A salmonella outbreak linked to Sheetz convenience stores in Pennsylvania may have crossed the line into Ohio.
The Ohio Department of Health is reporting 13 laboratory-confirmed cases of salmonella in people who had eaten at Sheetz. However, as of Tuesday afternoon, just two of those 13 cases were confirmed to be the same bacterial strain -- known as javiana -- that's being investigated in Pennsylvania.
Three of Ohio's cases are in Summit County and four are in Stark. There are two cases in Mahoning County and one each in Medina, Cuyahoga, Lorain and Tuscarawas counties.
Pennsylvania health officials said Monday that 110 people were sickened in that state after eating at Sheetz. The Food and Drug Administration reported additional illnesses in Maryland and West Virginia.
It's too soon to say, however, whether any of Ohio's cases are linked to Sheetz, health officials said.
"All we know right now is that we have four cases of salmonella," said Stark County Health Commissioner William Franks. "The investigation has not been completed, in terms of what they ate, where they ate and whether there's any connection."
Salmonella, generally spread through contaminated food or water, causes diarrhea, fever and cramps for as many as three days. Cases of salmonella infection aren't unusual, especially at this time of year when picnics and grilling are popular.
"There is a lot of salmonella around," said Dr. Marguerite Erme, head of epidemiology at the Akron Health Department. "Just because you've eaten at Sheetz, that doesn't mean that eating at Sheetz caused the illness."
The local health departments are performing "very extensive food interviews" with those who were infected, as well as with acquaintances who may have eaten at Sheetz without getting sick.
"You have to get down as close to possible to the source'' of the infection, Erme said. "You can't just say, 'It's this sandwich.' It may only be one component of the sandwich."
Health investigators are asking detailed questions of those sickened, down to every item put on a sandwich. The interviews will be forwarded to the Pennsylvania Department of Health and the U.S. Centers for Disease Control and Prevention, which are leading the investigation into the salmonella outbreak.
Pennsylvania officials had believed that tainted tomatoes or lettuce, or both, were to blame for the illnesses, because those who got sick ate those foods and because they ingested a strain of salmonella usually found on produce.
But tests of the tomatoes -- supplied by Wheeling, W.Va.-based Coronet Foods -- turned up a different strain of salmonella than that identified in those who have been sick.
"We have to keep looking," said Richard McGarvey, a spokesman for the Pennsylvania Health Department.
Sheetz, based in Altoona, Pa., pulled all tomatoes and lettuce from its 300-plus stores in Pennsylvania, Maryland, Ohio, West Virginia, Virginia and North Carolina after the salmonella cases were first reported last week. The stores sanitized their deli areas, switched suppliers and brought in new produce.
Those sickened in Pennsylvania bought sandwiches from at least 16 Sheetz stores, company officials have said.