WASHINGTON - More than 1,000 people now are confirmed ill from salmonella initially linked to raw tomatoes, a grim milestone Wednesday that makes this the worst foodborne outbreak in at least a decade.
Adding to the confusion, the U.S. government is implicating some types of hot peppers, too.
Certain raw tomatoes -- red round, plum and Roma -- remain a chief suspect and the government stressed again Wednesday that people 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 Centres for Disease Control and Prevention urged Wednesday.
Those at highest risk include the elderly, people with weak immune systems and infants.
There is evidence that raw jalapeno peppers may have caused some of the illnesses, conclude CDC investigations of two clusters of sick people who ate at the same restaurant or catered event.
The jalapenos don't explain the entire outbreak -- 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.
Also still being investigated is fresh 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."
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.
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 Centre for Science in the Public Interest.
"It's certainly a disturbing event to have this many illnesses spanning this many months."
