The number of salmonella cases in Pennsylvania linked to a regional outbreak grew by 40 yesterday to 170, putting it on track to become one of the larger salmonella outbreaks in the United States since 1997.
But yesterday's increase reflected newly reported cases from earlier in the month, not a continued spread of the sickness, said Richard McGarvey, spokesman for the state Department of Health.
People sickened in the outbreak ate contaminated food during the first 10 days or so of the month, McGarvey said. They then developed their cases of salmonellosis during the first half of the month, not this week.
"Some are going to the doctor now that they're recovering," he said. "So there's definitely a lag. With media attention, you have more people going to the doctor and getting tested."
The outbreak was linked last week to food sold at Sheetz convenience stores, with investigators putting the focus on lettuce and tomatoes. An attorney representing 60 people sickened in the outbreak reported yesterday that Sheetz has agreed to pay the costs of victims' medical bills and lost wages.
Chairman Steve Sheetz said his company has pledged since last week that it would do the right thing by those sickened.
Bill Marler of Seattle, the attorney, said in a statement: "They're showing that businesses really do care about their customers' well-being and not just the bottom line."
State health officials expect the outbreak numbers will continue to grow for the next several days, meaning it is certain to join the ranks of those salmonella outbreaks that resulted in 200 or more people getting sick.
Between 1997 and 2002, there were 12 other salmonella outbreaks that sickened that many, according to records maintained by the U.S. Centers for Disease Control and Prevention.
The largest during that time period sickened 700 people in Texas in 2002.
The outbreak tally in neighboring states was increasing yesterday, too.
Maryland officials were reporting 30 cases of people who had salmonella and contact with Sheetz, although they didn't necessarily eat food from the convenience stores. Of those, 12 people have probable or confirmed cases with the Javiana strain of salmonella, which is sickening people here.
In West Virginia, 19 people had salmonella and ate at Sheetz in June or July; four of the 19 had the Javiana strain. In Ohio, 13 people had salmonella with a Sheetz food history. Six of those sick in Ohio had the Javiana strain.
State Department of Agriculture officials announced Monday that they had found salmonella in a tomato sample removed from a Sheetz store in the wake of the outbreak. The health department reported yesterday that the salmonella discovered is a strain called "anatum," which caused five outbreaks between 1997 and 2002, according to CDC records.
None of the people sickened in the Sheetz outbreak has been infected with the anatum strain, McGarvey said yesterday.
Coronet Foods, of Wheeling, W.Va., supplied the tomatoes used at Sheetz. After finding salmonella Monday, state agriculture officials recommended that other stores with tomatoes from Coronet Foods remove them, if they were part of the same batch, said Bobby McLean, director of the food safety bureau.
It's unclear if the contamination -- which apparently is unrelated to the outbreak -- will prompt regulatory action. The state Agriculture Department doesn't regulate Coronet Foods, but Bobby McLean, director of the food safety bureau, said of the finding: "Any salmonella, as far as I'm concerned, is a problem, because it's an organism we don't like to see in food."
The U.S. Food and Drug Administration initiated a trace-back of tomatoes used at Sheetz Monday in the wake of Monday's discovery. There was no update from FDA or CDC officials yesterday about the search for a cause to the outbreak.
While it is clear that firms other than Sheetz received produce from Coronet, the Health Department still can't conclusively link any outbreak cases with retailers other than Sheetz.
"If we thought there was a risk from some other source, an indication that there's another place where people could be eating and being exposed to the salmonella, we would move to make sure to eliminate that source and also inform the public," McGarvey said.