Investigation Details
Posted June 7, 2023
This outbreak is over. Learn what you can do to prevent getting sick from flour.
CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) investigated a multistate outbreak of Salmonella Infantis infections.
Epidemiologic, laboratory, and traceback data showed that Gold Medal brand flour contaminated with Salmonella made people sick.
Epidemiologic Data
As of June 7, 2023, 14 people infected with the outbreak strain of Salmonella Infantis were reported from 13 states (see map). Illnesses started on dates ranging from December 6, 2022, to May 2, 2023 (see timeline).
Public health officials collected many different types of information from sick people, including their age, race, ethnicity, other demographics, and the foods they ate in the week before they got sick. This information provided clues to help investigators identify the source of the outbreak.
Sick people ranged in age from 12 to 81 years, with a median age of 64, and 93% were female. Of 11 people with race or ethnicity information available, 10 were White, 1 was Asian, and no one reported Hispanic ethnicity. Of 13 people with information available, 3 were hospitalized. No deaths were reported.
The true number of sick people in this outbreak was likely much higher than the number reported, and the outbreak may not have been limited to the states with known illnesses. This is because many people recover without medical care and are not tested for Salmonella.
State and local public health officials interviewed people about the foods they ate in the week before they got sick. Of the 8 people interviewed, 7 (88%) reported eating raw dough or batter. Of 6 sick people with brand information, all 6 (100%) reported buying Gold Medal brand flour. No other brands of flour were reported by ill people.
Traceback and Laboratory Data
FDA conducted a traceback investigation and identified a single production facility for the flour consumed by sick people. FDA initiated an inspection at the General Mills Kansas City, Missouri, facility and collected samples from flour. The outbreak strain was identified in one of the samples.
Whole genome sequencing analysis of bacteria from 14 people’s samples and 1 flour sample did not predict resistance to any antibiotics. Standard antibiotic susceptibility testing of one person’s sample by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory also showed no resistance.
Public Health Actions
On April 28, 2023, General Mills voluntarily recalled 2-pound, 5-pound, and 10-pound bags of Gold Medal Bleached and Unbleached All-Purpose Flour with “Better if Used By” dates of March 27, 2024, and March 28, 2024. Two Product UPCs of Gold Medal Unbleached All-Purpose Flour in 5- and 10-pounds bags were affected, and two Product UPCs of Gold Medal Bleached All-Purpose Flour in 2- and 5-pound bags were affected. Although this outbreak investigation has ended, CDC advises you to throw away or return any bags of recalled flour and to wash any containers used to store recalled flour with warm water and soap.
CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are collecting different types of data to identify the food source of a multistate outbreak of Salmonella Infantis infections.
Epidemiologic, laboratory, and traceback data show that Gold Medal brand flour contaminated with Salmonella has made people sick.
Epidemiologic Data
As of May 1, 2023, 13 people infected with the outbreak strain of Salmonella Infantis have been reported from 12 states (see map). Illnesses started on dates ranging from December 6, 2022, to March 1, 2023 (see timeline).
Public health officials collect many different types of information from sick people, including their age, race, ethnicity, other demographics, and the foods they ate in the week before they got sick. This information provides clues to help investigators identify the source of the outbreak.
Sick people range in age from 12 to 81 years, with a median age of 64, and 92% are female. Of 10 people with race or ethnicity information available, nine are White, one is Asian, and no one reported Hispanic ethnicity. Of 13 people with information available, three have been hospitalized. No deaths have been reported.
The true number of sick people in this outbreak is likely much higher than the number reported, and the outbreak may not be limited to the states with known illnesses. This is because many people recover without medical care and are not tested for Salmonella. In addition, recent illnesses may not yet be reported as it usually takes 3 to 4 weeks to determine if a sick person is part of an outbreak.
State and local public health officials are interviewing people about the foods they ate in the week before they got sick. Of the eight people interviewed, seven (88%) reported eating raw dough or batter. Of six sick people with brand information, all six (100%) reported buying Gold Medal brand flour. The only brand reported was Gold Medal.
Traceback and Laboratory Data
FDA conducted a traceback investigation and identified a single production facility of the flour consumed by sick people. FDA initiated an inspection at the General Mills Kansas City, Missouri facility and collected samples from retain flour. The outbreak strain was identified in one of the samples of flour.
Whole genome sequencing analysis of bacteria from 13 people’s samples did not predict resistance to any antibiotics. Standard antibiotic susceptibility testing of one person’s sample by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory also showed no resistance.
Public Health Actions
On April 28, 2023, General Mills voluntarily recalled 2-pound, 5-pound, and 10-pound bags of Gold Medal Bleached and Unbleached All-Purpose Flour with “Better if Used By” dates of March 27, 2024, and March 28, 2024. Two Product UPCs of Gold Medal Unbleached All-Purpose Flour in 5- and 10-pounds bags are affected, and two Product UPCs of Gold Medal Bleached All-Purpose Flour in 2- and 5-pound bags are affected. CDC advises you to throw away or return any bags of recalled flour and to wash any containers used to store recalled flour with warm water and soap.
CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are collecting different types of data to identify the food source of a multistate outbreak of Salmonella Infantis infections.
Epidemiologic data show that flour contaminated with Salmonella is making people sick. Investigators are working to identify specific brands of flour that may be linked to these illnesses.
Epidemiologic Data
As of March 30, 2023, 12 people infected with the outbreak strain of Salmonella have been reported from 11 states (see map). Illnesses started on dates ranging from December 6, 2022, to February 13, 2023 (see timeline).
Public health officials collect many different types of information from sick people, including their age, race, ethnicity, other demographics, and the foods they ate in the week before they got sick. This information provides clues to help investigators identify the source of the outbreak.
Sick people range in age from 12 to 81 years, with a median age of 64, and 92% are female. Of 10 people with race or ethnicity information available, 8 are White, 2 are Asian, and no one reported Hispanic ethnicity. Of 12 people with information available, 3 have been hospitalized. No deaths have been reported.
The true number of sick people in this outbreak is likely much higher than the number reported, and the outbreak may not be limited to the states with known illnesses. This is because many people recover without medical care and are not tested for Salmonella. In addition, recent illnesses may not yet be reported as it usually takes 3 to 4 weeks to determine if a sick person is part of an outbreak.
State and local public health officials are interviewing people about the foods they ate in the week before they got sick. Of the 7 people interviewed, 6 (86%) reported eating raw dough or batter. Flour was the only common ingredient in the raw dough or batter people reported eating. Investigators are working to identify a specific brand of raw flour that is linked to illnesses.
Laboratory Data
Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. CDC PulseNet manages a national database of DNA fingerprints of bacteria that cause foodborne illnesses. DNA fingerprinting is performed on bacteria using a method called whole genome sequencing (WGS).
WGS showed that bacteria from sick people’s samples are closely related genetically. This suggests that people in this outbreak may have gotten sick from eating the same food.
WGS analysis of bacteria from 12 people’s samples did not predict resistance to any antibiotics. Standard antibiotic susceptibility testing by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory is currently underway.
Public Health Actions
Investigators are working to identify specific brands of flour that are linked to illness. In the meantime, CDC always advises you not to eat raw cookie dough or cake batter.
