New product, old problem(s): multistate outbreak of Salmonella Paratyphi B variant L(+) tartrate(+) infections linked to raw sprouted nut butters, October 2015.

A cluster of Salmonella Paratyphi B variant L(+) tartrate(+) infections with indistinguishable pulsed-field gel electrophoresis patterns was detected in October 2015. Interviews initially identified nut butters, kale, kombucha, chia seeds and nutrition bars as common exposures. Epidemiologic, environmental and traceback investigations were conducted. Thirteen ill people infected with the outbreak strain were identified in 10 states with illness onset during 18 July-22 November 2015. Eight of 10 (80%) ill people reported eating Brand A raw sprouted nut butters. Brand A conducted a voluntary recall. Raw sprouted nut butters are a novel outbreak vehicle, though contaminated raw nuts, nut butters and sprouted seeds have all caused outbreaks previously. Firms producing raw sprouted products, including nut butters, should consider a kill step to reduce the risk of contamination. People at greater risk for foodborne illness may wish to consider avoiding raw products containing raw sprouted ingredients.

Evaluation and follow-up of abnormal Pap smears.

An estimated 13,500 cases of invasive cervical cancer and 6,000 related deaths occur each year in the United States. These numbers can be significantly reduced if all women are regularly screened with Papanicolaou (Pap) smears and undergo colposcopy when abnormalities are detected. Screening with Pap smears should begin at age 18 or at the age of first sexual intercourse and should be repeated every one to three years, depending on individual risk factors, until age 65. Screening may be discontinued in women over age 65 who have had normal findings on two consecutive Pap smears. Risk factors for cervical cancer include sexual intercourse before age 20, more than two sexual partners in a lifetime, cigarette smoking and genital human papillomavirus (HPV) infection. Use of a spatula and Cytobrush for cervical sampling will improve the chances of collecting an adequate sample containing endocervical cells. Family physicians must know the significance of various cervical abnormalities reported by the laboratory. In women with cervical or genital HPV infection and persistent inflammatory cervical changes unresponsive to appropriate therapy, colposcopy is necessary to screen for underlying dysplasia.