Multistate Outbreak of Salmonella Infections Linked to Imported

Maradol Papayas (Final Update)

Salmonella Infections Linked to Imported Maradol Papayas en Español

Recall & Advice to Consumers, Restaurants, and RetailersCase Count Maps
Epi CurvesSigns & SymptomsKey Resources

Posted November 3, 2017 3:00 PM ET

This outbreak appears to be over. This outbreak was one of four separate multistate outbreaks identified in
2017 linked to imported Maradol papayas from four different farms in Mexico. For information on the
other outbreaks, please visit the Reports of Salmonella Outbreak Investigations from 2017 webpage.

Highlights

Read the Recall and Advice to Consumers, Restaurants, and Retailers>>

This outbreak appears to be over.
CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration
(https://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm568097.htm) investigated
a multistate outbreak of Salmonella infections.
Epidemiologic and laboratory evidence indicated that Maradol papayas from the Carica de Campeche
farm in Tenabo, Campeche, Mexico were the likely source of this outbreak.
This outbreak included five types of Salmonella : Thompson, Kiambu, Agona, Gaminara, and Senftenberg.
The same strains of these types of Salmonella were found in samples collected from papayas and from ill
people.
A total of 220 people infected with the outbreak strains of Salmonella Thompson (144), Salmonella
Kiambu (54), Salmonella Agona (12), Salmonella Gaminara (7), or Salmonella Senftenberg (3) were
reported from 23 states.
Illnesses started on dates ranging from May 17, 2017 to October 4, 2017.
Sixty-eight ill people were hospitalized. One death was reported from New York City.

Outbreak Summary

Introduction
CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration
(FDA) (https://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm568097.htm)
investigated a multistate outbreak of Salmonella infections linked to imported Maradol papayas from the
Carica de Campeche farm in Mexico.

Public health investigators used the PulseNet system to identify illnesses that may have been part of this
outbreak. A total of 220 people infected with the outbreak strains of Salmonella Thompson (144),
Salmonella Kiambu (54), Salmonella Agona (12), Salmonella Gaminara (7), or Salmonella Senftenberg (3)
were reported from 23 states. A list of the states and the number of cases in each can be found on the Case
Count Map page. Whole genome sequencing (WGS) showed that isolates from people infected with
Salmonella were 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 17, 2017 to October 4, 2017. Ill people ranged in age from less
than 1 year to 95, with a median age of 40. Among ill people, 62% were female. Among 169 people with
available information, 113 (67%) were of Hispanic ethnicity. Among 170 people with available information,
68 (40%) were hospitalized. One death was reported from New York City.

WGS did not identify antimicrobial resistance genes among isolates from 139 ill people; one ill person’s
isolate, a Salmonella Senftenberg, contained a gene known to decrease susceptibility to ciprofloxacin.
Standard antibiotic susceptibility testing methods were used by CDC’s National Antimicrobial Resistance
Monitoring System (NARMS) laboratory on clinical isolates from 10 ill people in this outbreak and no
resistance was detected.

Investigation of the Outbreak

Epidemiologic and laboratory evidence indicated that Maradol papayas imported from Mexico were the
likely source of this multistate outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week
before they became ill. Of 145 people interviewed, 79 (54%) reported eating papayas. This proportion was
significantly higher than results from a survey [PDF – 29 pages] of healthy Hispanic people in which 22%

reported eating papayas in the summer months in the week before they were interviewed.

The Maryland Department of Health (https://health.maryland.gov/newsroom/Pages/State-urges-

Marylanders-not-to-consume-Caribe%C3%B1a%E2%80%99s-yellow,-Maradol-papayas.aspx) collected
papayas from a grocery store where several ill people reported eating papayas. One sample yielded
Salmonella Kiambu and another sample yielded Salmonella Thompson. Both samples were from Caribeña
brand Maradol papayas imported from Mexico. WGS showed that the Salmonella Kiambu papaya isolate
was closely related genetically to the Salmonella Kiambu isolates from ill people. WGS also showed that
the Salmonella Thompson papaya isolate was closely related genetically to Salmonella Thompson isolates
from ill people. On July 26, Grande Produce recalled
(https://www.fda.gov/Safety/Recalls/ucm568780.htm) Caribeña brand Maradol papayas that were
distributed between July 10 and July 19, 2017.

FDA (https://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm568097.htm) tested

other papayas imported from Mexico and isolated several types of Salmonella , including Salmonella Agona,
Salmonella Kiambu, Salmonella Gaminara, Salmonella Thompson, and Salmonella Senftenberg. Through
 this testing, FDA also identified Maradol papayas from the Carica de Campeche papaya farm in Campeche,
Mexico as a likely source of the outbreak. Investigators compared pulsed-field gel electrophoresis (PFGE)
and WGS results of Salmonella isolates from the papayas to isolates from ill people in the CDC PulseNet
database. These results showed the Salmonella isolates from papayas shared the same DNA fingerprint as
the Salmonella isolates from ill people. This result provided more evidence that people in this outbreak got
sick from eating contaminated Maradol papayas.

On August 5, Agroson’s LLC recalled (https://www.fda.gov/Safety/Recalls/ucm570258.htm) certain Cavi

brand Maradol papayas grown and packed by Carica de Campeche. On August 7, Freshtex Produce, LLC
recalled (https://www.fda.gov/Safety/Recalls/ucm570424.htm) Valery brand Maradol papayas grown
and packed by Carica de Campeche.

This outbreak appears to be over. This outbreak was one of four separate multistate outbreaks identified in
2017 linked to imported Maradol papayas from Mexico. For information on the other outbreaks, please
visit the Reports of Salmonella Outbreak Investigations from 2017 webpage.

Previous Investigation Updates

 September 13, 2017

 September 1, 2017

 August 18, 2017

 August 11, 2017

 August 4, 2017

 Initial Announcement

At A Glance

Case Count: 220

States: 23
Deaths: 1
Hospitalizations: 68
Recall: Yes

More Information

Recall & Advice to Consumers, Restaurants, and Retailers

Signs & Symptoms
Key Resources
Maradol Papaya: Maradol papayas are a large, oval fruit that weighs 3 or more pounds, with green skins
that turn yellow when the fruit is ripe. The flesh inside the fruit is salmon-colored.

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Related Links

Multistate Foodborne Outbreaks

Gastrointestinal (Enteric) Diseases from Animals
Division of Foodborne, Waterborne, and Environmental Diseases
Foodborne Illness A-Z
Estimates of Foodborne Illness
Foodsafety.gov (http://www.foodsafety.gov)
Report a Foodborne Illness
U.S. Food and Drug Administration (FDA) (http://www.fda.gov)
USDA Food Safety and Inspection Service (http://www.fsis.usda.gov/)

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Page last reviewed: July 21, 2017

Page last updated: November 3, 2017
Content source: Centers for Disease Control and Prevention (http://www.cdc.gov/)
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) (/ncezid/index.html)
Division of Foodborne, Waterborne, and Environmental Diseases (DFWED) (/ncezid/dfwed/index.html)