Five years after the first news of COVID, recent reports of an obscure respiratory virus in China may understandably raise concerns.
Chinese authorities first issued warnings about human metapneumovirus (hMPV) in 2023, but media reports indicate cases may be increasing again during China’s winter season.
Photo: Luisella Planeta/from Pixabay
For most people, hMPV will cause symptoms similar to a cold or the flu. In rare cases, hMPV can lead to severe infections. But it isn’t likely to cause the next pandemic.
What is hMPV?
hMPV was first discovered in 2001 by scientists from the Netherlands in a group of children where tests for other known respiratory viruses were negative.
But it was probably around long before that. Testing of samples from the 1950s demonstrated antibodies against this virus, suggesting infections have been common for at least several decades. Studies since have found hMPV in almost all regions in the world.
Australian data prior to the COVID pandemic found hMPV to be the third most common virus detected in adults and children with respiratory infections. In adults, the two most common were influenza and RSV (respiratory syncytial virus), while in children they were RSV and parainfluenza.
Like influenza, hMPV is a more significant illness for younger and older people.
Studies suggest most children are exposed early in life, with the majority of children by age five having antibodies indicating prior infection. In general, this reduces the severity of subsequent infections for older children and adults.
In young children, hMPV most commonly causes infections of the upper respiratory tract, with symptoms including runny nose, sore throat, fever as well as ear infections. These symptoms usually resolve over a few days to a week in children, and 1–2 weeks in adults.
Although most infections with hMPV are relatively mild, it can cause more severe disease in people with underlying medical conditions, such as heart disease. Complications can include pneumonia, with shortness of breath, fever and wheezing. hMPV can also worsen pre-existing lung diseases such as asthma or emphysema. Additionally, infection can be serious in people with weakened immune systems, particularly those who have had bone marrow or lung transplants.
But the generally mild nature of the illness, the widespread detection of antibodies reflecting broad population exposure and immunity, combined with a lack of any known major pandemics in the past due to hMPV, suggests there’s no cause for alarm.
Are there any vaccines or treatments?
It is presumed that hMPV is transmitted by contact with respiratory secretions, either through the air or on contaminated surfaces. Therefore, personal hygiene measures and avoiding close contact with other people while unwell should reduce the risk of transmission.
The virus is a distant cousin of RSV for which immunisation products have recently become available, including vaccines and monoclonal antibodies. This has led to the hope that similar products may be developed for hMPV, and Moderna has recently started trials into a mRNA hMPV vaccine.
There are no treatments that have been clearly demonstrated to be effective. But for severely unwell patients certain antivirals may offer some benefit.
Why are we hearing so many reports of respiratory viruses now?
Since the COVID pandemic, the pattern of many respiratory infections has changed. For example, in Australia, influenza seasons have started earlier (peaking in June–July rather than August–September).
Many countries, including Australia, are reporting an increased number of cases of whooping cough (pertussis).
In China, there have been reports of increased cases of mycoplasma, a bacterial cause of pneumonia, as well as influenza and hMPV.
There are many factors that may have impacted the epidemiology of respiratory pathogens. These include the interruption to respiratory virus transmission due to public health measures taken during the COVID pandemic, environmental factors such as climate change, and for some diseases, post-pandemic changes in vaccine coverage. It may also be the usual variation we see with respiratory infections – for example, pertussis outbreaks are known to occur every 3–4 years.
For hMPV in Australia, we don’t yet have stable surveillance systems to form a good picture of what a “usual” hMPV season looks like. So with international reports of outbreaks, it will be important to monitor the available data for hMPV and other respiratory viruses to inform local public health policy.
Ready to quit smoking in 2025? Ask your doctor for resources and guidance for quitting tobacco and nicotine.
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StatePoint - Looking to improve your health in 2025 and beyond? Check out these recommendations from the American Medical Association:
Make nutritional tweaks: Reduce your intake of sugar-sweetened beverages and processed foods, especially those with added sodium and sugar. Drinking sugary beverages, even 100% fruit juices, is associated with a higher mortality risk, according to a study published in JAMA Network Open. Drink water and choose nutritious, whole foods including fruits, vegetables, whole grains, nuts and seeds, low-fat dairy products, and lean meats and poultry.
Get active: A recent study published in JAMA found that putting down the TV remote and going for a walk can improve healthy aging—highlighting the importance of small everyday habits. Adults should get at least 150 minutes a week of moderate-intensity activity, or 75 minutes a week of vigorous-intensity activity.
Get up-to-date: Get your vaccines in advance of respiratory virus season—including the annual flu vaccine and the updated 2024-2025 COVID-19 vaccine for everyone six months and older, as well as pregnant people. People 65 and older and those who are moderately or severely immunocompromised should receive a second dose of the 2024-2025 COVID-19 vaccine six months later.
RSV can be dangerous for older adults. The Centers for Disease Control and Prevention recommend those 75 and older, and 60 and older at high risk for severe RSV, get vaccinated. Immunizations are also available to protect babies from getting very sick from RSV. This is important because RSV is the leading cause of infant hospitalization nationwide.
If you have questions, speak with your physician and review trusted resources, including GetMyFluShot.org. You can also reduce the spread of respiratory viruses by covering coughs and sneezes, frequently washing your hands, wearing masks, improving air quality, and staying home if you are sick.
Get screened: Make an appointment for preventive care, tests and screenings to help your doctor spot certain conditions before they become more serious.
Know your blood pressure numbers: Visit ManageYourBP.org to understand your blood pressure numbers and take necessary steps to get hypertension under control. Doing so will reduce your risk of heart attack and stroke. If checking your blood pressure at home, visit ValidateBP.org to see if your device has been tested for accuracy.
Learn your type 2 diabetes risk: Take a 2-minute self-screening test at DoIHavePrediabetes.org. Steps you take now can help prevent or delay the onset of type 2 diabetes, which carries a higher risk of heart disease, kidney disease and vision loss.
Drink only in moderation: If consuming alcohol, do so in moderation as defined by the U.S. Dietary Guidelines for Americans—up to one drink per day for women and two drinks per day for men, and only by adults of legal drinking age.
Quit tobacco and nicotine: Ask your doctor for resources and guidance for quitting tobacco and nicotine. Declare your home and car smoke-free to eliminate secondhand smoke exposure.
Follow dosage instructions: When taking prescription opioids or other medications, store them safely to prevent diversion or misuse, and properly dispose of any leftover medication. If you’re prescribed antibiotics, take the full course to prevent antibiotic resistance—a serious public health problem.
Manage stress: Good mental health is part of good overall health. Get sufficient sleep (at least 7.5 hours per night), exercise and ask for help from a mental health professional when you need it.
More health resources and tips can be found by visiting ama-assn.org.
“The best way to address the post-holiday doldrums is to do something good for your health,” said Bruce A. Scott, M.D., president of the AMA. “Even small, positive choices you make now can have a big impact on your long-term wellbeing.”
New data from the Centers for Disease Control and Prevention showed 75% of U.S. high school students said they have had at least one adverse childhood experience, or ACE.
Research has shown ACEs can alter a child's brain chemistry and produce a prolonged toxic stress response. Experiencing at least one ACE as a child is linked to having alcohol and substance use problems in adulthood, and chronic diseases such as diabetes and obesity.
Joe Bargione, a certified school psychologist, said the symptoms are troubling.
"We're seeing some of the same kinds of patterns," Bargione pointed out. "That increased sense of loneliness, isolation in our youth, increased levels of suicide ideation, exposure to violence, exposure to other adverse childhood experiences."
The Illinois Department of Public Health said 61% of adults have had at least one ACE, including witnessing domestic violence in the home, parental separation, or physical and sexual abuse. Females and several groups who identify as a racial or ethnic minority were at greater risk for experiencing four or more ACEs.
The Illinois Department of Health said preventing ACEs may lower the risk for depression, asthma, cancer, and diabetes in adulthood. Bargione added schools can help address the youth mental health crisis by cultivating a sense of belonging and connectedness, as well as increasing suicide prevention programs.
"Promoting mental health awareness," Bargione urged. "Teaching kids around social-emotional learning and dealing with their emotions in an effective way, increased mental health services."
The Illinois Department of Health said healthy childhoods can provide lasting benefits throughout their lives. One way to help at-risk youth is by educating communities, youth-serving and faith-based organizations, coaches, and caregivers to better understand ACEs.
NAPSI - While there’s no distinct COVID-19 season like there is for the flu, it’s been shown that COVID-19 can peak during the winter months. To help fight respiratory illnesses, it’s recommended you get a flu vaccination, as well as the updated COVID-19 vaccine.
According to the Centers for Disease Control and Prevention (CDC), people six months and older, with rare exception, should get the updated annual flu vaccine, ideally by the end of October. The CDC also recommends that everyone ages six months and older should get the updated 2024–2025 COVID-19 vaccine, unless otherwise noted, to help restore and enhance protection against the currently circulating virus variants.
It’s especially important to protect certain populations. This includes those at increased risk of complications from severe flu or COVID-19 illness, such as adults 65 and older, people with certain immunocompromising or chronic medical conditions, infants, children younger than two and pregnant women.
“Preventive vaccinations are the best way to protect yourself and your family from seasonal illnesses,” said Dr. Sree Chaguturu, executive vice president and chief medical officer at CVS Health. “Access to preventive vaccinations is critical to keeping communities healthy.”
According to Dr. Chaguturu, it’s helpful to understand the science behind vaccines so people feel informed and safe getting vaccinated.
Myth #1: You should wait until flu season peaks to get vaccinated.
According to the CDC, the timing of flu season is difficult to predict and can vary in different parts of the country and from season to season. It’s important to get vaccinated before flu season peaks or outbreaks occur in your area since it takes about two weeks for your body to build up protection after getting vaccinated.
Myth #2: You can’t receive other vaccinations with the flu shot.
The CDC says patients can get a COVID-19 vaccine at the same time as the flu vaccine and other eligible vaccines. At CVS Pharmacy, patients can schedule multiple vaccinations in one appointment.
Myth #3: You don’t need updated vaccinations for the flu.
Getting the flu shot every year is essential because the body’s protection from the vaccine declines over time. Also, flu viruses vary yearly, so receiving the latest vaccine formulation provides optimal protection.
Flu shot appointments (for up to four people in one appointment) can be scheduled at CVS Pharmacy or MinuteClinic by visiting CVS.com or the CVS Pharmacy app.
by Arthur Allen and Eliza Fawcett, Healthbeat Rebecca Grapevine, Healthbeat
Because viruses evolve as they infect people, the CDC has recommended updated covid vaccines each year.
The FDA has approved an updated covid shot for everyone 6 months old and up, which renews a now-annual quandary for Americans: Get the shot now, with the latest covid outbreak sweeping the country, or hold it in reserve for the winter wave?
The new vaccine should provide some protection to everyone. But many healthy people who have already been vaccinated or have immunity because they’ve been exposed to covid enough times may want to wait a few months.
Covid has become commonplace. For some, it’s a minor illness with few symptoms. Others are laid up with fever, cough, and fatigue for days or weeks. A much smaller group — mostly older or chronically ill people — suffer hospitalization or death.
It’s important for those in high-risk groups to get vaccinated, but vaccine protection wanes after a few months. Those who run to get the new vaccine may be more likely to fall ill this winter when the next wave hits, said William Schaffner, an infectious disease professor at Vanderbilt University School of Medicine and a spokesperson for the National Foundation for Infectious Diseases.
On the other hand, by late fall the major variants may have changed, rendering the vaccine less effective, said Peter Marks, the FDA’s top vaccine official, at a briefing Aug. 23. He urged everyone eligible to get immunized, noting that the risk of long covid is greater in the un- and undervaccinated.
Of course, if last year’s covid vaccine rollout is any guide, few Americans will heed his advice, even though this summer’s surge has been unusually intense, with levels of the covid virus in wastewater suggesting infections are as widespread as they were in the winter.
The Centers for Disease Control and Prevention now looks to wastewater as fewer people are reporting test results to health authorities. The wastewater data shows the epidemic is worst in Western and Southern states. In New York, for example, levels are considered “high” — compared with “very high” in Georgia.
Hospitalizations and deaths due to covid have trended up, too. But unlike infections, these rates are nowhere near those seen in winter surges, or in summers past. More than 2,000 people died of covid in July — a high number but a small fraction of the at least 25,700 covid deaths in July 2020.
Partial immunity built up through vaccines and prior infections deserves credit for this relief. A new study suggests that current variants may be less virulent — in the study, one of the recent variants did not kill mice exposed to it, unlike most earlier covid variants.
Alexandra Koch/Pixabay
Public health officials note that even with more cases this summer, people seem to be managing their sickness at home. “We did see a little rise in the number of cases, but it didn’t have a significant impact in terms of hospitalizations and emergency room visits,” said Manisha Juthani, public health commissioner of Connecticut, at a news briefing Aug. 21.
Unlike influenza or traditional cold viruses, covid seems to thrive outside the cold months, when germy schoolkids, dry air, and indoor activities are thought to enable the spread of air- and saliva-borne viruses. No one is exactly sure why.
“Covid is still very transmissible, very new, and people congregate inside in air-conditioned rooms during the summer,” said John Moore, a virologist and professor at Cornell University’s Weill Cornell Medicine College.
Or “maybe covid is more tolerant of humidity or other environmental conditions in the summer,” said Caitlin Rivers, an epidemiologist at Johns Hopkins University.
Because viruses evolve as they infect people, the CDC has recommended updated covid vaccines each year. Last fall’s booster was designed to target the omicron variant circulating in 2023. This year, mRNA vaccines made by Moderna and Pfizer and the protein-based vaccine from Novavax — which has yet to be approved by the FDA — target a more recent omicron variant, JN.1.
The FDA determined that the mRNA vaccines strongly protected people from severe disease and death — and would do so even though earlier variants of JN.1 are now being overtaken by others.
Public interest in covid vaccines has waned, with only 1 in 5 adults getting vaccinated since last September, compared with about 80% who got the first dose. New Yorkers have been slightly above the national vaccination rate, while in Georgia only about 17% got the latest shot.
Vaccine uptake is lower in states where the majority voted for Donald Trump in 2020 and among those who have less money and education, less health care access, or less time off from work. These groups are also more likely to be hospitalized or die of the disease, according to a 2023 study in The Lancet.
While the newly formulated vaccines are better targeted at the circulating covid variants, uninsured and underinsured Americans may have to rush if they hope to get one for free. A CDC program that provided boosters to 1.5 million people over the last year ran out of money and is ending Aug. 31.
The agency drummed up $62 million in unspent funds to pay state and local health departments to provide the new shots to those not covered by insurance. But “that may not go very far” if the vaccine costs the agency around $86 a dose, as it did last year, said Kelly Moore, CEO of Immunize.org, which advocates for vaccination.
People who pay out-of-pocket at pharmacies face higher prices: CVS plans to sell the updated vaccine for $201.99, said Amy Thibault, a spokesperson for the company.
“Price can be a barrier, access can be a barrier” to vaccination, said David Scales, an assistant professor of medicine at Weill Cornell Medical College.
Without an access program that provides vaccines to uninsured adults, “we’ll see disparities in health outcomes and disproportionate outbreaks in the working poor, who can ill afford to take off work,” Kelly Moore said.
New York state has about $1 million to fill the gaps when the CDC’s program ends, said Danielle De Souza, a spokesperson for the New York State Department of Health. That will buy around 12,500 doses for uninsured and underinsured adults, she said. There are roughly one million uninsured people in the state.
CDC and FDA experts last year decided to promote annual fall vaccination against covid and influenza along with a one-time respiratory syncytial virus shot for some groups.
It would be impractical for the vaccine-makers to change the covid vaccine’s recipe twice every year, and offering the three vaccines during one or two health care visits appears to be the best way to increase uptake of all of them, said Schaffner, who consults for the CDC’s policy-setting Advisory Committee on Immunization Practices.
At its next meeting, in October, the committee is likely to urge vulnerable people to get a second dose of the same covid vaccine in the spring, for protection against the next summer wave, he said.
If you’re in a vulnerable population and waiting to get vaccinated until closer to the holiday season, Schaffner said, it makes sense to wear a mask and avoid big crowds, and to get a test if you think you have covid. If positive, people in these groups should seek medical attention since the antiviral pill Paxlovid might ameliorate their symptoms and keep them out of the hospital.
As for conscientious others who feel they may be sick and don’t want to spread the covid virus, the best advice is to get a single test and, if positive, try to isolate for a few days and then wear a mask for several days while avoiding crowded rooms. Repeat testing after a positive result is pointless, since viral particles in the nose may remain for days without signifying a risk of infecting others, Schaffner said.
The Health and Human Services Department is making four free covid tests available to anyone who requests them starting in late September through covidtest.gov, said Dawn O’Connell, assistant secretary for preparedness and response, at the Aug. 23 briefing.
The government is focusing its fall vaccine advocacy campaign, which it’s calling “Risk less, live more,” on older people and nursing home residents, said HHS spokesperson Jeff Nesbit.
Not everyone may really need a fall covid booster, but “it’s not wrong to give people options,” John Moore said. “The 20-year-old athlete is less at risk than the 70-year-old overweight dude. It’s as simple as that.”
KFF Health News correspondent Amy Maxmen contributed to this report.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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PONTIAC - People everywhere are conquering their cabin fever and are enjoying the great outdoors after a long, bitter winter. But before you head out for that hike, health care experts remind you to take precautions to avoid tick bites.
The Centers for Disease Control (CDC) estimates around 300,000 people are infected with Lyme disease each year, and is now warning people to be on the lookout for signs and symptoms of the disease, which is usually contracted through tick bites.
Tina Barton, Infection Preventionist at OSF HealthCare says there are tell-tale signs of Lyme disease, including a rash around the bite mark that takes the shape of a bulls-eye.
"If you get infected, then it starts out with a rash. The rash may not appear for like three days or so and then it’s followed by a lot of like flu-like symptoms," said Barton. "So it can be fatigue and sore throats and things like that can go along with it too.”
When caught early, Lyme disease can be treated with antibiotics. However, when untreated the disease can develop into meningitis, or other severe illnesses that can require hospitalization and further treatment.
According to Barton, the best action against Lyme disease is to pay attention to your surroundings and avoid the bite in the first place.
“If you’re going to be in a wooded area or a weedy area, that type of thing, you need to stay in the middle of the path and not out where you’re up against it," she said. "Because there’s a myth out there that ticks fall out of trees, but they don’t fall out of trees, they’re on the ground so they get on you and they crawl up you.”
Tick bite bullseye
The CDC gives us some simple steps to keep tick bites at bay:
Avoid Direct Contact with Ticks
Avoid wooded and brushy areas with high grass and leaf litter
Walk in the center of trails
Repel Ticks on Skin and Clothing
Use repellent that contains 20 percent or more DEET, picaridin, or IR3535 on exposed skin for protection that lasts several hours.
Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5% permethrin. It remains protective through several washings. Pre-treated clothing is available and may be protective longer.
The Environmental Protection Agency (EPA) has an online tool to help you select the repellent that is best for you and your family.
Finding and Remove Ticks from Your Body
Bathe or shower as soon as possible after coming indoors (preferably within 2 hours) to wash off and more easily find ticks that are crawling on you.
Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.
Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs.
Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors.
Earlier today, the Centers for Disease Control and Prevention announced a recommendation that individuals who exhibit no symptoms after testing positive for Covid-19 need only to isolate for five days instead of the previously recommended 10 days.
The CDC justified the new guidance in a press release. "Both updates come as the Omicron variant continues to spread throughout the U.S. and reflects the current science on when and for how long a person is maximally infectious."
The change comes on the heals of a plea from the airline and healthcare industries who are experiencing labor shortages due to employees having to observe isolation guidelines.
Press release from the CDC:
Given what we currently know about COVID-19 and the Omicron variant, CDC is shortening the recommended time for isolation from 10 days for people with COVID-19 to 5 days, if asymptomatic, followed by 5 days of wearing a mask when around others. The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after. Therefore, people who test positive should isolate for 5 days and, if asymptomatic at that time, they may leave isolation if they can continue to mask for 5 days to minimize the risk of infecting others.
Additionally, CDC is updating the recommended quarantine period for those exposed to COVID-19. For people who are unvaccinated or are more than six months out from their second mRNA dose (or more than 2 months after the J&J vaccine) and not yet boosted, CDC now recommends quarantine for 5 days followed by strict mask use for an additional 5 days. Alternatively, if a 5-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure. Individuals who have received their booster shot do not need to quarantine following an exposure, but should wear a mask for 10 days after the exposure. For all those exposed, best practice would also include a test for SARS-CoV-2 at day 5 after exposure. If symptoms occur, individuals should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19.
Isolation relates to behavior after a confirmed infection. Isolation for 5 days followed by wearing a well-fitting mask will minimize the risk of spreading the virus to others. Quarantine refers to the time following exposure to the virus or close contact with someone known to have COVID-19. Both updates come as the Omicron variant continues to spread throughout the U.S. and reflects the current science on when and for how long a person is maximally infectious.
Data from South Africa and the United Kingdom demonstrate that vaccine effectiveness against infection for two doses of an mRNA vaccine is approximately 35%. A COVID-19 vaccine booster dose restores vaccine effectiveness against infection to 75%. COVID-19 vaccination decreases the risk of severe disease, hospitalization, and death from COVID-19. CDC strongly encourages COVID-19 vaccination for everyone 5 and older and boosters for everyone 16 and older. Vaccination is the best way to protect yourself and reduce the impact of COVID-19 on our communities.
by Bernice Yeung, Michael Grabell, Irena Hwang and Mollie Simon
ProPublica
In May 2018, a rare and virulent strain of salmonella caught the attention of America’s top disease detectives. In less than two months, the bacteria had sickened more than a dozen people, nearly all of them on the East Coast. Many said they’d eaten chicken, and federal food safety inspectors found the strain in chicken breasts, sausages and wings during routine sampling at poultry plants.
But what seemed like a straightforward outbreak soon took a mystifying turn. Cases surfaced as far away as Texas and Missouri. A 1-year-old boy from Illinois and a 105-year-old woman from West Virginia fell ill. There was a teenager who’d just returned from a service trip in the Dominican Republic and a woman who’d traveled to Nicaragua. But there were also people who hadn’t traveled at all.
Victims were landing in the hospital with roiling stomach pains, uncontrollable diarrhea and violent bouts of vomiting. The source of the infections seemed to be everywhere.
Seasoned chicken thighs from a local supermarket retailer are waiting to go into the oven. During an investigation from ProPublica, they found meat and poultry from some stores that bears the USDA seal approval may not be safe. According to their research, the USDA does not prohibit companies from selling chicken contaminated with salmonella. (Photo: PhotoNews Media)
Even more alarming was that this strain of salmonella, known as multidrug-resistant infantis, was invincible against nearly all the drugs that doctors routinely use to fight severe food poisoning.
With a public health threat unfolding across the country, you might have expected federal regulators to act swiftly and decisively to warn the public, recall the contaminated poultry and compel changes at chicken plants. Or that federal investigators would pursue the root cause of the outbreak wherever the evidence led.
None of that happened.
Instead, the team at the Centers for Disease Control and Prevention closed the outbreak investigation nine months later even though people were continuing to get sick. The U.S. Department of Agriculture, which oversees meat and poultry, was not only powerless to act but said nothing to consumers about the growing threat. So supermarkets and restaurants continued selling chicken tainted with drug-resistant infantis.
And they continue to do so today.
...even when there’s persistent evidence of contamination in a plant’s products, the USDA can’t use those findings to suspend operations.
An eight-month ProPublica investigation into this once rare, but now pervasive form of salmonella found that its unchecked spread through the U.S. food supply was all but inevitable, the byproduct of a baffling and largely toothless food safety system that is ill-equipped to protect consumers or rebuff industry influence.
Several European countries have dramatically reduced salmonella in poultry by combating it on the farms where chickens are raised. But over the past 25 years, the U.S. has failed to bring down the incidence of salmonella food poisoning — even as the rates for E. coli and other bacteria have fallen dramatically.
Consumers may get the impression that the meat and poultry they find at supermarkets is safe because it bears the USDA seal of approval. But the agency doesn’t prohibit companies from selling chicken contaminated with dangerous salmonella like infantis. And even when people get sick, it has no power to order recalls.
Instead, the agency relies on standards it can’t enforce and that don’t target the types of salmonella most likely to make people sick. The USDA’s Food Safety and Inspection Service, unlike its counterparts in some countries, has no authority to control salmonella on farms, where the bacteria often spreads. And even when there’s persistent evidence of contamination in a plant’s products, the USDA can’t use those findings to suspend operations. All the agency can do is conduct a general review of the plant, and that rarely leads to a shutdown.
"It’s a system that’s untenable," said Sarah Sorscher, a consumer advocate at the Center for Science in the Public Interest.
Last week, after repeated interview requests from ProPublica and years of criticism from consumer groups, the USDA announced that it was rethinking its approach to salmonella. The agency didn’t announce any concrete changes but said it would set up pilot projects and hold meetings in an effort to come up with a plan.
"Whether it should have been done sooner or could have been done sooner, the good news is we’re doing it," said Sandra Eskin, the agency’s deputy undersecretary for food safety. "We’re going to really take a look at everything we could look at and, I hope, develop a different approach that winds up being more effective."
Scientific advancements over the last decade have provided the USDA with tools to identify the most dangerous strains of salmonella. But the agency isn’t using those tools to prevent it from spreading in our food supply.
To piece together how food safety officials and the poultry industry allowed infantis to spread, ProPublica used the same genetic data available to the USDA and other agencies, analyzing seven years of infantis samples taken from food and patients and catalogued by the National Institutes of Health.
Through dozens of public records requests, ProPublica was then able to link the genetic information on those 8,000 samples to the foods that victims ate and the processing plants the chicken samples came from.
The analysis, along with hundreds of internal government records and interviews with nearly two dozen scientists, allowed us to uncover that the infantis outbreak never abated and has continued to run rampant through the chicken industry.
In fact, ProPublica found that more than twice a day this year, on average, USDA inspectors detected multidrug-resistant infantis in poultry that’s genetically similar to the outbreak strain. Each month, the CDC continues to receive dozens of reports of people getting sick from it.
"Many people are still becoming ill, and some of them gravely ill," Robert Tauxe, director of the CDC’s Division of Foodborne, Waterborne and Environmental Diseases, told ProPublica.
One internal CDC presentation noted that this single strain is “responsible for an estimated 11,000-17,000 illnesses per year.” But the CDC is limited in its ability to protect American consumers from foodborne illnesses. It has no power to order companies to take action or to provide information that would help it solve outbreaks.
And the CDC, despite noting that the strain was "widespread in the chicken industry," took the spotlight off infantis when it closed its outbreak investigation in February 2019. Tauxe said the investigation ended because the agency had learned as much as it could. "That does not mean that the outbreak was over," he said. "In fact, we think it may still be expanding."
As the CDC has contended with infantis, the agency has held several private meetings with the chicken industry, which has publicly downplayed the threat of the strain and its ability to do something about it.
But since closing the investigation, neither federal health officials nor the USDA has said anything to consumers about what the CDC quietly regards as an "epidemic."
Marva Lamping knew none of this in July 2019 when she took her longtime partner, Arthur Sutton, out to celebrate his 70th birthday at their favorite Mexican restaurant in Bend, Oregon. As Lamping tested her luck at the restaurant’s video slot machines, Sutton snacked on chips and salsa while waiting for a platter of chicken enchiladas.
That night, Sutton began vomiting repeatedly, his stomach aching so badly that he couldn’t lay down. By the next morning, the pain was unbearable, and Lamping rushed him to the emergency room.
At the hospital, doctors would discover that Sutton’s intestines were leaking. Again and again, surgeons opened his abdomen to repair the tears and cut out dead segments of his bowels.
Doctors had quickly identified the cause of Sutton’s ailments as salmonella. But for reasons they couldn’t understand, his body was wasting away.
None of the antibiotics were working.
Missed Opportunities
As sudden as the infantis outbreak seemed to investigators at the CDC, it wasn’t the first time the government had seen this strain, known as Infantis Pattern 1080. In the three years before the outbreak started, USDA inspectors had found the strain 74 times. But they could do nothing to stop the chicken from going to supermarkets and restaurants nationwide.
By the summer of 2018, people all over the country were falling ill. And as investigators studied the cases, clues soon emerged from the USDA, which oversees meat and poultry, and the Food and Drug Administration, which regulates almost all other foods.
The FDA had received a complaint that a dog had recurring diarrhea after eating raw pet food, and samples of chicken-and-vegetable dog food tested positive for multidrug-resistant infantis. A few months later, a Chicago woman fell sick with the outbreak strain after feeding her dog the same brand. Could the pet food be the source of the outbreak? Possibly, but not all the victims had a dog.
There was another lead. Victims reported eating Perdue Farms chicken more than any other brand. Public health officials in Pennsylvania and Minnesota found the outbreak strain in packages of Perdue wings, thighs and drumsticks in three supermarkets. And when USDA inspectors found the strain in raw chicken, more than a quarter of the samples came from Perdue plants.
The FDA’s investigation had quickly led to a pet food recall. But while the FDA prohibits salmonella in the foods it oversees — including dog and cat food — the USDA allows it in raw meat and poultry destined for human consumption.
When people fall ill, the USDA can only request that a company voluntarily recall its products. But to do even that for salmonella, regulators face a high bar: To ensure a strong case, they’re expected to try to find a patient with an unopened package of meat that tests positive for the same strain that made the outbreak victims sick.
“Often, by that time, most of the meat that’s going to be eaten has been eaten,” said Sorscher of the CSPI.
In June 2018, what could have been a key piece of evidence surfaced. An Illinois victim who’d been hospitalized told investigators that he still had a package of Perdue chicken tenders in his freezer. The USDA could have tested the package, but nobody ever went out to collect it, he said.
Perdue did not respond to more than a dozen calls and emails seeking comment, and it didn’t answer questions sent to top company officials.
Wade Fluckey, Perdue’s senior director of food safety at the time, told ProPublica that the company was targeted because Perdue has better brand recognition than other chicken companies, which skewed patient interviews.
“I don’t know that any one company could say they didn’t have it,” said Fluckey, now a vice president at a pork processor. “Had they focused on other places, they would have found the same thing.”
While no company showed up more frequently than Perdue, food inspectors were finding the Pattern 1080 strain in dozens of chicken processing plants as well as raw pet food and live chickens. To investigators, that was unusual because it meant that the salmonella couldn’t have come from a single company or chicken product. It had to be coming from somewhere upstream in the supply chain — perhaps the farms or the few companies that breed nearly all the nation’s chickens.
The country’s antiquated meat safety system virtually ensured it would be no match for a germ like infantis.
The USDA operates under a law passed in 1906, where inspectors physically examine every carcass for signs of animal disease, illegal additives and spoilage. The system didn’t account for invisible pathogens like salmonella and E. coli, which had not yet been linked to eating meat.
That did not change until 1994 after four children died from eating Jack in the Box hamburgers. The USDA made it illegal to sell meat tainted with a strain of E. coli called O157:H7. But it didn’t ban salmonella despite a series of high-profile outbreaks in chicken. Instead, the USDA required processing plants to limit how often salmonella was found on their products and began testing for it. Plants that repeatedly violated these standards faced a shutdown.
That powerful threat didn’t last long. In 1999, a Texas meat processor challenged the USDA’s authority to close plants, arguing that salmonella "appears naturally" in raw meat. Two years later, the 5th U.S. Circuit Court of Appeals agreed that Congress hadn’t given the agency the power to regulate salmonella that’s present before products enter processing plants or to deem a facility unsanitary based on the bacteria alone.
The decision, Supreme Beef Processors v. USDA, has left the agency gun-shy, according to former department officials and food safety advocates. And Mansour Samadpour, a microbiologist who runs a testing and consulting firm that works with the food industry, said the decision distorts the underlying science. Just because salmonella "colonizes" chickens’ guts doesn’t mean it’s "the natural state of the animal," he said. "It’s nonsense."
The court ruling severely clipped the USDA’s powers. So it has tried to pressure plants to improve by creating standards for how often salmonella should be found. Plants are rated on the results, which are published online. Violating those standards doesn’t carry a penalty, but it allows the agency to visit the plant and look for more general problems like unsanitary conditions. If they can document significant problems, the USDA can temporarily shut down the plant, though the agency rarely takes such action.
Today, food poisoning sickens roughly 1 in 6 Americans every year, according to the CDC, and salmonella hospitalizes and kills more people than any other foodborne pathogen. Each year, about 1.35 million people get sick from salmonella. While most recover, more than 400 people die and 26,500 people are hospitalized. Some are left with long-term conditions like severe arthritis and irritable bowel syndrome. Salmonella costs the economy an estimated $4.1 billion a year, more than any other type of food poisoning.
Salmonella outbreaks have been linked to other foods like onions, but poultry remains the biggest culprit, and people are eating more of it than ever. On average, people in the U.S. eat nearly 100 pounds of chicken each year, a number that has grown by about 40% in the last 25 years.
Cooking poultry to an internal temperature of 165 degrees will kill salmonella. But studies by the USDA and others have found that despite decades of consumer education, home cooks routinely cross-contaminate their kitchens, and few use a meat thermometer to ensure their poultry is cooked properly.
Illnesses haven’t declined even as salmonella rates in raw poultry have. And infections are getting harder to treat. The CDC recently found that salmonella infections were becoming increasingly resistant to antibiotics. In contrast, food poisoning related to E. coli O157:H7 has dropped by about 70%.
Consumer advocates, industry consultants and former USDA officials say that’s because the agency focuses solely on whether salmonella is found in chicken or turkey at the processing plant.
This approach has been criticized for years. One former meatpacking executive called it “worthless.” Even the USDA’s own research arm has said the agency’s measure for salmonella is “not a good indicator” of food safety.
The USDA doesn’t consider two key risk factors: how much salmonella is in the poultry and how dangerous that type of salmonella is. There are 2,500 types of salmonella, but only a fraction cause the vast majority of illnesses.
The industry has greatly reduced the prevalence of one common type of the bacteria, known as salmonella Kentucky, which rarely causes illnesses in the U.S. But it’s made far less progress with the types of salmonella most likely to make people sick, the ProPublica analysis found.
The rate of infantis, for example, has more than quintupled over the past six years.
The full extent of the salmonella problem isn’t even known. The agency does little testing for salmonella to begin with. On an average day in 2020, the USDA took about 80 samples of raw poultry across hundreds of processing plants. But those plants slaughter more than 25 million chickens and turkeys a day.
The new technology would help identify pathogens in foods like raw flour, peaches and romaine lettuce that were once rarely seen as sources of outbreaks.
In recent years, consumer advocates have recommended the agency ban the sale of raw meat carrying the types of salmonella that most often make people sick. That approach has contributed to improvements in Europe. In the U.S., the FDA has seen a dramatic decrease in salmonella outbreaks tied to eggs since the 1990s when it began targeting the most common type.
Last month, a few of the largest poultry companies, including Perdue and Tyson, joined with the CSPI and other consumer advocates to urge the USDA to fix the system. But the letter to the agency didn’t outline specific reforms, and a consensus on salmonella regulations has long proved elusive.
The last push came during the Obama administration, but citing the need for more data, the USDA rejected a proposal to ban certain antibiotic-resistant strains. The agriculture secretary at the time was Tom Vilsack, who now leads the agency again under President Joe Biden.
As the food safety project director for the Pew Charitable Trusts before joining the USDA, Eskin also pushed for reform, but her efforts were met with resistance. With food safety directors from some of the largest companies, she helped craft recommendations to Congress to modernize the meat safety system, including setting new limits on salmonella contamination and giving regulators oversight of farms.
The group sought to enlist trade associations, which represent not only the biggest players but hundreds of other companies. But when it comes to regulation, divergent interests often leave the trade groups lobbying for the lowest common denominator. "They shut us down," she said in an interview before taking her government post. "They’re the ones that blocked us — not the companies, the trade associations."
Asked what was standing in the way of change, she said, "I’ll make it simple: Powerful interests in the industry do not want it."
"We Are Basically Only Talking About Protecting Industry"
Just months before the infantis outbreak started, the USDA gathered representatives from the food industry, researchers and regulators at the agency’s brick-and-limestone headquarters in Washington to discuss a scientific breakthrough that one participant called the "biggest thing" for food safety in 100 years.
Whole-genome sequencing had given food safety researchers an unprecedented look at the DNA of foodborne bacteria. New technology, known as "next-generation sequencing," was creating a trove of new information and revealing connections that could help investigators stop outbreaks before they spun out of control.
As stakeholders took turns presenting slides in the wood-paneled auditorium, some spoke of the possibility that genome sequencing might help solve the stagnant rate of salmonella poisoning.
The new technology would help identify pathogens in foods like raw flour, peaches and romaine lettuce that were once rarely seen as sources of outbreaks.
While whole-genome sequencing couldn’t confirm the source of an outbreak without additional evidence, it provided powerful clues about the bacteria’s genetic history that could point epidemiologists in the right direction.
But for all the potential, much of the conversation that day in October 2017 centered on how to make this scientific breakthrough palatable to industry. Trade groups had requested the meeting, and they voiced concerns about how the new tool could be used for enforcement or might inaccurately connect companies’ products to outbreaks. Speakers, including USDA officials, emphasized the importance of proceeding with caution. They discussed strengthening firewalls to keep testing data private and establishing “safe harbors” from USDA enforcement.
During a roundtable discussion, one representative from the United Fresh Produce Association raised concerns about the idea of companies sharing genome sequencing data with the government. “I think right now, it’s viewed as very one-sided,” she said. “We see the benefit to the agencies, but it’s less clear how a company would directly benefit.”
The industry’s influence wasn’t lost on regulators. Former USDA officials hold key posts at some of the food industry’s biggest companies. Indeed, two people who led the 2017 meeting for the agency now work for the food industry.
Sitting in the auditorium, Jørgen Schlundt, the former head of food safety for the World Health Organization, was growing increasingly frustrated. Schlundt had helped achieve dramatic reductions in salmonella in Denmark while working for the country’s food agency.
"I understand that I’m in the U.S., but surely this must also be about protecting consumers," he told the audience. "We are basically only talking about protecting industry here. I thought that this was, the basic purpose was to protect consumers, avoid American consumers and other consumers from dying from eating food."
While the USDA tiptoed around the new technology, whole-genome sequencing, which is now used to solve criminal cases and track COVID-19 variants, would prove pivotal to the CDC’s infantis investigation.
As the infantis outbreak spread, epidemiologists noticed something unusual: The outbreak strain, Pattern 1080, carried an unusual combination of antibiotic-resistance genes that looked similar to another strain they’d seen before, Louise Francois Watkins, an epidemiologist at the CDC, said in an interview.
At the time, the CDC was still using a method called pulsed-field gel electrophoresis, or PFGE, which produced barcode-like patterns from the bacteria’s DNA that scientists used to connect cases. So the investigators asked the lab to line up the patterns and compare the two strains.
"And sure enough," Francois Watkins said, the strains were so similar, they differed by “only a single band” of the barcode. With that clue, they decided to analyze the strains using whole-genome sequencing.
That allowed scientists to compare the individual building blocks in the genomes of bacteria. And the infantis investigators discovered that not only were the two strains genetically similar but that PFGE was masking the scope of the problem.
In fact, Pattern 1080 was just one wave in a much larger surge of drug-resistant infantis — one that had been detected nearly a decade ago in Israel and was now circulating worldwide in countries as far apart as Italy, Peru and Vietnam.
One of the reasons the U.S. variant is so concerning is that it typically carries a unique gene that makes it especially hard to treat.
"It’s resistant to four of the five antibiotics that are commonly recommended for treatment,"” Francois Watkins said. "The antibiotics that your doctor is going to pick when they suspect you have a salmonella infection are pretty likely not to be effective."
The strain is also a major public health concern because it has the ability to pass those genes to other bacteria, adding to the growing global problem of antibiotic resistance.
"We don’t want to see resistance climbing in our food supply because it’s not going to stay in that one space," Francois Watkins said.
Whole-genome sequencing had helped investigators discover that the outbreak was actually a widespread problem in the country’s chicken supply.
But even with these new revelations, public health officials still lacked one of the most basic tools to control the strain.
“A Gap in Our Regulations”
CDC investigators knew that infantis was spreading in chickens long before the birds arrived at the slaughterhouse. But enlisting the USDA’s Food Safety and Inspection Service would be a dead end because the agency has no regulatory authority over farms. The USDA can only force farms to take measures when animals get sick, not when humans do.
That also made it difficult for the CDC investigators to pursue leads involving breeders and feed suppliers to trace back how dangerous bacteria got into the food supply.
"That’s a gap in our regulations," Tauxe of the CDC said.
The CDC emphasized how risky this particular bacteria was because of its resistance to first-line drugs used to treat salmonella...
Nearly all the chickens we eat descend from birds bred by two companies, Aviagen and Cobb-Vantress, a subsidiary of Tyson Foods. This breeding process has allowed consumers to walk into any grocery store and find chicken of the same quality. But that pyramid structure also makes it possible for salmonella to circulate since the bacteria can be transferred from hens to their offspring, and a single breeding flock might produce 3 million chickens over several years. (Both companies declined to comment.)
And nearly every step of their journey from chicken house to our plates presents an opportunity for salmonella to spread.
As far back as 2005, the USDA has held public meetings exhorting the poultry industry to take steps at the farm. It has recommended that farmers change or chemically treat the litter between flocks, use traps and bait to eliminate pests and vaccinate hens and chicks against salmonella.
Denmark, Sweden and Norway have largely eradicated salmonella on farms by keeping chicken houses clean, frequently testing the birds and destroying infected breeding flocks.The United Kingdom has dramatically reduced salmonella illnesses by pressuring the industry to vaccinate.
The structure of the U.S. chicken industry makes it ideally suited to implement such interventions. The same company that slaughters the chickens often owns the hatchery and feed mill, and it contracts with farmers to raise the chickens to its specifications. The catch is that because companies are essentially doing business with themselves, there’s little incentive for any of them to press others to reduce salmonella, the industry consultant Samadpour said.
"If it was four or five different companies," he said, "the processing plant would tell the farms, ‘If you are more than so much positive, you can’t send it here,’ the farm would tell the hatchery, ‘If the chicks coming in are positive, we are not going to take them.’ They would tell the feed mill that if the feed is contaminated with salmonella, ‘We are not going to bring it in.’ Can you do that? No, it all belongs to you."
Because more isn’t done on the farm, the birds’ skin and feathers are often highly contaminated with salmonella by the time they reach the processing plant, according to the USDA. And in the plant, there are many ways bacteria can spread.
Birds can be further cross-contaminated when workers cut carcasses into breasts, legs and wings. The USDA recommends workers wash their hands and sanitize knives between each bird. But workers often have a few seconds to make each cut.
Ground chicken, which has become increasingly popular, is especially prone to contamination. Meat sent to the grinder comes from multiple birds, increasing the chance of cross-contamination. The fine texture of ground chicken can also get caught in small pieces of equipment, potentially tainting multiple batches.
While salmonella is found in 8% of the chicken parts tested by the USDA, 25% of ground chicken samples contain the bacteria.
And when the USDA tested for salmonella during the infantis outbreak, more than half of the positive samples were found in ground chicken.
“The Company Can Do Whatever It Wants”
In July 2018, as outbreak investigators began to discover infantis in Perdue products, the USDA had a chance to press the company for answers. Routine salmonella testing had found that the company’s plant in Cromwell, Kentucky, was exceeding the USDA’s salmonella standards, which say no more than 15.4% of chicken parts at a plant should test positive for the pathogen.
So USDA staff were sent to conduct an assessment of the plant, which might have seemed well-timed. Of the 76 plants where the infantis outbreak strain had been found, Cromwell, with 8% of the positive samples, had more than any other facility. But failing the agency’s salmonella standard doesn’t give the USDA the power to do anything more than review the plant’s practices.
The USDA noted that Perdue had responded to its high rate of salmonella by adding more chemical dip tanks and sprays to disinfect the chicken. Because Perdue’s internal sampling data showed the new steps appeared to be reducing the bacteria, the agency gave Perdue more time and recommended “no further action be taken.”
According to the USDA report, Fluckey, then the food safety director at Perdue, told auditors that the agency’s testing didn’t paint an accurate picture of the plant because it wasn’t measuring the quantity of salmonella. He added that Perdue managers hadn’t concentrated on the salmonella types most likely to make people sick because they were focused on "meeting the performance standard."
A year later, USDA sampling indicated that the plant had continued to violate salmonella standards, with a third of chicken parts testing positive for the bacteria. In addition, the USDA said 12 of Perdue’s samples were highly related genetically to samples from people who’d recently gotten sick.
Still, the agency once again deferred to the company’s testing results, which showed a decrease in the rate of salmonella at the plant. The USDA decided it couldn’t cite the plant and that no action was necessary.
ProPublica found that many plants have repeatedly violated the agency’s standards without being shut down or facing any recent public sanction. According to the most recent data, more than a third of the plants producing ground chicken are violating the USDA standard. And many large companies — including Tyson, Pilgrim’s Pride, Perdue, Koch Foods and the processors that produce chicken for Costco and Whole Foods — currently have plants with high rates of the types of salmonella most likely to make people sick.
Whole Foods said it has a team of experts who review the salmonella results of its suppliers and works with them to lower their salmonella rates. The processor, Pine Manor Farms, said it has “worked diligently to make corrections.” Tyson and Costco declined to comment; Pilgrim’s and Koch didn’t respond to questions.
Other Perdue plants where the infantis outbreak strain was found also had a poor track record with salmonella overall. In the last three years, its plants in Rockingham, North Carolina, and Georgetown, Delaware, had more than 35% of their ground chicken samples test positive for the bacteria, and nearly all of them were types commonly linked to human illnesses. Yet neither plant has faced any recent public enforcement action, according to a review of USDA reports. (In April, ProPublica requested detailed files for both plants, but the USDA has yet to provide them.)
In an interview before she joined the USDA, Eskin said the consequences for companies violating the standards aren’t "anything meaningful in terms of enforcement." "At the end of the day," she said, "I think the company can do whatever it wants."
The USDA doesn’t appear to have traced the supply chain for the plants that tested positive for the outbreak strain. Detroit Sausage had one of the highest numbers of samples with the strain.
Phil Peters, one of the owners, said he doesn’t remember anyone from the USDA asking the company who supplied its chicken. "I can’t control something that’s coming in from somewhere else unless I stop using it," he said.
The company no longer produces chicken sausage because his clients no longer order it. But as a small processor, Peters said, he has little ability to demand chicken companies provide him meat carrying less salmonella. "They’re too big to worry about us," he said.
A Hidden "Epidemic"
With no powers of its own and stuck with a hesitant regulator in the USDA, the CDC’s investigators needed the industry’s help.
On Aug. 8, 2018, the CDC offered a stark assessment of the outbreak to representatives of the industry’s trade group, the National Chicken Council: Drug-resistant infantis had become a "particular clinical and public health concern" because it was spreading through the chicken industry and increasingly making people sick.
The USDA seemed to take a less urgent approach. After an Aug. 16 foodborne illness investigations meeting with infantis on the agenda, an agency official wrote that there were "zero active illness investigations." The USDA had begun tracing victims’ grocery purchases, but beyond that, it decided infantis was an "illness cluster" to watch — not a situation that required additional resources.
By then, three months into the outbreak investigation, neither the CDC nor the USDA had said anything to consumers.
People continued to get sick. Twelve days after the USDA meeting, a New York City resident began having stomach cramps. The patient’s spouse told investigators the victim had eaten and shopped in the Flatbush section of Brooklyn. The patient went to the hospital but died two days later, the first known fatality from the infantis outbreak.
For nearly two months, there was still no public warning.
In October 2018, the CDC privately met again with the National Chicken Council. By then, public health officials were convinced that the outbreak strain originated high up in the chicken supply chain.
“The outbreak strain may be persisting in chicken populations, their environments or their feed,” according to the CDC’s presentation to the industry group. "Further investigation is needed to help prevent new illnesses and similar outbreaks in the future."
The CDC drew up a list of questions for the National Chicken Council:
How was it possible that so many different companies could have the same strain of salmonella infantis?
Were common sources of chickens, eggs or other farming products widely used?
Would one or more companies be willing to partner with the CDC and USDA to explore possible connections?
The council didn’t have many answers. According to a government official’s notes, the industry said that it “does a lot to try to reduce salmonella across the board,” but that it didn’t have a specific preventative measure for infantis. An industry representative added that it “might have been helpful to have the discussion 4 years ago,” when the first signs of drug-resistant infantis popped up in processing plants.
A few days after the October meeting, a 2-year-old Michigan girl began rubbing her belly before developing a fever and diarrhea, making her the latest Pattern 1080 patient. Her parents said that before she got sick, she’d eaten chicken nuggets and touched a package of raw chicken in their kitchen.
The next day — more than nine months after the first patient from the outbreak got sick — the CDC issued its first public notice. By then, 92 people in 29 states had been infected with the outbreak strain. But the number was likely far higher: The CDC estimates that for every confirmed salmonella case, an additional 30 are never reported. That meant that nearly 3,000 people had likely been infected.
Though the CDC knew that infantis wasn’t a typical outbreak strain, the notice offered little advice to consumers other than to remind them to follow standard food safety steps when handling raw poultry. The CDC told ProPublica that there was little more it could say to consumers. Infantis was so pervasive, Tauxe said, that the CDC couldn’t tell consumers to avoid any specific kind of chicken or brand.
Instead, public health officials held another private meeting with the chicken industry in February 2019, telling trade organization officials that they considered this strain of infantis to be an "epidemic."
The CDC emphasized how risky this particular bacteria was because of its resistance to first-line drugs used to treat salmonella, especially illnesses involving children and patients with blood infections.
Health officials also presented the clues that had pointed toward Perdue as a potential source of some of the illnesses. The agency wanted to sit down with Perdue, but with no power to compel the company to answer questions, it would be months before a meeting happened.
A little over a week after the February 2019 meeting with industry, the CDC closed its investigation. In its second and last public notice about the outbreak, it said 129 people had gotten sick, 25 had been hospitalized and one person had died. There was no mention of Perdue or any other company.
In ending the investigation, the CDC seemed to send mixed messages. While the agency noted that "illnesses could continue because this salmonella strain appears to be widespread in the chicken industry," it also told Consumer Reports that the decision was prompted by a decrease in new cases.
Infantis Strikes Another Victim
Five months after the CDC closed the infantis investigation, Arthur Sutton and Marva Lamping walked into El Rodeo, a lively Mexican restaurant in Bend, Oregon, where copper art hangs on rustic yellow walls and red-clay mosaics line the archways.
The couple typically went there at least once a month after paying their mortgage or when friends were in town. Sutton’s stomach had been bothering him since eating there the week before, but he didn’t know why. He decided he was up for going out anyway. It was his 70th birthday, and the couple always went to El Rodeo for their birthdays.
... the county Health Department would ask her if Sutton had eaten salsa and slaw, which an investigator later described in an internal email as the "likely culprit" ...
Lamping and Sutton had met 15 years earlier at the local community college when Sutton decided to put his past struggles with addiction to constructive use by becoming a counselor. After math class, a group of students would go out to a Mexican restaurant.
"He just one day said, ‘I noticed when we go out for nachos, that you don’t have a margarita with all the other ladies,’" Lamping said. "And I said, ‘No, I don’t drink and drive.’ And he said: ‘Well, I’ll give you a ride. If you’d like a margarita, I’ll take you.’"
Lamping, 63, was drawn to Sutton’s warm and accepting way of engaging with the world — a demeanor that seemed perfectly suited for his counseling work. Lamping said his clients clearly had a bond with him. Once, while he and Lamping were stuck in construction traffic, a former client working as a flagger recognized Sutton and came over to shake his hand.
Sutton, a large man with a square chin, broad forehead and glasses, was quieter than usual that night as a waiter brought out tortilla chips, salsa and a small oval dish of chopped cabbage slaw mixed with diced jalapenos, tomatoes and cilantro. Lamping went to play a few rounds of video slots in the back of the restaurant before dinner while Sutton dug into the salsa and slaw.
Those appetizers would take on grave importance for Lamping after Sutton developed severe food poisoning that night. She said that during its investigation of Sutton’s illness, the county Health Department would ask her if Sutton had eaten salsa and slaw, which an investigator later described in an internal email as the "likely culprit" behind multiple food poisoning cases connected to the restaurant.
El Rodeo’s owner, Rodolfo Arias, said he “didn’t know anything” about the investigation.
An inspection of the restaurant would find concerns with cross-contamination because El Rodeo thawed and washed frozen chicken in the same three-compartment sink in which it washed lettuce, tomatoes and cilantro. Inspectors also noted the faucet was “uncleanable” because it was wrapped in black tape.
Arias denied that his restaurant was responsible for Sutton’s illness. “I don’t think it was possible,” Arias said.
After dinner, the ache in Sutton’s stomach erupted. He began vomiting and couldn’t lay down to sleep. By the next morning, he could no longer stand the pain. He called Lamping at work, where she handles patient admissions at St. Charles Medical Center. She went home and took him to the emergency room, several hundred feet from her desk.
After a CT scan, a doctor diagnosed Sutton, who was obese and had other medical problems, with a hernia. He was discharged with plans for surgery.
But the pain didn’t go away. Ongoing diarrhea sent him to the toilet every 10 minutes. He tried to hide his pain, but Lamping finally convinced him to return to the hospital. "I’m looking into your eyes right now, Arthur," she remembers telling him. "You’re dying."
Sutton’s hospital stay, detailed in 2,000 pages of medical records provided by Lamping, would be marked by one wrenching episode after another. In the emergency room, when a nurse put a feeding tube up his nose, blood started gushing out.
Still, Sutton maintained his signature equanimity. Medical staff described him in notes as “very relaxed and accepting and taking it all in stride.”
Initially, the intensive care doctors thought Sutton was still struggling with the effects of a complex hernia. But in the operating room, it became clear that things were worse than doctors imagined. His bowels were severely damaged. Surgeons set about removing dead segments of his intestines and reconnecting the functioning parts. They also noted that Sutton had an acute kidney injury caused by “profound” dehydration and septic shock from a widespread infection.
Over 16 days, Sutton underwent a similar procedure seven more times. Surgeons cut out pieces of dead intestine, centimeter by centimeter, and tried to repair tears and leaks in his bowels. Sutton was going in for surgery so often they placed a medical dressing over his abdomen so they wouldn’t have to cut him open every time.
Throughout, Sutton cycled through periods of decline followed by flashes of normalcy. Sleep-deprived, he began hallucinating that there were monkeys in trees and sailboats emerging from the ceiling. But he was also able to sit in a hallway chair in the sun with Lamping, eat a popsicle and jokingly tell the physical therapist, “You look like Tom Cruise.”
Still, Sutton was deteriorating. One day, Lamping found a note on the bedside table that Sutton had scratched out: "Why is this happening?"
Sutton’s doctors were also puzzled. After the first surgery, they’d quickly identified salmonella as the source of Sutton’s illness and immediately started antibiotics. But after nearly a week, they couldn’t understand why there was no improvement.
What Sutton’s doctors didn’t yet know was that a pernicious type of bacteria was poisoning Sutton’s blood: the strain of multidrug-resistant infantis circulating throughout the chicken industry.
To Industry, the Mystery of Infantis "Went Away"
A month before Sutton got sick, the CDC’s top foodborne disease experts held another meeting with the National Chicken Council. This time Perdue and four other big chicken processors were at the table.
Internal agency notes drafted before the meeting showed officials bracing for an unreceptive audience. "They have known about our concerns for years," the notes read. "They know about European practices. As a member-run trade association, their position is often driven by the lowest common denominator. Business margins are ‘razor’ thin; some companies are unable or unwilling to embrace expensive control strategies upstream."
During the three-hour meeting, the group discussed salmonella prevention and lessons learned from infantis.
But the CDC’s message — that infantis was a serious problem that demanded action — doesn’t seem to have resonated with Ashley Peterson, the industry representative who organized and attended the meeting. In September 2019, Peterson, the National Chicken Council’s senior vice president of scientific and regulatory affairs, told trade magazine Poultry Health Today that infantis wasn’t a problem anymore, according to a video of the interview.
“We don’t really understand where it came from or why it went away,” Peterson said.
Learning of Peterson’s comments, Tauxe of the CDC seemed surprised and puzzled.
“It didn’t go away,” he said. “We have met with the NCC repeatedly and have emphasized with them that it’s an ongoing problem. That’s wishful thinking of some kind.”
National Chicken Council spokesperson Tom Super said Peterson was referring to the CDC investigation ending and only learned later that the CDC was still seeing cases of infantis. He added that the industry has invested tens of millions of dollars a year in food safety and it has never downplayed infantis.
More than two years after Peterson’s comments — as infantis has sickened thousands more people — the trade group still hasn’t answered most of the CDC’s questions about the strain and has shared little with the agency about efforts to curb it, Tauxe said.
"How it got into the chickens in the first place, and why it expanded across the country through the chickens and why it’s persisting remain open questions for us," he said. "Stopping it is going to depend on what the industry is willing to step up to and do."
Super denied that the industry hadn’t answered the CDC’s questions but didn’t provide responses when ProPublica posed them again. “The industry never stopped working to address salmonella infantis — an effort that continues today,” he said.
Swifter action might have made the difference for Sutton.
At the hospital in Oregon, Sutton’s prognosis worsened. By mid-August 2019, the doctors had learned that the type of salmonella ravaging Sutton’s body was infantis. The finding might have helped doctors change course, but it was too late. The bacteria had already taken its toll.
Back in his room after a half-dozen surgeries, Sutton signaled to Lamping, waving two hands to show that he was done. "He just kept going: ‘Enough, enough. No more,’" Lamping said.
She looked at Sutton and shook her head, refusing to give up. But there wasn’t much the doctors could do.
During his eighth visit to the operating room, a surgeon noted that the leak in his bowels was probably so deep that it wasn’t accessible to surgeons: "Any further dissection would be significantly risking more bowel injury and making his current problem worse," the medical records said.
More than two weeks into his hospital stay, Sutton’s salmonella infection had led to kidney failure. Sutton would need round-the-clock dialysis and a feeding tube to survive.
Lamping and Sutton’s brother, Jim, gathered in Sutton’s room to decide what to do. They agreed that Sutton wouldn’t want to live constantly hooked up to machines.
They told the hospital to stop treatment and move him to comfort care. “Time for him to go to heaven,” Jim Sutton said. After life support was removed, Lamping sat next to the bed and rested her head on Arthur’s hand.
The next day, on Aug. 16, 2019, Arthur Sutton died. The cause was severe blood poisoning and acute organ dysfunction brought on by salmonella. Lamping was paralyzed by grief. Her visions of the future had always included him.
"I watched a man go from happy-go-lucky — someone who should have been with me another 20 years — I lost him," Lamping said. "I Iost him."
Two years later, she still replays Sutton’s battle with salmonella over in her mind, certain that something could have been done differently.
Lamping has focused on potential problems with how their food was handled at El Rodeo and hired a lawyer to file a lawsuit against the restaurant in 2020. She blames the restaurant, in part, because a county health inspection after Sutton died noted that it had told El Rodeo about the "findings from the state health lab on salmonella infantis cases." In court filings, the restaurant denied the allegations.
But Lamping also says there are things that food safety regulators and the industry could have done long before the chicken arrived at El Rodeo.
“If they know that infantis is in the chicken, if they know it’s there, why are they selling it to us?” Lamping asked.
The USDA, to this day, has never said anything to consumers about the risk of multidrug-resistant infantis.
Because of the pandemic, Lamping and Jim Sutton have had to delay Arthur’s memorial. They hope that someday soon, they’ll be able to gather his friends and family on a hill overlooking a canyon in central Oregon.
They’ll walk through shale rock, wildflowers and junipers, and look over the canyon’s edge where a buck can sometimes be seen running through the sagebrush. They’ll open Sutton’s urn and let the wind carry his ashes away.
About the Data: How ProPublica Analyzed Bacterial Pathogen Presence Data Used
ProPublica obtained bacterial pathogen genomic sequencing data from the National Center for Biotechnology Information’s Pathogen Detection project. The project integrates data from bacterial pathogens sampled from food, the environment and human patients by participating public health agencies in the United States and around the world. The NCBI analyzes data as it is submitted, and the results are monitored by public health agencies, including the CDC as part of foodborne illness outbreak investigations. The data includes metadata about each bacterial isolate submitted by the person or institute who collected the bacterial sample, as well as computational predictions by NCBI.
Through Freedom of Information Act requests, ProPublica obtained epidemiological information about bacterial samples taken as part of the 2018-19 salmonella infantis outbreak investigation and samples obtained during routine testing in establishments regulated by the USDA’s Food Safety and Inspection Service. ProPublica also obtained epidemiological information connected to patients considered part of this outbreak, including the date of sample collection and details about a patient’s illness, recent food consumption and demographics — details crucial to foodborne illness investigations. Data about bacteria found during USDA inspections also included the type of meat or poultry the sample was obtained from, the date of collection and the name and location of the facility. Integrating these details with the NCBI metadata offered a way to group samples together not just by genetic similarity, but also by location and time.
The USDA posts public datasets containing the results of its salmonella sampling at poultry processing plants since 2015, which detail the collection date, type of poultry product sampled and, if salmonella was present, information on type and any antimicrobial resistance. The datasets include both routine sampling, conducted at every plant, and follow-up sampling, conducted at plants where the agency has identified high levels of salmonella. (Samples from USDA inspections that contain salmonella are reflected in both the NCBI data and the agency’s inspection data.)
Analysis Decisions
To confirm the persistence of multidrug-resistant infantis in food processing facilities, grocery stores and patients with salmonella infections, ProPublica relied on both metadata submitted to NCBI and genetic features computed by NCBI. ProPublica restricted its analysis to isolates in the NCBI data belonging to what was known as SNP cluster PDS000089910.78, as of Oct. 19, 2021. This cluster contains most isolates involved in the infantis outbreak, and the CDC said it is monitoring most of the isolates in the cluster. ProPublica also filtered for isolates that were reported to be serotype infantis by the submitter or, when user-submitted information was unavailable, were computationally predicted to be infantis by the NCBI data processing pipeline.
ProPublica used data about evolutionary modeling computed by NCBI to establish the degree of genetic similarity between bacterial isolates from the outbreak and isolates collected more recently.
ProPublica’s analysis of salmonella rates in poultry plants is based on methods the USDA uses, using the agency’s routine sampling data to calculate positivity rates — that is, the number of positive tests compared with all salmonella tests taken at the facility — for each type of poultry a plant processed. ProPublica also calculated the high-risk salmonella rate for plants, determining the percentage of samples at the facility that tested positive for one of the 30 salmonella types the CDC has found to be most associated with human illnesses.
The USDA inspection data was also used to compare the number of samples found to contain salmonella infantis and salmonella Kentucky with the total number of routine samples taken each year to determine the rate at which each was occurring in the sampling program across all plants and poultry types.
ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.
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