{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T12:58:33Z","timestamp":1791377913836,"version":"4.3.2"},"reference-count":27,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T00:00:00Z","timestamp":1668556800000},"content-version":"unspecified","delay-in-days":319,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2022]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:p>From 2016\u20132019, dry bulb onions were the suspected cause of three multistate outbreaks in the United States. We investigated a large multistate outbreak of <jats:italic>Salmonella<\/jats:italic> Newport infections that caused illnesses in both the United States and Canada in 2020. Epidemiologic, laboratory and traceback investigations were conducted to determine the source of the infections, and data were shared among U.S. and Canadian public health officials. We identified 1127 U.S. illnesses from 48 states with illness onset dates ranging from 19 June to 11 September 2020. Sixty-six per cent of ill people reported consuming red onions in the week before illness onset. Thirty-five illness sub-clusters were identified during the investigation and seventy-four per cent of sub-clusters served red onions to customers during the exposure period. Traceback for the source of onions in illness sub-clusters identified a common onion grower in Bakersfield, CA as the source of red onions, and onions were recalled at this time. Although other strains of <jats:italic>Salmonella<\/jats:italic> Newport were identified in environmental samples collected at the Bakersfield, CA grower, extensive environmental and product testing did not yield the outbreak strain. This was the third largest U.S. foodborne <jats:italic>Salmonella<\/jats:italic> outbreak in the last 30 years. It is the first U.S. multistate outbreak with a confirmed link to dry bulb onions, and it was nearly 10-fold larger than prior outbreaks with a suspected link to onions. This outbreak is notable for its size and scope, as well as the international data sharing that led to implication of red onions as the primary cause of the outbreak. Although an environmental assessment at the grower identified several factors that likely contributed to the outbreak, no main reason was identified. The expedient identification of the outbreak vehicle and response of multiple public health agencies allowed for recall and removal of product from the marketplace, and rapid messaging to both the public and industry on actions to protect consumers; these features contributed to a decrease in cases and expeditious conclusion of the outbreak.<\/jats:p>","DOI":"10.1017\/s0950268822001571","type":"journal-article","created":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T08:20:51Z","timestamp":1668586851000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":27,"title":["Bi-national outbreak of <i>Salmonella<\/i> Newport infections linked to onions: the United States experience"],"prefix":"10.1017","volume":"150","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7105-3770","authenticated-orcid":false,"given":"Z. D.","family":"McCormic","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Higa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Bancroft","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Donovan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Edwards","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Adcock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Bond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Pereira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Doyle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. E.","family":"Wise","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0575-4579","authenticated-orcid":false,"given":"L.","family":"Gieraltowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Salmonella Newport Investigation Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2022,11,16]]},"reference":[{"key":"S0950268822001571_ref8","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1017\/S095026880700859X","article-title":"Recurrent multistate outbreak of Salmonella Newport associated with tomatoes from contaminated fields, 2005","volume":"136","author":"Greene","year":"2008","journal-title":"Epidemiology and Infection"},{"key":"S0950268822001571_ref11","doi-asserted-by":"publisher","DOI":"10.12688\/wellcomeopenres.16291.2"},{"key":"S0950268822001571_ref5","first-page":"509","article-title":"Preliminary incidence and trends of infections with pathogens transmitted commonly through food \u2013 foodborne diseases active surveillance network, 10 U.S. Sites, 2016\u20132019","volume":"69","author":"Tack","year":"2020","journal-title":"MMWR"},{"key":"S0950268822001571_ref2","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268818001620"},{"key":"S0950268822001571_ref9","unstructured":"9. Whole Genome Sequencing (WGS). Centers for Disease Control and Prevention. Available at https:\/\/www.cdc.gov\/pulsenet\/pathogens\/wgs.html (Accessed 9 December 2020)."},{"key":"S0950268822001571_ref3","unstructured":"3. National Outbreak Reporting System (NORS). Centers for Disease Control and Prevention. Atlanta, Georgia. Available at wwwn.cdc.gov\/NORS (Accessed 5 November 2020)."},{"key":"S0950268822001571_ref19","unstructured":"19. Outbreak of Salmonella Newport Infections Linked to Onions (2020) Centers for Disease Control and Prevention. Available at https:\/\/www.cdc.gov\/salmonella\/newport-07-20\/index.html (Accessed 5 November 2020)."},{"key":"S0950268822001571_ref20","unstructured":"20. Public Health Notice: Outbreak of Salmonella infections linked to red onions imported from the United States (2020). Public Health Agency of Canada. Available at https:\/\/www.canada.ca\/en\/public-health\/services\/public-health-notices\/2020\/outbreak-salmonella-infections-under-investigation.html (Accessed 5 November 2020)."},{"key":"S0950268822001571_ref26","unstructured":"26. SEDRIC: System for Enteric Disease Response, Investigation, and Coordination. Centers for Disease Control and Prevention. Available at https:\/\/www.cdc.gov\/foodsafety\/outbreaks\/investigating-outbreaks\/sedric.html (Accessed 6 November 2020)."},{"key":"S0950268822001571_ref14","unstructured":"14. Bacteriological Analytical Manual Chapter 5. Available at https:\/\/www.fda.gov\/food\/laboratory-methods-food\/bam-chapter-5-salmonella (Accessed 30 April 2021)."},{"key":"S0950268822001571_ref17","unstructured":"17. Foodbook Report. Ottawa, Ontario: Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Infectious Diseases Prevention and Control Branch, Public Health Agency of Canada."},{"key":"S0950268822001571_ref18","unstructured":"18. Investigation Report: Factors potentially contributing to the contamination of red onions implicated in the summer 2020 outbreak of Salmonella Newport. US Food and Drug Administration. Available at https:\/\/www.fda.gov\/food\/outbreaks-foodborne-illness\/factors-potentially-contributing-contamination-red-onions-implicated-summer-2020-outbreak-salmonella (Accessed 1 July 2021)."},{"key":"S0950268822001571_ref24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fmicb.2019.02667","article-title":"Multistate outbreaks of foodborne illness in the United States associated with fresh produce from 2010 to 2017","volume":"10","author":"Carstens","year":"2019","journal-title":"Frontiers in Microbiology"},{"key":"S0950268822001571_ref23","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1089\/fpd.2017.2324","article-title":"An updated scheme for categorizing foods implicated in foodborne disease outbreaks: a tri-agency collaboration","volume":"14","author":"Richardson","year":"2017","journal-title":"Foodborne Pathogens and Disease"},{"key":"S0950268822001571_ref6","first-page":"713","article-title":"Outbreak of Salmonella Newport infections with decreased susceptibility to azithromycin linked to beef obtained in the United States and soft cheese obtained in Mexico \u2013 United States, 2018\u20132019","volume":"68","author":"Plumb","year":"2019","journal-title":"MMWR"},{"key":"S0950268822001571_ref1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3201\/eid1701.P11101","article-title":"Foodborne illness acquired in the United States \u2013 major pathogens","volume":"17","author":"Scallan","year":"2011","journal-title":"Emerging Infectious Diseases"},{"key":"S0950268822001571_ref12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgen.1007261","article-title":"A genomic overview of the population structure of Salmonella","volume":"14","author":"Alikhan","year":"2018","journal-title":"PLoS Genetics"},{"key":"S0950268822001571_ref13","unstructured":"13. Foodborne Disease Outbreak Investigation and Surveillance Tools. Available at https:\/\/www.cdc.gov\/foodsafety\/outbreaks\/surveillance-reporting\/investigation-toolkit.html (Accessed 25 June 2021)."},{"key":"S0950268822001571_ref4","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.4315\/JFP-21-112","article-title":"An overview of traceback investigations and three case studies of recent outbreaks of Escherichia coli O157:H7 infections linked to romaine lettuce","volume":"84","author":"Irvin","year":"2021","journal-title":"Journal of Food Protection"},{"key":"S0950268822001571_ref7","first-page":"144","article-title":"Outbreak of Salmonella Newport infections linked to cucumbers \u2013 United States, 2014","volume":"64","author":"Angelo","year":"2015","journal-title":"MMWR"},{"key":"S0950268822001571_ref21","unstructured":"21. Outbreak Investigation of Salmonella Newport: Red Onions (July 2020) (2020) U.S. Food and Drug Administration. Available at https:\/\/www.fda.gov\/food\/outbreaks-foodborne-illness\/outbreak-investigation-salmonella-newport-red-onions-july-2020 (Accessed 5 November 2020)."},{"key":"S0950268822001571_ref22","unstructured":"22. FSIS Issues Public Health Alert for Ready-to-Eat Meat and Poultry Products Containing FDA-Regulated Onions that have been Recalled due to Possible Salmonella Newport Contamination (2020) United States Department of Agriculture. Available at https:\/\/www.fsis.usda.gov\/wps\/portal\/fsis\/newsroom\/news-releases-statements-and-transcripts\/news-release-archives-by-year\/archive\/2020\/pha-08052020-01 (Accessed 5 November 2020)."},{"key":"S0950268822001571_ref25","unstructured":"25. National Onion Association (2010) Commodity specific food safety guidelines for the dry bulb onion supply chain. 1st edn. pp 36."},{"key":"S0950268822001571_ref27","unstructured":"27. Salmonella Outbreak Linked to Onions. Centers for Disease Control and Prevention. Available at https:\/\/www.cdc.gov\/salmonella\/oranienburg-09-21\/index.html (Accessed 16 December 2021)."},{"key":"S0950268822001571_ref15","unstructured":"15. Pathogen Detection. National Library of Medicine (US), National Center for Biotechnology Information. Available at https:\/\/www.ncbi.nlm.nih.gov\/pathogens\/ (Accessed 9 March 2021)."},{"key":"S0950268822001571_ref16","unstructured":"16. Centers for Disease Control and Prevention (2006\u20132007) Foodborne Active Surveillance Network (FoodNet) Population Survey Atlas of Exposures. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention."},{"key":"S0950268822001571_ref10","unstructured":"10. BioNumerics (version 7.6; Applied Maths): WGS analysis software platform. Applied Maths. Available at http:\/\/www.applied-maths.com\/bionumerics (Accessed 5 January 2021)."}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268822001571","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T09:44:24Z","timestamp":1669974264000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268822001571\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022]]},"references-count":27,"alternative-id":["S0950268822001571"],"URL":"https:\/\/doi.org\/10.1017\/s0950268822001571","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022]]},"assertion":[{"value":"Copyright \u00a9 United States Government, 2022","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e199"}}