Outbreak of E. coli Infections Linked to Flour

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June 24, 2019 at 4:45 PM ET

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA)external icon are investigating a multistate outbreak of Shiga toxin-producing Escherichia coli (E. coli) O26 infections linked to flour.

Advice to Consumers, Restaurants, and Retailers
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At A Glance

 

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Several brands and types of flour have been recalled because they may be contaminated with E. coli. Consumers should not use recalled products. The following products have been recalled:

Brand Castle Mixes

  • On June 21, 2019, Brand Castle, LLC, of Bedford Heights, Ohio, recalledexternal icon several brands of cookie and brownie mix because flour used in them was potentially contaminated with coli. The following Brand Castle mixes, sold in 25-oz and 32-oz glass jars, were recalled:
    • Brand Castle Arctic Chill Chocolate Mint Cookie Mix: UPC 6-54448-01035-2, Lot L6112618
    • Brand Castle Hot Cocoa Cookie Mix: UPC 6-54448-01036-9, Lot L5111918
    • Sisters Gourmet Million Dollar Cookie Mix: UPC 6-54448-00002-5, Lot L2121818
    • Sisters Gourmet Billion Dollar Brownie Mix: UPC 6-54448-00017-9, Lot 31OCT2019BC8324
    • In the Mix Chocolate Mint Chip Cookie Mix: UPC 6-54448-01081-9, Lot LM101518
    • Brand Castle The Grinch Sugar Cookie Mix with Sprinkles: UPC 6-54448-01038-3, Lot 25JUL2019BC8324

Pillsbury Best Bread Flour

  • On June 14, 2019, Hometown Food Company, a customer of ADM Milling Co., announced a recall of 5-lb. bags of Pillsbury Best Bread Flour with UPC Code 0 5150020031 5 and the following lot codes and use-by dates:
    • Lot Code: 8 342, Use-By Date: JUN 08 2020
    • Lot Code: 8 343, Use-By Date: JUN 09 2020

King Arthur Flour

  • On June 13, 2019, King Arthur Flour, Inc., a customer of ADM Milling Co., announced a recallexternal icon of 14,218 cases of 5-lb. bags of King Arthur Unbleached All-Purpose Flour. You can identify recalled flour by looking for the following best-used-by dates and lot codes on the bag’s side panel, below the nutrition facts box:
    • Best Used By 12/07/19, Lot: L18A07C
    • Best Used By 12/08/19, Lots: L18A08A, L18A08B
    • Best Used By 12/14/19, Lots: L18A14A, L18A14B, L18A14C

ALDI Baker’s Corner All Purpose flour

  • On May 23, 2019, ALDI, in association with ADM Milling Co., recalled pdf icon[PDF – 142 KB]external icon all 5-lb. bags of Baker’s Corner All Purpose Flour.
  • Recalled flour was sold at retail locations in the following states: Connecticut, Delaware, Massachussetts, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont, and West Virginia.

Consumers should not use any of the recalled flour. Throw it out.

  • If you stored flour in another container without the packaging and don’t remember the brand or “use by” date, throw it away.
  • Thoroughly wash the container before using it again.

Eating raw dough can make you sick.

  • Any flour or raw eggs used to make dough or batter might be contaminated with harmful germs.
  • Bake or cook food made with raw dough or batter before eating it. Follow the recipe or instructions on the package. Do not use recalled flour in cooking or baking.
  • Do not taste raw dough or batter. Even tasting a small amount could make you sick.

Clean up thoroughly after baking.

  • Wash any bowls, utensils, and other surfaces that were used when baking with warm water and soap.
  • Wash your hands with water and soap before and after baking.

Contact your healthcare provider if you think you may have become ill from eating raw dough.

Restaurants and other retailers should not use, sel,l or serve any of the recalled flour.

  • If you stored flour in another container without the packaging and don’t remember the brand or “use by” date, throw it away.
  • Restaurants and retailers should thoroughly wash flour storage containers before using them again.

Restaurants and other retailers should always be safe with raw dough.

  • Do not give customers raw dough to play with or eat. It is not safe to eat or play with raw dough, whether made from recalled flour or any other flour.
  • Bake or cook food made with raw dough or batter before serving or selling it. Follow the recipe or instructions on the package. Do not use recalled flour in cooking or baking.
Latest Outbreak Information
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  • Seventeen people infected with the outbreak strain of E. coli O26have been reported from eight states.
    • Illnesses started on dates ranging from December 11, 2018, to April 18, 2019.
    • Three hospitalizations and no deaths have been reported.
  • Epidemiologic and laboratory evidence indicates flour is a likely source of this outbreak.
  • Several products have been recalled because they may be contaminated with E. coli. Those products include all 5-lb. bags of Baker’s Corner All Purpose Flour sold at ALDI, some 5-lb. bags of King Arthur Unbleached All-Purpose Flour, and certain 5-lb. bags of Pillsbury Best Bread Flour. For more information about these recalls, visit the FDA websiteexternal icon.
  • This investigation is ongoing. FDA is working to determine whether other brands or lots of flour may be contaminated and need to be recalled. CDC will provide updates when more information is available.
Symptoms of E. coli Infection
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  • People usually get sick from Shiga toxin-producing E. coli (STEC) 2–8 days (average of 3–4 days) after swallowing the germ.
  • Some people with a STEC infection may get a type of kidney failure called hemolytic uremic syndrome (HUS).
  • E. coli infection is usually diagnosed by testing a stool sample.
  • For more information, see Symptoms of E. coli Infection.
Advice to Clinicians

Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out. Some studies have shown that administering antibiotics to patients with E. coliinfections might increase their risk of developing HUS, and a benefit of treatment has not been clearly demonstrated.

Investigation Details

May 24, 2019

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA)external icon are investigating a multistate outbreak of E. coli O26 infections.

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is performed on E. coli bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE. WGS performed on bacteria isolated from ill people showed that they were closely relatedly genetically. This means that people in this outbreak are more likely to share a common source of infection.

As of May 24, 2019, 17 people infected with the outbreak strain of E. coli O26 have been reported from 8 states. A list of the states and the number of cases in each can be found on the Map of Reported Cases page.

Illnesses started on dates ranging from December 11, 2018 to April 18, 2019. Ill people range in age from 7 to 86 years, with a median age of 23. Sixty-five percent of ill people are female. Of 17 people with information available, 3 have been hospitalized. No deaths have been reported.

Illnesses might not yet be reported due to the time it takes between when a person becomes ill with E. coli and when the illness is reported. This takes an average of two to three weeks.

Investigation of the Outbreak

Epidemiologic and laboratory evidence indicates that flour is a likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Of seven people who were interviewed, four (57%) reported eating, licking, or tasting raw, homemade dough or batter. Two people with detailed information reported eating raw dough or batter made with flour or baking mixes from ALDI.

Investigators with the Rhode Island Department of Health collected records and flour samples at a bakery where an ill person reported eating raw dough. Records indicated that the bakery used Baker’s Corner All Purpose Flour from ALDI. The outbreak strain was isolated from an unopened bag of Baker’s Corner All Purpose Flour collected at the bakery.

WGS results showed that the E. coli O26 strain identified in the Baker’s Corner All Purpose Flour sample was closely related genetically to the E. coli O26 strain identified in ill people. These results provide additional evidence that people in this outbreak got sick from eating flour.

On May 23, 2019, ADM Milling Co. and Aldi recalled pdf icon[PDF – 142 KB]external icon 5 lb. bags of Baker’s Corner All Purpose Flour sold at retail locations in the following states because they may be contaminated with E. coli: Connecticut, Delaware, Massachussetts, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont, and West Virginia.

This investigation is ongoing. FDA is working to determine whether other brands or lots of flour may be potentially contaminated and need to be recalled. CDC will provide updates when more information is available.