Though it seems to have slipped from the headlines, last month's Salmonella outbreak, originally pinned on tainted tomatoes, continues to make consumers sick. The nationwide toll has reached 1,148, making it the largest tainted food outbreak in more than a decade.

At least 220 people have been hospitalized from Salmonella Saintpaul, according to the latest count by the Centers for Disease Control. Meanwhile, health officials don't appear any closer to figuring out what caused the outbreak and where it originated.

The CDC says an initial investigation in New Mexico and Texas comparing foods eaten by persons who were ill in May to foods eaten by well persons identified consumption of raw tomatoes as strongly linked to illness.

A similar but much larger, nationwide study comparing persons who were ill in June to well persons found that ill persons were more likely to have recently consumed raw tomatoes, fresh jalapeño peppers, and fresh cilantro. These items were commonly, though not always, consumed together, so that study could not determine which item or items caused the illnesses.

Recently, many clusters of illnesses have been identified in several states among persons who ate at restaurants. The CDC said most clusters involve fewer than five ill persons and that three larger clusters have been intensively investigated.

In one, illnesses were linked to consumption of an item containing fresh tomatoes and fresh jalapeño peppers. In the other two, illnesses were linked to an item containing fresh jalapeño peppers and no other of the suspect items. The accumulated data from all investigations indicate that jalapeño peppers caused some illnesses but that they do not explain all illnesses.

Raw tomatoes, fresh serrano peppers, and fresh cilantro also remain under investigation. Investigators from many agencies are collaborating to track the source of the implicated peppers and other produce items, the CDC said.

Since April, more than 1,100 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in 42 states, the District of Columbia, and Canada. These were identified because clinical laboratories in all states send Salmonella strains from ill persons to their State public health laboratory for characterization. No new states report ill persons.

The number of ill persons identified in each state is as follows: Alabama (2 persons), Arkansas (14), Arizona (54), California (9), Colorado (15), Connecticut (4), Florida (2), Georgia (28), Idaho (6), Illinois (104), Indiana (16), Iowa (2), Kansas (18), Kentucky (1), Louisiana (1), Maine (1), Maryland (32), Massachusetts (26), Michigan (21), Minnesota (19), Mississippi (2), Missouri (17), New Hampshire (4), Nevada (11), New Jersey (12), New Mexico (102), New York (32), North Carolina (22), Ohio (10), Oklahoma (25), Oregon (10), Pennsylvania (12), Rhode Island (3), South Carolina (2), Tennessee (8), Texas (449), Utah (2), Virginia (31), Vermont (2), Washington (17), West Virginia (1), Wisconsin (13), and the District of Columbia (1). Four ill persons are reported from Canada; all four appear to have been infected while traveling in the United States.

Among the 813 persons with information available, illnesses began between April 10 and July 4, 2008, including 357 who became ill on June 1 or later. Patients range in age from 1 to 99 years, with an equal number of males and females becoming sick. The rate of illness is highest among persons 20 to 29 years old; the rate of illness is lowest in children 10 to 19 years old and in persons 80 or more years old.

A man in his eighties who died in Texas from cardiopulmonary failure had an infection with the outbreak strain at the time of his death and the CDC says the infection may have contributed to his death. A man in his sixties who died in Texas from cancer had an infection with the outbreak strain of at the time of his death and again, the CDC says the infection may have contributed to his death.

Only 6 persons infected with this strain of Salmonella Saintpaul were identified in the country during April through June of 2007.

"The previous rarity of this strain and the distribution of illnesses in all U.S. regions suggest that the implicated food is distributed throughout much of the country," the CDC said. "Because many persons with Salmonella illness do not have a stool specimen tested, it is likely that many more illnesses have occurred than those reported. Some of these unreported illnesses may be in states that are not on today's map."

Symptoms of salmonella include bloody diarrhea, abdominal pain and fever.

It can cause serious and sometimes fatal infections particularly in young children, frail or elderly people, and those with weakened immune systems. Healthy people often experience fever, diarrhea, nausea, vomiting, and abdominal pain. In rare circumstances, the organism can get into the bloodstream and produce more severe illnesses.