and Utah. Portions of the population in Colorado (49%), Minnesota (55%), New Mexico (61%), and Utah (35%) and the whole population of Maryland are included as part of the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET). https://www.cdc.gov/coronavirus/2019-ncov/covid-data/ covid-net/purpose-methods.html † A COVID-19 case (confirmed or probable) was defined as the detection of SARS-CoV-2 RNA or antigen in a respiratory specimen collected from a person aged ≥18 years per the Council of State and Territorial Epidemiologists' update to the standardized surveillance case definition and national notification for 2019 novel coronavirus disease (COVID-19) (21-ID-01

From 1998 through 2006, four outbreaks of salmonellosis associated with raw, frozen, microwaveable, breaded, prebrowned, stuffed chicken products were identified in Minnesota. In 1998, 33 Salmonella Typhimurium cases were associated with a single brand of Chicken Kiev. In 2005, four Salmonella Heidelberg cases were associated with a different brand and variety (Chicken Broccoli and Cheese). From 2005 to 2006, 27 Salmonella Enteritidis cases were associated with multiple varieties of product, predominately of the same brand involved in the 1998 outbreak. In 2006, three Salmonella Typhimurium cases were associated with the same brand of product involved in the 2005 Salmonella Heidelberg outbreak. The outbreak serotype and pulsed-field gel electrophoresis subtype of Salmonella were isolated from product in each outbreak. In these outbreaks, most individuals affected thought that the product was precooked due to its breaded and prebrowned nature, most used a microwave oven, most did not follow package cooking instructions, and none took the internal temperature of the cooked product. Similar to previous salmonellosis outbreaks associated with raw, breaded chicken nuggets or strips in Canada and Australia, inadequate labeling, consumer responses to labeling, and microwave cooking were the key factors in the occurrence of these outbreaks. Modification of labels, verification of cooking instructions by the manufacturer, and notifications to alert the public that these products contain raw poultry, implemented because of the first two outbreaks, did not prevent the other outbreaks. Microwave cooking is not recommended as a preparation method for these types of products, unless they are precooked or irradiated prior to sale.

Contaminated peanut butter and peanut products caused a nationwide salmonellosis outbreak. Ingredient-driven outbreaks are challenging to detect and may lead to widespread contamination of numerous food products.

An outbreak of Salmonella enterica serotype Agona infections associated with nationwide distribution of cereal from Company X was identified in April 2008. This outbreak was detected using PulseNet, the national molecular subtyping network for foodborne disease surveillance, which coincided with Company X's voluntary recall of unsweetened puffed rice and wheat cereals after routine product sampling yielded Salmonella Agona. A case patient was defined as being infected with the outbreak strain of Salmonella Agona, with illness onset from 1 January through 1 July 2008. Case patients were interviewed using a standard questionnaire, and the proportion of ill persons who reported eating Company X puffed rice cereal was compared with Company X's market share data using binomial testing. The Minnesota Department of Agriculture inspected the cereal production facility and collected both product and environmental swab samples. Routine surveillance identified 33 case patients in 17 states. Of 32 patients interviewed, 24 (83%) reported eating Company X puffed rice cereal. Company X puffed rice cereal represented 0.063% of the total ready-to-eat dry cereal market share in the United States at the time of the investigation. Binomial testing suggested that the proportion of exposed case patients would not likely occur by chance (P < 0.0001). Of 17 cereal samples collected from case patient homes for laboratory testing, 2 (12%) yielded Salmonella Agona indistinguishable from the outbreak strain. Twelve environmental swabs and nine product samples from the cereal plant yielded the outbreak strain of Salmonella Agona. Company X cereal was implicated in a similar outbreak of Salmonella Agona infection in 1998 with the same outbreak strain linked to the same production facility. We hypothesize that a recent construction project at this facility created an open wall near the cereal production area allowing reintroduction of Salmonella Agona into the product, highlighting the resilience of Salmonella in dry food production environments.

This study extends evidence that patients with antimicrobial-resistant nontyphoidal Salmonella infections have more severe outcomes. Prevention efforts are needed to reduce unnecessary antimicrobial use in patient care settings and in food animals to help prevent the emergence of resistance and infections with resistant nontyphoidal Salmonella.