By Amanda Gardner and Steven Reinberg
HealthDay Reporters FRIDAY, June 13 (HealthDay News) -- Even as the number of reported illnesses from salmonella-tainted tomatoes continued to climb, U.S. health officials were still grappling to find the source of the contamination.
The number of people sickened in the outbreak has risen to 228 in 23 states, with 25 hospitalizations, health officials announced Thursday. Six more states -- Florida, Georgia, Missouri, New York, Tennessee and Vermont -- have now reported cases.
And, officials said, the number of infections is likely to climb as more suspected cases are formally diagnosed as salmonellosis, the infection caused by the salmonella bacteria.
"The CDC [U.S. Centers for Disease Control and Prevention] considers the outbreak ongoing," Dr. David Acheson, associate commissioner for food protection at the U.S. Food and Drug Administration, said during a late-Thursday teleconference. "The lag time between somebody consuming a tomato and winding up in the system could be two weeks or longer. You always see a delay between consumption and it actually appearing in a database."
Despite assurances earlier this week that officials were zeroing in on the source of the infections, Acheson said the cause of the outbreak still hasn't been determined.
"I understand the frustration. We were being too optimistic earlier in the week. The truth is, every time we get more information, we are getting a little closer," he said.
"It's true to say that we may never know what farm the outbreak started on," Acheson added. "The goal is to trace it back to the farm and try to find out what went wrong."
States reporting illnesses include: Arizona, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, New Mexico, Missouri, New York, Oklahoma, Oregon, Tennessee, Texas, Utah, Vermont, Virginia, Washington, and Wisconsin, the FDA said.
On Tuesday, the warning about salmonella-contaminated tomatoes was expanded to include the entire country.
So far there have been no confirmed deaths, but the death of a Texas man was still under investigation, Dr. Ian Williams, chief of the OutbreakNet Team at the CDC, said during a Wednesday teleconference. The man had cancer and consumed pico de gallo, which is made with tomatoes.
The particular type of salmonella involved, Salmonella Saintpaul, is virulent and relatively rare, accounting for only about 400 reported cases annually in the United States, Williams said.
FDA officials have said the outbreak seems to be linked to certain types of raw and red tomatoes and products containing these tomatoes. In particular, the agency said, raw, red plum tomatoes; raw, red Roma tomatoes; and raw, round red tomatoes should be avoided at this time.
Cherry tomatoes, grape tomatoes, homegrown tomatoes and tomatoes sold with the vine still attached appear to be safe. But all tomatoes should be washed before eating, officials advised.
The FDA recommends consuming raw, red plum, raw, red Roma or raw, red round tomatoes only if you know they have been grown and harvested from these areas: Alabama, Arkansas, California, Georgia, Hawaii, Louisiana, Maine, Maryland, Minnesota, Mississippi, New York, Nebraska, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, West Virginia, Belgium, Canada, the Dominican Republic, Guatemala, Israel, the Netherlands and Puerto Rico.
Salmonella is a bacteria that can cause bloody diarrhea in humans. Some 40,000 cases of salmonellosis are reported in the United States each year, although the CDC estimates that because milder cases are not diagnosed or reported, the actual number of infections may be 30 or more times greater. Approximately 600 people die each year after being infected.
In related news, there were these actions on Thursday: