March 21, 2018

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Salmonella Typhimurium infections.

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is performed on Salmonella bacteria isolated from ill people using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE.

As of March 20, 2018, 13 people infected with the outbreak strain of Salmonella Typhimurium have been reported from 8 states. A list of the states and the number of cases in each can be found on the Case Count Map page. WGS performed on bacteria isolated from ill people showed that they were closely relatedly genetically. This means that people in this outbreak are more likely to share a common source of infection.

Illnesses started on dates ranging from September 22, 2017 to February 26, 2018. Ill people range in age from 1 to 73 years, with a median age of 40. Sixty-seven percent are female. Three hospitalizations have been reported. No deaths have been reported.

This outbreak can be illustrated with a chart showing the number of people who became ill each day. This chart is called an epidemic curve, or epi curve. Illnesses that occurred after January 25, 2018, might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. Please see the Timeline for Reporting Cases of Salmonella Infection for more details.

WGS analysis did not identify predicted antibiotic resistance in 10 of 11 isolates from ill people. One isolate contained resistance genes for ampicillin and azithromycin. Testing of outbreak isolates using standard antibiotic susceptibility testing methods by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory revealed two isolates with no antimicrobial resistance and one isolate with resistance to streptomycin. This resistance is unlikely to affect the choice of antibiotic used to treat most people, but some infections may be difficult to treat with antibiotics usually prescribed and may require a different antibiotic.

Investigation of the Outbreak

Epidemiologic, laboratory, and traceback evidence indicates that dried coconut is 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. Seven (88%) of eight people interviewed reported eating dried coconut from grocery stores. Of the seven people who reported eating dried coconut, four people purchased the product at different Natural Grocers store locations. Public health officials continue to interview ill people to learn more about what they ate in the week before becoming sick.

FDA and state health and regulatory officials collected leftover dried coconut from ill people’s homes, as well as dried coconut from Natural Grocers store locations where ill people shopped and from the Natural Grocers’ Distribution Center. FDA testing identified the outbreak strain of Salmonella Typhimurium in an unopened sample of Natural Grocers Coconut Smiles Organic collected from Natural Grocers. The outbreak strain was also identified in an opened, leftover sample of Natural Grocers Coconut Smiles Organic collected from an ill person’s home.

FDA also collected dried coconut from International Harvest, Inc. The outbreak strain of Salmonella Typhimurium was identified in samples of International Harvest Brand Organic Go Smile! Dried Coconut Raw and Go Smiles Dried Coconut Raw.

On March 16, 2018, International Harvest, Inc. recalled bags of Organic Go Smile! Raw Coconut and bulk packages of Go Smiles Dried Coconut Raw. The recalled Organic Go Smile! Raw Coconut was sold online and in stores in 9-ounce bags with sell-by dates from January 1, 2018 through March 1, 2019. Recalled bulk Go Smiles Dried Coconut Raw was sold in a 25-pound case labeled with batch/lot numbers OCSM-0010, OCSM-0011, and OCSM-0014. These products were sold in various grocery stores. Regulatory officials are working to determine where else Organic Go Smile! Raw Coconut and Go Smiles Dried Coconut Raw were sold.

On March 19, 2018, Vitamin Cottage Natural Food Markets, Inc. recalled packages of Natural Grocers Coconut Smiles Organic labeled with barcode 8034810 and packed-on numbers lower than 18-075. Recalled Natural Grocers Coconut Smiles Organic were sold in 10-ounce clear plastic bags with the Natural Grocers label. The packed-on number can be found in the bottom left-hand corner of the label.

CDC recommends people not eat recalled International Harvest, Inc. brand Organic Go Smile! Raw Coconut, Go Smiles Dried Coconut Raw, or recalled Natural Grocers Coconut Smiles Organic. Throw it away or return it to the place of purchase for a refund. Retailers should not sell or serve recalled dried coconut products.

This investigation is ongoing and we will provide updates when more information is available.