Salmonellosis  
Annual Summary of Reportable Diseases

Salmonellosis is a disease caused by the bacteria, Salmonella, which typically causes gastrointestinal symptoms. During 2022, 1,045 Salmonella cases were reported. Of those, 925 were culture-confirmed and 120 only tested positive by a culture-independent diagnostic test (CIDT) and were not subsequently culture-confirmed. The 925 culture-confirmed cases of Salmonella infection (16.4 per 100,000 population) reported in 2022 represents an 11% increase from the median number of culture-confirmed cases reported annually from 2012 to 2021 (median, 832 cases; range, 660 to 1,009) (Figure 1).

Of the 100 serotypes identified among culture-confirmed cases in 2022, 5 serotypes accounted for 61% of cases: S. Enteritidis (272), S. Typhimurium (103), S. I 4,[5],12:i:- (83), S. Newport (59), and S. Infantis (44). Salmonella was isolated from stool in 789 (85%) cases, blood in 62 (7%), and urine in 60 (6%). Other specimen sources included wound (2), abscess, body fluid, peritoneal fluid, pleural fluid, synovial fluid, bile, bone, intervertebral disc, ear, hip structure, elbow structure, and spleen.

The incidence of Salmonella infections, based on reported case race, was 17.7 per 100,000 population among Asian Minnesotans, 14.9 among Black Minnesotans, 14.6 among white Minnesotans, and 12.3 among American Indian/Alaska Native Minnesotans. The incidence of Salmonella infections was 15.2 per 100,000 population for Hispanic Minnesotans. The median age of culture-confirmed cases was 41 years (range, 0 to 96 years).

Two hundred and seven (22%) culture-confirmed cases were hospitalized; the median length of hospital stay was 4 days (range, 1 to 113 days). Eight culture-confirmed cases died. Salmonella I 4,[5],12:i:- was isolated from a post-mortem blood specimen from a one year-old who died of Salmonella sepsis. S. Ituri was isolated from post-mortem blood and spleen tissue from a different one year-old who also died of Salmonella sepsis. A 51-year-old died of acute hypoxic respiratory failure and COVID-19 27 days after S. Dublin was isolated from blood. A 60-year-old died of respiratory failure, stroke, spinal cord infarct, and myasthenia gravis 23 days after S. Infantis was isolated from stool. A 72-year-old died of metastasized pancreatic cancer and severe sepsis “with abdominal source” 23 days after S. Enteritidis was isolated from blood. A 73-year-old died of severe sepsis with shock, ischemic colitis, enterococcus and Gram negative rod bacteremia, and multi-organ failure 2 days after S. IV 48:g,z51:- was isolated from blood. A 76-year-old died of sepsis and Salmonella bacteremia 13 days after S. Dublin was isolated from blood. A 95-year-old died of kidney failure 5 days after S. Infantis was isolated from stool.

Of the 715 culture-confirmed cases with known travel history, 152 (21%) had traveled internationally during the week prior to their illness onset. There were three S. Typhi cases; one travelled to India, one was unable to be interviewed, and one had no known international travel. There was one S. Paratyphi A case who was unable to be interviewed.

During 2022, 120 cases with specimens that were positive by a CIDT conducted at a clinical laboratory, but were not subsequently culture-confirmed, were reported. CIDTs have become widely adopted by clinical laboratories for the detection of Salmonella in stool. The median age of the CIDT-positive only cases was 47 years (range, 0 to 95 years). Thirty (25%) cases were hospitalized; the median hospital stay was 5 days (range, 2 to 29 days). Two cases died. One hundred twenty laboratory-confirmed (118 culture-confirmed and 2 CIDT-positive only) cases were part of eight Salmonella outbreaks in 2022, including four cases that were part of an outbreak that began before 2022 and one case that was part of a sapovirus outbreak. Three of the eight outbreaks involved foodborne transmission, two involved person-to-person transmission, one was due to animal contact, and one had an unknown source of transmission. Three of the outbreaks involved cases with exposure in multiple states. The eight outbreaks resulted in a median of 4 culture-confirmed cases per outbreak (range, 0 to 69).

Four culture-confirmed cases of S. Enteritidis infection were associated with travel to Jamaica. The cases were part of a larger multi-state outbreak that also included cases with no travel; the source of exposure and route of transmission were unknown. Three culture-confirmed and one probable case of S. Panama infection were associated with a person-to-person outbreak in the infant room at a childcare center. Thirty-three culture-confirmed cases of Salmonella infection with various serotypes (S. I 4:i:- [15], S. Berta [9], S. Agona [7], and S. Infantis [2]) were associated with direct or indirect exposure to a live animal market in Minnesota. S. enterica was found in 17 of 40 (43%) environmental swabs collected at the market, including isolates highly related to the S. Berta, S. Agona, and S. Infantis case isolates. Four culture-confirmed cases of S. Typhimurium infection were part of a multi-state outbreak of 88 cases from 11 states that was associated with cantaloupe from a packing facility in Indiana. The source and mechanism of contamination were not identified, but positive environmental samples and past Salmonella outbreaks in 2012 and 2020, also linked to cantaloupe grown in southwestern Indiana, suggest persistent environmental Salmonella reservoirs in the growing region. One culture-confirmed case of S. IIIb 61:z52:z53 infection was part of a multi-state outbreak of 20 cases from 15 states associated with contact with bearded dragons. State and national partners worked with two primary dragon suppliers on Salmonella prevention activities. Four culture-confirmed cases of S. Braenderup infection in 2022 were associated with a Minnesota breakfast restaurant outbreak that included 10 cases from April 17, 2021 to September 18, 2023. The source of contamination and vehicle of transmission were not identified. The long duration of the outbreak was indicative of environmental contamination at the restaurant leading to cross-contamination of food products. A positive environmental sample matching the outbreak strain confirmed this as the outbreak source. One probable case of Salmonella infection (who was also positive for sapovirus) was associated with a person-to-person outbreak of sapovirus gastroenteritis in the infant and toddler rooms at a childcare center. The outbreak included a total of 2 laboratory-confirmed and 7 probable sapovirus cases. Sixty-nine culture-confirmed cases of Salmonella infection with various serotypes (S. Enteritidis [51], S. Infantis [13], S. Hadar [4], and S. Mbandaka [1]) were associated with a multi-state outbreak linked to live poultry contact. Nationally, there were 1,230 people infected with the outbreak strains across 49 states, the District of Columbia, and Puerto Rico, with illness onset dates ranging from January 24, 2022 to October 18, 2022.

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During 2021, 1,024 Salmonella cases were reported. Of those, 853 were culture-confirmed Salmonella and 171 only tested positive by a culture-independent diagnostic test (CIDT) and not subsequently culture-confirmed.The 853 culture-confirmed cases of Salmonella infection (15.1 per 100,000 population) reported in 2021 represents a 6% increase from the median number of culture-confirmed cases reported annually from 2011 to 2020 (median, 808 cases; range, 660 to 1,009) (Figure 2).

Of the 91 serotypes identified among culture-confirmed cases in 2021, 6 serotypes, S. Enteritidis (191), S. Typhimurium (108), S. I 4,[5],12:i:- (90), S. Infantis (63), S. Newport (51), and S. Oranienburg (40) accounted for 64% of cases. Salmonella was isolated from stool in 741 (87%), urine in 58 (7%), and blood in 48 (6%) cases. Other specimen sources included body fluid, groin, left knee, perineal swab, skin/ subcutaneous tissue, and vaginal swab.

The incidence of Salmonella infections was 16.2 per 100,000 population among cases who reported Black race, 14.3 among cases who reported Asian race, 12.5 among cases who reported white race, and 11.2 among cases who reported American Indian/ Alaska Native race. The incidence of Salmonella infections was 20.8 per 100,000 population for cases who reported Hispanic ethnicity.

One hundred eighty-four (22%) culture-confirmed cases were hospitalized; the median length of hospital stay was 4 days (range, 1 to 70 days). Two culture-confirmed cases died. An 80 year-old died of bacteremia, Salmonella infection, and respiratory distress 7 days after S. Newport was isolated from blood. A 76 year-old died of respiratory failure, air embolism, septic shock, and Salmonella infection 9 days after S. Paratyphi B var. L(+) tartrate+ (formerly Java) was isolated from stool.

Of the 730 culture-confirmed cases with known travel history, 94 (13%) had traveled internationally during the week prior to their illness onset. There were three S. Typhi cases; one travelled to Sierra Leone, one traveled to Mexico, and one had no known international travel. There was one S. Paratyphi A case with no known international travel.

During 2021, 171 cases with specimens that were positive by a CIDT conducted at a clinical laboratory, but were not subsequently culture-confirmed, were reported. CIDTs have become widely adopted by clinical laboratories for the detection of Salmonella in stool. The median age of the CIDT-positive only cases was 52 years (range, 0 to 92 years). Fifty (29%) cases were hospitalized; the median hospital stay was 6 days (range, 2 to 66 days). Two cases died.

One hundred sixty-eight laboratory-confirmed (166 culture-confirmed and 2 CIDT-positive only) cases were part of 20 Salmonella outbreaks in 2021. Sixteen of the 20 outbreaks involved foodborne transmission, and 4 were due to animal contact. Twelve of the outbreaks involved cases with exposure in multiple states. The 20 outbreaks resulted in a median of 3 culture-confirmed cases per outbreak (range, 1 to 56). In addition, there was one multi-state investigation that included two Minnesota cases, which CDC classified as an outbreak with an unknown source.

Five culture-confirmed cases and two probable (clinically defined illness) cases of S. I 4,5,12:i:- infection were associated with a funeral event that served food prepared in private homes. The source of contamination and vehicle of transmission were not identified.

Four culture-confirmed cases of S. Enteritidis infection were part of a multi-state outbreak associated with a specific producer of raw, frozen, breaded, stuffed chicken products that included 36 cases in 11 states. This was the 10th outbreak associated with this type of product in Minnesota, and the 5th with products from the same producer since 1998.

Three culture-confirmed cases of S. Javiana infection were part of a multi-state outbreak of 4 cases from 2 states associated with pre-packaged Napa salad. The Napa cabbage component was the most plausible contaminated ingredient. However, the source or mechanism of contamination could not be determined.

Two culture-confirmed cases of S. Muenster infection were part of a multi-state outbreak associated with contact with bearded dragons. The genetic relatedness of isolates from this outbreak to S. Muenster isolates from a previous 2020 outbreak associated with bearded dragons indicates a continuing source of contamination in the pet bearded dragon industry.

One culture-confirmed case of S. Vitkin infection was part of a multi-state outbreak of 12 cases from 10 states associated with contact with bearded dragons.

Two culture-confirmed cases of S. Uganda infection were part of a multi-state outbreak of 56 cases from 26 states associated with contact with bearded dragons.

Seven culture-confirmed cases and one probable case of S. Enteritidis infection were linked to a Mexican-style restaurant where the potential vehicle was chicken or guacamole salad. Improper cold holding and lack of adequate cleaning/sanitization may have contributed to the outbreak.

One culture-confirmed case of S. Typhimurium infection and one culture-confirmed case of S. Infantis infection were part of a multi-state outbreak that included 40 cases (26 S. Typhimurium and 14 S. Infantis) from 17 states. The outbreak vehicle was antipasto trays containing various Italian-style meats.

Twenty-four laboratory-confirmed (22 culture-confirmed and 2 CIDT-positive only) cases and four probable cases of S. Enteritidis infection were associated with watermelon consumption at an Asian-style buffet restaurant. The most likely cause of the outbreak was cross contamination from raw meat to watermelon, partially due to the use of a spray hose. This was the third S. Enteritidis outbreak associated with this restaurant since 2018.

Eight culture-confirmed cases and nine probable cases of S. Typhimurium infection were associated with a graduation party. The vehicle of transmission was not identified.

Two culture-confirmed cases of S. Enteritidis infection were part of a multi-state outbreak for which the suspected vehicle was chicken. There were 50 cases from 20 states.

Twenty-eight culture-confirmed cases and 10 probable cases of S. Oranienburg infection were part of a multi-state outbreak associated with whole, fresh onions imported from Mexico that included 1,040 cases in 39 states. Following a 2020 multi-state S. Newport outbreak, this was the second consecutive year in which there was a multi-state outbreak of over 1,000 Salmonella infections associated with onions.

Two culture-confirmed cases of S. Thompson infection were part of a multi-state outbreak associated with seafood primarily from a distributor in Colorado. There were 115 cases from 15 states, and one of the Minnesota cases was part of a subcluster in Colorado.

Three culture-confirmed cases of S. I 4,5,12:i:- infection were part of a multi-state outbreak associated with Italian-style meat sticks that included 36 cases from 11 states. Timely and detailed reinterviewing of cases allowed MDH staff to rapidly identify the outbreak vehicle with only three cases.

Three culture-confirmed cases of S. Typhimurium infection were linked to a Minnesota restaurant where the vehicle of transmission was not identified. Poor hand-washing and bare-hand contact practices at the restaurant might have contributed to the outbreak.

Ten culture-confirmed cases and one probable case of S. Typhimurium infection were linked to a Minnesota Mexican-style restaurant. Lettuce was a possible vehicle of transmission. An infected food worker was the most plausible source of contamination, and therefore any ready-to-eat food item could have been a vehicle of transmission.

One culture-confirmed case and four probable cases of S. Enteritidis infection, plus a culture-confirmed case in an out-of-state resident, were linked to the same Asian-style buffet restaurant that was the source of another S. Enteritidis outbreak that occurred earlier in 2021 (reported above). No specific food vehicle was identified, but extensive issues in the restaurant created a high risk for contamination of equipment, food preparation surfaces, and ready-to-eat food items.

Two culture-confirmed cases of S. Newport infection were likely associated with a college cafeteria; however, a vehicle was not identified.

One culture-confirmed case of S. Saintpaul infection was part of a multi-state outbreak of 60 cases from 14 states that was likely associated with tomatoes. One specific grower in Florida was identified as a common source of tomatoes for three subcluster establishments by traceback.

Fifty-six culture-confirmed cases of Salmonella infection with various serotypes (S. Infantis [37], S. Enteritidis [9], S. Hadar [8], S. Mbandaka [1], and S. Muenchen [1]) were associated with a multi-state outbreak linked to live poultry contact. Nationally, there were 1,135 people infected with the outbreak strains across 48 states, with illness onset dates ranging from December 15, 2020 to October 10, 2021.

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In 2020, 660 Salmonella cases (11.7 per 100,000 population) were reported. This is an 18% decrease from the median annual number of cases reported from 2010 to 2019 (median, 808 cases; range, 695 to 1,009) (Figure 2).

Of the 82 serotypes identified in 2020, 5 serotypes, S. Enteritidis (159), S. Typhimurium (80), S. I 4,[5],12:i:- (70), S. Newport (42), and S. Paratyphi B var. L(+) tartate+ (formerly Java) (25) accounted for 57% of cases. Salmonella was isolated from stool in 552 (84%), blood in 51 (8%), and urine in 46 (7%) cases. Other specimen sources included wound/swab/abscess (5), lung, buttock, peritoneal fluid, gallbladder fluid, abdominal fluid, and groin tissue.

One hundred seventy-five (27%) cases were hospitalized; the median length of hospital stay was 4 days (range, 1 to 40 days). Three culture-confirmed cases died: a 43 year-old died of COVID-19 13 days after S. Dublin was isolated from blood; a 76 year-old died of septic shock 3 days after S. Pomona was isolated from stool; and, S. Enteritidis was isolated after death from the stool, spleen, and lung of a 47 year-old.

Of the 575 cases with known travel history, 55 (10%) had travelled internationally during the week prior to their illness onset. There were 3 S. Typhi cases and 1 S. Paratyphi A case; all had no international travel.

In 2015, culture-independent diagnostic tests (CIDTs) for the detection of Salmonella nucleic acid in stool became commercially available. In 2020, 53 patient specimens that were positive by a CIDT conducted at a clinical laboratory were not subsequently culture-confirmed, and therefore did not meet the surveillance case definition for inclusion in MDH case count totals.

One hundred thirteen culture-confirmed cases were part of nine Salmonella outbreaks in 2020, including 1 case that was part of an outbreak that began before 2020. Seven of the nine outbreaks involved foodborne transmission, and two were due to animal contact. Eight of the outbreaks involved cases with exposure in multiple states. The nine outbreaks resulted in a median of 4 culture-confirmed cases per outbreak (range, 1 to 43).

Four cases of S. Typhimurium infection were part of a multi-state outbreak associated with hedgehog contact that included 49 cases from 25 states. No common breeder or source was identified. The outbreak strain was also identified in previous outbreaks associated with hedgehogs.

Eleven culture-confirmed cases and 5 probable cases of S. Paratyphi B var. L(+) tartate+ (formerly Java) infection were part of a multi-state outbreak that included 18 cases from four states. An outbreak vehicle was not confirmed, though cashews were the most plausible vehicle. The Minnesota cases were part of a cluster associated with a juice bar.

Twenty-eight cases of S. Enteritidis infection were part of a multi-state outbreak that included 102 cases from 17 states. The outbreak vehicle was peaches from a single supplier. This was the first outbreak of salmonellosis associated with peaches to be reported to the CDC National Outbreak Reporting System.

Nineteen cases of S. Newport infection were part of a multi-state outbreak of 1,127 cases in 48 states that was associated with red onions, and likely also yellow, white, and sweet onions, sourced from a California supplier. The source and mechanism of contamination were not identified. Four cases of S. Dublin infection were part of a multi-state outbreak that also included 4 Pennsylvania cases. The suspected outbreak vehicle was ground beef. Traceback investigations suggested that the beef was processed by a Wisconsin firm.

Two cases of S. Enteritidis infection were linked to a Minnesota restaurant by epidemiology and whole genome-sequencing; the vehicle of transmission and source of contamination were not identified.

One case of S. Newport infection was part of a multi-state outbreak of 80 cases in 15 states that was associated with cantaloupe and watermelon. A farm in Indiana was suspected as the source. The source and mechanism of contamination were not identified.

Forty-three cases of Salmonella infection with various serotypes (S. Enteritidis [27], S. Hadar [11], S. Braenderup [2], S. Infantis [2], and S. Anatum [1]) were associated with a multi-state outbreak linked to live poultry contact. Nationally, there were 1,722 people infected with the outbreak strains across 50 states, with isolation dates ranging from January 6, 2020 to November 30, 2020.

One case of S. Saintpaul infection was part of a multi-state outbreak likely associated with strawberries that began in 2019 (there were 3 other Minnesota cases from 2019). The outbreak included 97 cases from 16 states and Washington D.C. A specific source or supplier was not identified.

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In 2019, 805 Salmonella cases (14.3 per 100,000 population) were reported. This is similar to the median annual number of cases reported from 2009 to 2018 (median, 796 cases; range, 578 to 1,009).

Of the 86 serotypes identified in 2019, 5 serotypes, S. Enteritidis (203), S. I 4,[5],12:i:- (73), S. Typhimurium (69), S. Newport (50), and S. Infantis (38) accounted for 54% of cases. Salmonella was isolated from stool in 702 (87%), urine in 47 (6%), and blood in 46 (6%) cases. Other specimen sources included wound/swab/abscess (4), pleural fluid (2), peritoneal fluid (2), pericardial fluid, and perineum.

One hundred eighty-two (23%) cases were hospitalized; the median length of hospital stay was 4 days (range, 1 to 38 days). Two culture-confirmed cases died: a 73 year-old died of adenocarcinoma 10 days after a hospitalization during which S. Poona was isolated from stool, and an 83 year-old with lymphoma died 10 days after S. Typhimurium was isolated from blood.

Of the 727 cases with known travel history, 190 (26%) had traveled internationally during the week prior to their illness onset. There were 10 S. Typhi cases; 3 traveled to India, 1 to Pakistan, 1 to El Salvador, 1 to Thailand and India, and 4 had no known international travel. There was 1 S. Paratyphi A case who had traveled to Bangladesh and Qatar.

In 2015, culture-independent tests (CIDTs) for the detection of Salmonella nucleic acid in stool became commercially available. In 2019, 49 patient specimens that were positive by a CIDT conducted at a clinical laboratory were not subsequently culture-confirmed, and therefore did not meet the surveillance case definition for inclusion in MDH case count totals.

Eighty-eight culture-confirmed cases were part of 28 Salmonella outbreaks in 2019, including 2 cases that were part of outbreaks that began before 2019. Twenty of the 28 outbreaks involved foodborne transmission, 3 involved animal contact, 2 were due to person-to-person transmission, and the transmission route was unknown for 3 outbreaks. Sixteen of the outbreaks involved cases with exposure in multiple states. The 28 outbreaks resulted in a median of 2 culture-confirmed cases per outbreak (range, 1 to 16).

Ten cases of S. Montevideo infection (including one food worker) and 1 case of S. Oranienberg infection (also a food worker) were part of a multi-state outbreak of 32 cases in 13 states that was likely associated with iceberg lettuce from fast food restaurants. The Minnesota cases were linked to two locations of a fast food burger chain. No common lettuce supplier was identified.

Nine cases of S. Bovismorbificans were part of a multi-state outbreak of 107 cases in 35 states. The national investigation determined this to be an outbreak with an unknown source, but epidemiological data among cases in Minnesota suggested that contaminated watermelon was the most likely source.

Three cases of S. Carrau infection were part of a multi-state outbreak of 137 cases from 10 states associated with pre-cut melon (including cantaloupe, watermelon, and honeydew) commercially distributed by an Indiana company. A product recall was initiated.

Three cases of S. Javiana infection were part of a multi-state outbreak of 16 cases from 8 states associated with eating a pre-packaged salad mix that contained iceberg lettuce, romaine lettuce, red cabbage, carrot, and radish.

Two cases of S. Enteritidis infection were part of a multi-state outbreak of 52 cases from 16 states that was associated with chicken; national laboratory and traceback evidence suggested a possible single facility as the source.

Two cases of S. Infantis infection were part of a multi-state outbreak that included 4 cases in Wisconsin. The implicated vehicle was vegetable trays purchased from a convenience store chain. In a separate outbreak, 1 case of S. Infantis infection was associated with a multi-state outbreak of 154 cases in 34 states that included 7 serotypes and spanned 4 years. The outbreak was associated with pig ear pet treats. No single supplier/brand/distributor was identified, and the Minnesota case’s exposures were unknown.

One culture-confirmed case a S. Newport infection was part of a multi-state outbreak of 13 cases in 7 states associated with raw tuna. A product recall was issued.

One case of S. Paratyphi B Var. L(+) Tartrate(+) infection was part of a multi-state outbreak of 12 cases in 6 states that was associated with raw tuna.

Sixteen cases of S. Enteritidis (n=14, includes a food worker), S. Infantis (n=1), and both S. Enteritidis and S. Infantis (n=1) infection were part of an outbreak at a county jail that was most likely associated with a raw, mechanically separated chicken product used in some jail meals. Leftover product tested positive for the same serotypes of Salmonella found in the human cases, and epidemiologic evidence suggested a meal that included the chicken product as the most likely source of many of the infections. Lack of temperature testing during food preparation likely contributed to the outbreak.

Seven culture-confirmed (including 2 food workers) and 2 probable cases of S. Braenderup infection were associated with a foodborne outbreak at a Minnesota restaurant. Tomato and romaine lettuce consumption were statistically associated with illness. The positive food workers may have been the source of the outbreak.

Four cases of S. Enteritidis infection were associated with an outbreak at a restaurant. The outbreak vehicle was not identified, although the environmental assessment identified multiple issues that could have led to potential contamination of either food items or equipment. Whole genome sequencing (WGS) analyses indicated that there likely was a common source of illness between cases in this outbreak and a 2018 outbreak linked to the same restaurant. In a separate outbreak, 2 cases of S. Enteritidis infection were associated with a restaurant/grocery store outbreak; no vehicle of transmission was identified.

Three cases of S. Reading infection were associated with a restaurant. The outbreak vehicle was not identified, although turkey was a plausible source, given that the outbreak cases were closely related to isolates from a recent multi-state outbreak associated with turkey. Issues were identified at the restaurant related to turkey preparation and handling that could have allowed for Salmonella survival and proliferation.

Two culture-confirmed cases of S. IV 50:z4,z23:- infection were associated with bubble tea served by a vendor at a festival. While both cases reported consuming tea from the same vendor, it is possible that they shared additional exposures at the market that were not reported, as no source of contamination was identified during the investigation.

Three culture-confirmed and 1 probable case of S. Typhi infection were associated with a fundraising event at a private home. The source of contamination and vehicle of transmission were not identified. A local health alert was issued to clinicians.

Three cases of S. Typhimurium infection were associated with horse contact. Hand hygiene training for barn crew student workers was recommended.

Two cases of S. Saintpaul infection were both inpatients at the same hospital facility prior to specimen collection. The route of transmission was unknown.

Two cases of S. Infantis infection were part of a person-to-person outbreak at a childcare center. One culture-confirmed case and 2 probable cases of S. I 4,5,12:i:- infection were part of a person-to-person outbreak at an in-home child care.

One culture-confirmed and 5 probable cases of S. Reading infection were associated with a game feed event in Iowa. The implicated vehicle was smoked turkey sourced from a Minnesota producer.

One culture-confirmed case of S. Paratyphi B Var. L(+) Tartrate(+) was part of an outbreak associated with a restaurant in Kentucky.

One culture-confirmed case of S. I 4,5,12:i:- infection was part of an outbreak of salmonellosis and rotavirus gastroenteritis associated with a private gathering in Wisconsin. The transmission route was unknown.

One culture-confirmed case and 1 probable case of S. Enteritidis infection were part of a foodborne outbreak at a Wisconsin restaurant associated with steak tartare.

One case of S. Javiana infection was associated with a family reunion outbreak in Arkansas with an unknown transmission route.

One case of S. Javiana infection was part of a foodborne outbreak at a hotel in New York City.

Among the 2 Salmonella cases in 2019 who were part of outbreaks that began before 2019, 1 (S. Typhimurium) was part of a 2018 outbreak associated with hedgehogs, and 1 (S. Infantis) was part of a 2018 national outbreak associated with chicken.

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In 2018, 1,009 Salmonella cases (18.1 per 100,000 population) were reported. This is a 31% increase from the median annual number of cases reported from 2008 to 2017 (median, 768 cases; range, 578 to 975), and the highest number of Salmonella cases reported since at least 1988.

Of the 99 serotypes identified in 2018, 5 serotypes, S. Enteritidis (264), S. Typhimurium (104), S. I 4,[5],12:i:- (88), S. Infantis (42), and S. Saintpaul (40) accounted for 53% of cases. Salmonella was isolated from stool in 860 (85%), urine in 87 (9%), and blood in 54 (5%) cases. Other specimen sources included abscess (3), wound (2), cerebrospinal fluid, peritoneal fluid, and synovial fluid.

Two hundred forty (24%) cases were hospitalized; the median length of hospital stay was 4 days (range, 2 to 60 days). Five culture-confirmed cases died: a 75 year-old died of septic shock and Salmonella bacteremia; an 86 year-old died of chronic obstructive pulmonary disease and community-acquired pneumonia, with contributing Gram-negative sepsis secondary to S. Enteritidis and E. coli urinary tract infection; a 72 year-old died of acute respiratory distress syndrome and Salmonella bacteremia; a 99 year-old died of “natural” causes 6 days after S. Enteritidis was isolated from urine; and, an 80 year-old who of multiple causes including sepsis and Salmonella colitis.

Of the 912 cases with known travel history, 141 (15%) had travelled internationally during the week prior to their illness onset. There were 4 S. Typhi cases associated with travel to or immigration from India, Liberia, Guatemala, and Nepal. There were 3 S. Paratyphi A cases; 2 travelled to India and 1 had no known international travel. There were 4 S. Paratyphi B cases; 1 was not able to be interviewed, and 3 had no known travel history.

In 2015, culture-independent tests (CIDTs) for the detection of Salmonella nucleic acid in stool became commercially available. In 2018, 73 patient specimens that were positive by a CIDT conducted at a clinical laboratory were not subsequently culture-confirmed, and therefore did not meet the surveillance case definition for inclusion in MDH case count totals.

One hundred sixty cases were part of 20 Salmonella outbreaks in 2018, including 18 cases that were part of outbreaks that began in 2015 or 2017. Fifteen of the 20 outbreaks involved foodborne transmission, 2 involved animal contact, and 3 were due to person-to-person transmission. Ten of the outbreaks involved cases in multiple states. The 20 outbreaks resulted in a median of 4 culture-confirmed cases per outbreak (range, 1 to 32).

Eleven culture-confirmed and 5 probable cases of S. Enteritidis infection were associated with a restaurant outbreak. The vehicle of transmission was smoked chicken. The most plausible explanation for the outbreak was undercooking of the smoked chicken that was served on the implicated meal date. Six culture-confirmed cases of S. Infantis (n=3), S. Enteritidis (n=2), and S. Typhimurium (n=1) infection were associated with a second restaurant outbreak. Three of the infections were from two food workers. A single outbreak vehicle was not identified. Thirty-two culture-confirmed cases and 1 probable case of S. Enteritidis infection were part of an extended outbreak at a third restaurant. The investigation included four rounds of environmental health interventions, including three rounds of employee stool specimen submissions. A single outbreak vehicle was not identified. The outbreak was ongoing for 5 months, indicating there was a reservoir for the bacteria in the restaurant; this reservoir could have been food workers, the environment, or both. Two culture-confirmed cases of S. Enteritidis infection were part of an outbreak at a fourth restaurant. The vehicle and source of contamination were not identified. Two culture-confirmed cases of S. I 4,[5],12:i:- infection were associated with an outbreak at a fifth restaurant. The vehicle and source of contamination were not identified. Six culture-confirmed cases of S. Thompson infection were part of a sixth restaurant outbreak. One of the cases was a food worker; however, the outbreak vehicle was not identified.

Two culture-confirmed cases of S. Enteritidis infection were reported from a child care center; the outbreak was suspected to be caused by person-to- person transmission. Two culture-confirmed cases of S. I 4,[5],12:i:- infection were associated with an outbreak at a second child care center. Two culture-confirmed cases of S. Typhimurium infection were identified who attended the same in-home child care facility.

Four culture-confirmed and 1 probable case of S. Typhimurium infection were part of a multi-state outbreak of 265 cases in 8 states associated with commercially produced chicken salad sold at grocery stores. Seven culture-confirmed cases of S. Enteritidis infection were associated with raw breaded chicken products that were distributed primarily through a pop-up pantry program in unlabeled bags. The outbreak included 6 cases in Wisconsin, and chicken from case households in both states tested positive for the outbreak strain. Twenty-five culture-confirmed and 11 probable cases of S. Sandiego (n=23) and S. IIIb 61:l,v:1,5,7 infection (2 cases) were linked to a multi-state outbreak of 101 cases in 10 states that was associated with commercially distributed pasta salad. These numbers include 1 case who was positive for both serotypes and was therefore counted as 2 cases. A subset of the Minnesota cases attended a wedding where the pasta salad was served. The pasta salad was produced at a central commissary kitchen in Nebraska; the source of contamination was not identified.

Twenty culture-confirmed cases of Salmonella infection (S. Enteritidis, n=17; S. Indiana, n=2; and S. Montevideo, n=1) were part of a multi-state outbreak linked to live poultry contact. Nationally, 334 cases from 47 states in this outbreak were infected with 6 Salmonella serotypes. Four culture-confirmed cases of S. Infantis infection were part of a multistate outbreak of 129 cases in 32 states. Laboratory and epidemiological evidence suggests that the outbreak strain occurs widely in live chickens and a variety of raw chicken products.

Four culture-confirmed cases of Salmonella infection (S. Montevideo, n=2; S. Cubana, n=2) were part of a multi-state outbreak associated with alfalfa sprouts. One culture-confirmed case of S. Mbandaka infection was linked to a multi-state outbreak of 135 cases in 36 states. The implicated product was a dry breakfast cereal; multiple food samples also tested positive, and the company issued a recall. Five culture-confirmed cases of S. Typhimurium infection were included in a multi-state CDC-defined outbreak that may have been associated with spices. Two culture-confirmed cases of S. Newport infection were linked to a multistate outbreak of 403 cases from 30 states. The implicated vehicle was raw ground beef from a single supplier; the supplier subsequently recalled approximately 12 million pounds of beef products. Two culture-confirmed cases of S. Typhimurium infection were associated with hedgehog contact; these cases were part of a multi-state outbreak that included 17 cases in 11 states. Hedgehogs were purchased from a variety of sources, including hedgehogs bred in-house in Minnesota, and some were positive for the outbreak strain of Salmonella. Two culture-confirmed and 2 probable cases of S. I 4,[5],12:i:- infection were associated with a pig roast event. A single vehicle was not identified.

Among the 18 Salmonella cases in 2018 who were part of outbreaks that began before 2018, 2 (S. Heidelberg) were part of a 2015 outbreak associated with dairy calves, 2 (S. Infantis) were part of a 2017 child care outbreak, 2 (S. Montevideo) were part of a 2017 casino outbreak in Iowa, and 12 (S. Paratyphi B var. L(+) tartrate(+), n=7; S. Thompson, n=3; S. Okatie, n=1; and S. Weltevreden, n=1) were part of a multi-state outbreak associated with kratom. Kratom is a product derived from a tree endemic to Southeast Asia having opioid or stimulant properties.

• For up to date information see>> Salmonellosis (Salmonella)

• Archive of Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health
  Archive of past summaries (years prior to 2023 are available as PDFs).