Report 2021-09, 2022-01

Salmonella Outbreaks Linked to ItalianStyle Meats

Outbreak Investigation After Action Review

Highlights

• The Food Safety and 

Inspection Service 

(FSIS), the Centers for 

Disease Control and 

Prevention (CDC) and 

public health partners 

investigated two 

Salmonella outbreaks 

involving ready-to-eat 

(RTE), fermented, dried, 

Italian-style meat 

products. The products 

were produced using 

multiple interventions 

(e.g., fermentation and 

drying) to control

Salmonella and other 

bacteria that can make 

people sick. 

• Retailers voluntarily 

removed implicated 

products from their 

shelves. Also, retailers promptly provided a list of foods purchased by ill people to 

public health officials. One retail chain had a customer loyalty program that was 

used to gather purchase information. Another retailer, without a loyalty program,

provided purchase histories using limited credit card information that ill people

shared with public health officials. This information helped to identify and confirm 

the common food consumed prior to people becoming sick and was used to trace 

the products back to the producing establishments.

• FSIS is working with research partners to identify ways to improve the safety of 

these products, including a project assessing proper drying times needed for 

various diameters of sausages.

Outbreaks at a Glance

Outbreak 1 Outbreak 2

Illnesses 40 34

States included 17 10

Hospitalizations 12 7

Deaths 0 0

Response at a Glance

Recall or Public 

Health Alert Yes Yes

Process Improvements

• FSIS is developing a guideline for establishments related 

to validating lethality treatments for RTE products that 

achieve lethality using multiple steps.

• FSIS is working with the National Advisory Committee on 

Meat and Poultry Inspection (NACMPI) to determine how 

to address research gaps related to shelf stable, RTE 

fermented, salt-cured or dried products that rely on 

multiple hurdles for lethality and how FSIS can better 

verify the safety of these products.

 

 
What Happened?

Outbreak 1

From August through September 2021, public 

health officials, CDC and FSIS investigated an 

outbreak of 40 Salmonella illnesses (14 serotype 

Infantis and 26 serotype Typhimurium) linked to 

RTE antipasto Italian-style meats manufactured in 

an FSIS-regulated establishment. Interviews with 

ill people and review of food purchase information 

confirmed that the uncured antipasto Italian-style 

meat product was a food consumed that was in 

common among the ill people. CDC issued a Food Safety Alert to notify the public about 

the outbreak. The retailer who sold the Italian-style meat trays voluntarily removed any

remaining product from store shelves. FSIS traced the antipasto products to the FSISregulated establishment where they were produced. As a result of strong epidemiologic 

and traceback evidence, the establishment voluntarily recalled the affected uncured 

antipasto products available in commerce. FSIS conducted assessments at the 

establishment and identified factors that may have contributed to the outbreak, including 

the use of a reduced salt formulation and lack of validated scientific support to achieve a 5-

log reduction in Salmonella.

Outbreak 2

From October through December 2021, public health 

officials, CDC and FSIS investigated an outbreak of 34

Salmonella I 4,[5],12:i:- illnesses linked to RTE Italianstyle salami sticks produced at another FSIS-regulated 

establishment. Nearly all cases reported eating salami

sticks prior to illness onset and most reported the 

same Italian-style salami stick brand. Public health 

partners notified the public about the outbreak,

retailers voluntarily removed the product from the shelves and the producing establishment 

voluntarily stopped producing these products. Public health partners and FSIS tested 

product samples during the investigation; two salami stick samples collected by the 

California Department of Public Health were positive for Salmonella Derby. However, 

these positive samples were not related genetically to the outbreak strain or any other 

clinical or non-clinical isolates. FSIS traced ill people’s salami stick purchases to the 

producing establishment. As a result of the positive samples and the strong epidemiologic 

and traceback evidence, the establishment voluntarily recalled the affected salami stick 

products available in commerce. FSIS conducted assessments at the establishment and 

determined that there was not sufficient evidence to support the fermentation and drying 

interventions to adequately control Salmonella. 
What we Learned from These Outbreaks

Research 

Fermented and dried ready-to-eat (RTE) meat products must be free of 

pathogens such as Salmonella and Listeria monocytogenes. A 5-log 

reduction of Salmonella and other pathogens during processing is 

recommended to ensure the finished product is pathogen-free. Multihurdle approaches (i.e., lethality achieved using multiple steps) are used 

for many RTE products to eliminate pathogens, particularly when

production processes do not include cooking. Unlike cooking, other 

common production steps, including fermentation to a low pH, and 

drying, do not generally achieve a 5-log reduction and additional hurdles 

may be needed. FSIS assessments found that while processing controls 

including meeting ‘degree hours’ parameters (for Staphylococcus aureus 

control), following a minimum number of drying days (for Trichinella

elimination), and achieving a final water activity level (for shelf stability)

were all met by the outbreak establishments, these were not validated to 

achieve a 5-log reduction in Salmonella. Research demonstrates that 

small diameter products may require longer drying times to achieve 

significant reductions in Salmonella. Understanding the contributing 

factors for survival of pathogens during production can help 

manufacturers produce safe product. FSIS lists a research priority

associated with these products on the FSIS Food Safety Research 

Priorities and Studies webpage.

Collaboration with Retailers

During these outbreak investigations, ill people shared loyalty program 

and limited credit card information with public health officials who 

worked closely with retailers to obtain their food purchase histories. 

This information helped to identify the food making people sick and to 

prevent additional illnesses.

Close coordination between public health partners and retailers is

valuable to quickly obtain records of foods purchased by ill people, an 

essential step in narrowing down the common food consumed. We can 

achieve shared food safety goals by establishing and maintaining 

relationships before an outbreak occurs.
What Can You do to Prevent or Solve the Next 

Outbreak?

Helpful Links

 utbreak 1

• ecall 030-2021, ugust 27, 2021

• ood afety lert, ctober 26, 2021

 utbreak 2

• ecall 042-2021, ovember 10, 2021

• FSIS Public Health Alert, October 29, 2021 

• ood afety lert, ecember 8, 2021

 stablishments that 

produce fermented and 

dried meat products that 

use multi-hurdle 

approaches to achieve 

lethality should ensure 

that they have sufficient 

scientific support that 

the process will result in 

a 5-log reduction of 

Salmonella f an 

establishment produces 

different diameter 

products but only has a 

study performed with 

one diameter, it must 

determine the impact of 

differences from the 

study to the actual 

process (e g , drying 

time) to make sure the 

process is still effective

in achieving the target 5-

log reduction 

 ontinue to build 

relationships with 

retailers to promote 

timely and effective 

response when 

requesting food 

purchase information

associated with ill 

people in the outbreak 

 onsider adding

questions about 

fermented and dried 

meat products to routine 

illness questionnaires 

Public Health Partners

 ubscribe here to get 

email updates from 

 about food safety, 

including actions 

consumers can take 

when specific products 

are linked to illness 

outbreaks 

Industry Consumers
• Minnesota Department of Health News Release, ctober 22, 2021

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• 2020 ational dvisory ommittee on eat and oultry nspection ( ) 

 eports, ubcommittee 1: Validation of eady-to- at ( ) helf- table ultihurdle ethality reatments

• ood afety esearch riorities and tudies

• eport a roblem with ood | ood afety and nspection ervice (usda gov)

• ind more information about ’ response to foodborne outbreaks on the 

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• ssociation of ood and rug fficials ( ) Webpage: everaging ood 

 urchase History to olve oodborne utbreaks

• You an Help olve oodborne utbreaks

• DeSouza, J.D., Ahmed, R., Strange, P., Barbut, S., and Balamurugan, 

S. 2018. Effect of caliber size and fat level on the inactivation of E. coli O157:H7 

in dry fermented sausages. Internal Journal of Food Microbiology. 266: 167-172.