genome sequencing (WGS).
For each outbreak strain, WGS showed that bacteria from sick people’s samples are closely related genetically. This suggests that people in each outbreak got sick from eating the same food.
Outbreak of Salmonella Typhimurium infections
WGS of bacteria from 26 sick people’s samples predicted resistance to ampicillin for 25 (96%) samples and to chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline for all samples. Testing of three clinical isolates using standard antibiotic susceptibility testing methods by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory confirmed these results (streptomycin was not tested by this method). Most people with Salmonella illness recover without antibiotics. However, if antibiotics are needed, illnesses in this outbreak may be difficult to treat with ampicillin and may require a different antibiotic choice.
Outbreak of Salmonella Infantis infections
WGS of bacteria from 12 people’s samples did not predict any antibiotic resistance. Testing of two clinical isolates using standard antibiotic susceptibility testing methods by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory also found no resistance.
Public Health Actions
On August 27, 2021, USDA-FSIS announced that Fratelli Beretta was recalling one of their Uncured Antipasto products. The trays have the establishment number “EST. 7543B” inside the U.S. Department of Agriculture’s mark of inspection.
Public Health Actions
On August 27, 2021, Fratelli Beretta issued a recall of one of their uncured antipasto products; however, CDC continues to advise people to not eat any Fratelli Beretta brand Uncured Antipasto trays with “best by” dates on or before February 11, 2022.
Since the notice on August 24, 2021, CDC combined the outbreak of Salmonella Infantis infections and the outbreak of Salmonella Typhimurium infections into one investigation. As of August 26, the data for the two outbreaks will be reported together. No new cases have been reported since the previous notice.
Epidemiologic data show that Fratelli Beretta brand prepackaged Uncured Antipasto trays may be contaminated with Salmonella and may be making people sick.
Epidemiologic Data
As of August 25, 2021, a total of 36 people infected with either the Salmonella Infantis (13) or Salmonella Typhimurium (23) strain have been reported from 17 states (see map). Illnesses started on dates ranging from May 9, 2021, to July 27, 2021 (see timeline).
The true number of sick people in the outbreaks is likely much higher than the number reported, and the outbreaks may not be limited to the states with known illnesses. This is because many infected people recover without medical care and are not tested for Salmonella. In addition, recent illnesses may not yet be reported as it usually takes 3 to 4 weeks to determine if a sick person is part of an outbreak.
State and local public health officials interviewed people about the foods they ate in the week before they got sick. Officials also obtained sick people’s shopper records with their consent.
Of the 25 people with information, 22 (88%) reported eating a variety of Italian-Style meats. Among 15 people who remembered the specific product or had shopper card records showing a purchase, 14 had Fratelli Beretta brand prepackaged Uncured Antipasto trays.
Public Health Actions
CDC is advising people not to eat Fratelli Beretta brand prepackaged Uncured Antipasto trays with “best by” dates on or before February 11, 2022. This does not include Italian-style meats sliced at a deli. The investigation is ongoing to determine if additional products are linked to illness.
CDC, public health and regulatory officials in several states, and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) are collecting different types of data to investigate two multistate outbreaks of Salmonella infections—one involving Salmonella Typhimurium infections and one with Salmonella Infantis infections.
Epidemiologic data show that the likely sources of both outbreaks are Italian-style meats. Investigators are working to determine specific brands and products that are causing illnesses and whether the outbreaks are linked to the same Italian-style meat brands and products.
Epidemiologic Data
As of August 24, 2021, a total of 36 people infected with either Salmonella outbreak strain have been reported. This includes 23 people who are part of the Salmonella Typhimurium outbreak and 13 people who are part of the Salmonella Infantis outbreak.
The true number of sick people in the outbreaks is likely much higher than the number reported, and the outbreaks may not be limited to the states with known illnesses. This is because many people recover without medical care and are not tested for Salmonella. In addition, recent illnesses may not yet be reported as it usually takes 3 to 4 weeks to determine if a sick person is part of an outbreak.
Outbreak of Salmonella Typhimurium infections
Twenty-three sick people have been reported from 14 states (see map). Illnesses started on dates ranging from May 30, 2021, to July 27, 2021 (see timeline).
Sick people range in age from 4 to 91 years, with a median age of 44, and 67% are male. Of 21 people with information available, 9 have been hospitalized. No deaths have been reported.
State and local public health officials interviewed people about the foods they ate in the week before they got sick. Officials also obtained sick people’s shopper records with their consent. Of the 16 people with information, 14 (88%) ate Italian-style meats, including salami, prosciutto, coppa, and soppressata, that can often be found in antipasto or charcuterie assortments; several brands were reported. This percentage was significantly higher than the 40% of respondents who reported eating pepperoni or other Italian-style meats in the FoodNet Population Survey—a survey that helps estimate how often people eat various foods linked to diarrheal illness. This comparison suggests that people in this outbreak got sick from eating Italian-style meats.
Outbreak of Salmonella Infantis infections
Thirteen sick people have been reported from seven states (see map). Illnesses started on dates ranging from May 9, 2021, to June 24, 2021 (see timeline).
Sick people range in age from 1 to 74 years, with a median age of 41 years, and 31% are male. Of 10 people with information available, 3 have been hospitalized. No deaths have been reported.
State and local public health officials interviewed people about the foods they ate in the week before they got sick and collected their shopper records with their consent. Of the 8 people with information, all (100%) ate Italian-style meats, including salami and prosciutto, that can often be found in antipasto or charcuterie assortments; several brands were reported. This percentage was significantly higher than the 40% of respondents who reported eating pepperoni or other Italian-style meats in the FoodNet Population Survey—a survey that helps estimate how often people eat various foods linked to diarrheal illness. This comparison suggests that people in this outbreak got sick from eating Italian-style meats.
Laboratory Data
Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. CDC PulseNet manages a national database of DNA fingerprints of bacteria that cause foodborne illnesses. DNA fingerprinting is performed on bacteria using a method called whole genome sequencing (WGS).
For each outbreak, WGS showed that bacteria from sick people’s samples are closely related genetically. This suggests that people in each outbreak got sick from eating the same food.
Outbreak of Salmonella Typhimurium infections
WGS of bacteria from 20 sick people’s samples predicted resistance to ampicillin for 19 (95%) samples and to chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline for all samples. Standard antibiotic susceptibility testing by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory is currently underway. Most people with Salmonella illness recover without antibiotics. However, if antibiotics are needed, illnesses in this outbreak may be difficult to treat with ampicillin and may require a different antibiotic choice.
Outbreak of Salmonella Infantis infections
WGS of bacteria from 12 people’s samples did not predict any antibiotic resistance. Standard antibiotic susceptibility testing by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory is currently underway.
Public Health Actions
Investigators are working to identify which Italian-style meat brands and products are making people sick.
Until then, CDC is advising people at higher risk for severe Salmonella illness to heat Italian-style meats to an internal temperature of 165°F or until steaming hot before eating.
