Since the CDC recorded 20 Salmonella Oranienburg infections on September 2, the numbers have grown rapidly to 652 infections, including at least 129 who have required hospitalization. Those who have fallen ill range in age from younger than 1 year to 91 years, with a median age of 37. Nearly 6 in 10 are female. So far, no one has died. While cases have been recorded in 37 states, the produce was distributed nationwide, so all Americans may be at risk. Texas has the most cases, with 158. Other states with relatively high counts include Oklahoma (98), Virginia (59), Maryland (48), and Illinois (37). Although ProSource Inc. (also known as ProSource Produce LLC) of Hailey, Idaho, has been named as a source, investigators are working to determine if other onions or suppliers are linked to this outbreak. “Throw away any unlabeled onions at home,” tweeted the CDC. “Do not eat, sell, or serve red, white, or yellow onions imported from Mexico and distributed U.S.-wide by ProSource Inc.” ProSource Inc. has agreed to voluntarily recall red, yellow, and white onions imported from the state of Chihuahua, Mexico, with import dates from July 1, 2021, through August 27, 2021. Descriptions of these onion types include, but are not limited to, jumbo, colossal, medium, and sweet onions. The FDA shared on October 21 that the onions were distributed under the following brand names: Big Bull, Peak Fresh Produce, Sierra Madre, Markon First Crop, Markon Essentials, Rio Blue, ProSource, Rio Valley, and Sysco Imperial. In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Of 193 people who provided information, 145 (75 percent) reported eating or maybe eating raw onions or dishes likely containing raw onion before they became sick. Several ill people reported eating at the same restaurants, indicating they may be part of illness clusters.

Cilantro Was Previously Thought to Be the Culprit

Investigators had earlier considered cilantro as a possible source of the illness when they found the outbreak strain of Salmonella Oranienburg in a restaurant condiment cup that contained leftover lime and cilantro. The sick person who had consumed the condiment reported that the condiment cup had also contained onions, although none were left when that item was tested. The FDA says that salmonella bacteria can transmit through food handlers who do not wash their hands or the surfaces and tools they use between food preparation steps, and when people eat raw or undercooked foods. Common symptoms of salmonella infection include diarrhea, fever, and stomach cramps, but most people recover without specific treatment. Symptoms usually begin six hours to six days after infection and last four to seven days. The most harmful effects to be aware of include a fever higher than 102 degrees F, diarrhea for more than three days, bloody diarrhea, extensive vomiting, and severe dehydration, according to the CDC. The federal health agency estimates that 26,500 people are hospitalized every year due to salmonella exposure and about 420 Americans die annually from related illness. Older adults, infants, and persons with weakened immune systems are more likely to develop a severe illness.

Other Outbreaks Traced to Meats and Salad Greens

The United States saw a major salmonella outbreak linked to Italian-style meats earlier this month, and on October 6, the CDC ended another investigation of salmonella contamination found in Bright Farms packaged salad greens that began back in mid-July of this year. That outbreak, which sickened 31 and hospitalized four in four states, is now officially over. Despite these recent outbreaks, a study released September 24 in the CDC’s Morbidity and Mortality Weekly Report estimated that 26 percent fewer infections were transmitted by food during 2020 compared with the average annual number during 2017–2019. Scientists attributed the decline in part to safety measures instituted during the pandemic. “Consumers can reduce their risk of foodborne illness by following safe food-handling and preparation recommendations,” wrote the study authors.