WASHINGTON — More than 1,000 people now have become ill from salmonella initially linked to raw tomatoes, a sobering milestone Wednesday that makes this the worst foodborne outbreak in at least a decade. Adding to the confusion, the government is warning certain people to avoid types of hot peppers, too.
Certain raw tomatoes _ red round, plum and Roma _ remain a chief suspect and the government stressed again Wednesday that all consumers should avoid them unless they were harvested in areas cleared of suspicion.
But people at highest risk of severe illness from salmonella also should not eat raw jalapeno and serrano peppers, the Centers for Disease Control and Prevention urged Wednesday. The most vulnerable are the elderly, people with weak immune systems and infants.
Raw jalapenos caused some of the illnesses, conclude CDC investigations of two clusters of sick people who ate at the same restaurant or catered event.
But jalapenos cannot be the sole culprit _ because many of the ill insist they didn't eat hot peppers or foods like salsa that contain them, CDC food safety chief Dr. Robert Tauxe told The Associated Press. As for serrano peppers, that was included in the warning because they're difficult for consumers to tell apart.
In some clusters of illnesses, jalapenos "simply were not on the menu," Tauxe said. "We are quite sure that neither tomatoes nor jalapenos explain the entire outbreak at this point. ... We're presuming that both of them have caused illness."
That has Food and Drug Administration inspectors looking hard for farms that may have grown tomatoes earlier in the spring and then switched to pepper harvesting, or for distribution centers that handled both types of produce.
Also still being investigated is fresh cilantro, because a significant number of people who got sick most recently say they ate all three _ raw tomatoes, jalapenos and cilantro.
"I understand the frustration" that after weeks of warnings, the outbreak isn't solved, Tauxe said. "But we really are working as hard and as fast as we can to sort out this complicated situation and protect the health of the American people."
Added FDA food safety chief Dr. David Acheson: "It's just been a spectacularly complicated and prolonged outbreak."
The outbreak isn't over, or even showing any sign of slowing, said Tauxe _ with about 25 to 40 cases being a reported a day for weeks now, to a total of 1,017 known since the outbreak began on April 10.
Illnesses now have been reported in 41 states _ and even four cases in Canada, although three of those people are believed to have been infected while traveling in the U.S. and the fourth is still being probed.
At least 300 people became ill in June, with the latest falling sick on June 26. Two deaths are associated with the outbreak _ a Texas man in his 80s, and another Texas man who died of cancer but for whom salmonella may have played a role _ and 203 people have been hospitalized.
The toll far surpasses what had been considered the largest foodborne outbreak of the past decade, the 715 salmonella cases linked to peanut butter in 2006, Tauxe said. In the mid-1990s, there were well over 1,000 cases of cyclospora linked to raspberries, and previous large outbreaks of salmonella from ice cream and milk.
The CDC acknowledges that for every case of salmonella confirmed to the government, there may be 30 to 40 others that go undiagnosed or unreported.
"The outbreak could actually be tens of thousands of people rather than 1,000 people," agreed Caroline Smith DeWaal of the consumer advocacy Center for Science in the Public Interest. "It's certainly a disturbing event to have this many illnesses spanning this many months."