The number of confirmed cases of Salmonella poisoning from frozen raw tuna used primarily to make sushi has jumped by 58 to 316, and two more states have reported cases related to the outbreak, the Centers for Disease Control and Prevention reported Thursday.

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The outbreak is now spread over 26 states and the District of Columbia, with Colorado and Vermont each for reporting tuna-linked illnesses for the first time. Onset of the most recent confirmed case was May 3, the CDC said.

According to this latest update on the investigation, tests conducted by public health labs in Connecticut, Maryland, Massachusetts, Pennsylvania, South Caroline and Wisconsin isolated Salmonella from 53 (96 percent) of 55 samples taken from intact packages of frozen yellow fin tuna distributed by Moon Marine USA Corp. or from sushi prepared with the tuna product, which is known as “scrape.”

Scrape appears to be chopped or minced tuna. Traditionally, however, it is bits of tuna scraped from the backbone after a fish has been filleted.

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Nearly 59,000 pounds of Nakaochi Scrape were recalled on April 13 by Moon Marine, which is located in Cupertino, CA. The product, imported from India, had been shipped in boxes labeled “To be cooked before consumption.” The U.S. Food and Drug Administration says those shipments may have been broken down into smaller lots for further sale, possibly without new labeling.

The boxes contained vacuum-wrapped packages of frozen tuna with no labeling. The tuna was not available for sale to individual consumers but went to outlets that used the tuna to make sushi or other dishes to be sold in restaurants and grocery stores.

Food safety attorney Bill Marler, publisher of Food Safety News, noted that, “It will be interesting to see if restaurants and grocery stores that used the tuna scrape received the boxes or if the boxes were only used to ship the product from India to the United States.

It will also be interesting to see if Moon Marine marketed tuna scape as a product that could be consumed raw.”

A six-day investigation by FDA inspectors of the plant in India that processed and supplied the tuna, Moon Fishery (India), found a number of food safety violations, including dirty water and ice, fish residue on the ceiling and cutting knives, and peeling paint above processing line.

The FDA also found Salmonella in a sample of tuna strips that had not yet been distributed, and on May 10 Moon Fishery (India) recalled earlier shipments of tuna strips that had gone to four wholesalers in Georgia, Massachusetts, New Jersey and New York.

The outbreak of illnesses associated with sushi tuna involves two strains of Salmonella – Bareilly and Nchanga. The CDC said 304 individuals are confirmed infected with Salmonella Bareilly and 12 people are confirmed infected with Salmonella Nchanga.

New York, with 48 confirmed cases, has reported the greatest number of S. Bareilly infections, followed by Massachusetts with 33; Illinois and Maryland with 27; New Jersey with 26; Pennsylvania with 25; Virginia with 22; Wisconsin with 19; Georgia with 13;  North Carolina with 10; Connecticut with 9; Texas with 7; Rhode Island with 6; California, Louisiana, Missouri and Tennessee with 4; Alabama and South Carolina with 3; the District of Columbia and Mississippi with 2; and Arkansas, Colorado, Florida, Indiana, Nebraska and Vermont with 1.

New York also has reported six cases of S. Nchanga, followed by Georgia and New Jersey with 2 each, and Virginia and Wisconsin each with 1.

The onset of the earliest illness was January 28. Those sickened range in age from younger than 1 to 86 years; median age is 30. At least 37 people have been hospitalized.

The CDC has the following advice for consumers regarding the outbreak:

– Do not eat the recalled frozen raw yellowfin tuna product, known as Nakaochi Scrape, from Moon Marine USA Corporation. This product is tuna backmeat that is scraped from the bones of tuna and may be used to make sushi, particularly “spicy tuna” sushi.

– If you purchase “spicy tuna” or other sushi, sashimi, ceviche, or similar dishes that might contain Nakaochi Scrape tuna product from a restaurant or grocery store, check with the establishment to make sure that it does not contain raw recalled product from Moon Marine USA Corporation. When in doubt, don’t eat it.

– Persons who think they might have become ill from eating possibly contaminated raw Nakaochi Scrape tuna product should consult their healthcare providers.

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CDC Outbreak Map