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E. COLI EHEC - USA (08): O26, FLOUR, ALERT, RECALL

E. COLI EHEC - USA (08): O26, FLOUR, ALERT, RECALL

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A ProMED-mail post <http://www.promedmail.org> ProMED-mail is a program of the International Society for Infectious Diseases <http://www.isid.org>

Date: Fri 24 May 2019 6:30 PM ET
Source: Centers for Disease Control and Prevention (CDC), _E. coli_homepage, 2019 outbreaks [edited] <https://www.cdc.gov/ecoli/2019/flour-05-19/index.html>


Outbreak of _E. coli_ infection linked to flour
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CDC, public health and regulatory officials in several states, and the US Food and Drug Administration (FDA) are investigating a multistate outbreak of _Escherichia 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 24 May 2019, 17 people infected with the outbreak strain of _E. coli_ O26 have been reported from 8 states.

State / Ill people
------------------
California / 1
Connecticut / 1
Missouri / 1
New Jersey / 1
New York / 5
Ohio / 5
Pennsylvania / 2
Rhode Island / 1
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Total / 17

Illnesses started on dates ranging from 11 Dec 2018 to 18 Apr 2019. Ill people range in age from 7 to 86 years, with a median age of 23. 65% 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 2 to 3 weeks.

Investigation of the outbreak
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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 7 people who were interviewed, 4 (57%) reported eating, licking, or tasting raw, homemade dough or batter. 2 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 23 May 2019, ALDI, in association with ADM Milling Co., recalled 5 lb [about 2kg] 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, Massachusetts, 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.

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communicated by: ProMED-mail from HealthMap Alerts <promed@promedmail.org>

[Although commercial flour is not generally thought of as a source of enteric pathogens it certainly needs to be thought of in the right situation. - Mod.LL

HealthMap/ProMED-mail map of the United States: <http://healthmap.org/promed/p/106>.]

[See Also:

E. coli EHEC - USA (07): O103, ground beef, CDC, recall http://promedmail.org/post/20190514.6468615
E. coli EHEC - USA (06): O103, ground beef, CDC, recall http://promedmail.org/post/20190424.6436748
E. coli EHEC - USA (05): O103, ground beef, CDC http://promedmail.org/post/20190413.6420590
E. coli EHEC - USA (04): O103, CDC http://promedmail.org/post/20190410.6414420
E. coli EHEC - USA (03): O103, CDC http://promedmail.org/post/20190405.6406761
E. coli EHEC - USA (02): O103, multistate spread http://promedmail.org/post/20190404.6404859
E. coli EHEC - USA: (KY) O103 http://promedmail.org/post/20190329.6393053

2018
---
E. coli EHEC - USA, Canada: O157, romaine lettuce http://promedmail.org/post/20181122.6159743
E. coli EHEC - USA (28): O157, romaine lettuce http://promedmail.org/post/20181120.6156581
E. coli EHEC - USA (27): (UT) http://promedmail.org/post/20181028.6113669
E. coli EHEC - USA (26): O26, ground beef, alert, recall http://promedmail.org/post/20180920.6041171
E. coli EHEC - USA (25): (WA) raw milk http://promedmail.org/post/20180909.6016693
E. coli EHEC - USA (24): (FL) O26, grocery chain ground beef, alert, recall http://promedmail.org/post/20180831.5998786
E. coli EHEC - USA (23): (OK) possible recreational water exposure http://promedmail.org/post/20180801.5941698
E. coli EHEC - USA (22): (WA) restaurants http://promedmail.org/post/20180708.5893948
E. coli EHEC - USA (21): (TN) O157, 2 clusters, 2 sources http://promedmail.org/post/20180706.5891482
E. coli EHEC - USA (20): O157, romaine lettuce, water source http://promedmail.org/post/20180702.5882323
E. coli EHEC - USA (19): (UT, AZ) O157, 2017 http://promedmail.org/post/20180616.5858104
E. coli EHEC - USA (18): (TN) raw milk, more cases http://promedmail.org/post/20180614.5856110
E. coli EHEC - USA (17): (OR) O111, daycare center http://promedmail.org/post/20180613.5854733
E. coli EHEC - USA (16): (TN) raw milk http://promedmail.org/post/20180607.5844304
E. coli EHEC - USA (15): O157, romaine lettuce, more cases, fatal http://promedmail.org/post/20180604.5837662
E. coli EHEC - USA (14): (WA) sandwich shops http://promedmail.org/post/20180527.5820803
E. coli EHEC - USA (13): O157, romaine lettuce, increasing cases, fatality http://promedmail.org/post/20180517.5799620
E. coli EHEC - USA (12): O157, romaine lettuce, increasing cases, fatality http://promedmail.org/post/20180510.5791677
E. coli EHEC - USA (11): (OK) day care center http://promedmail.org/post/20180502.5780250
E. coli EHEC - USA (10): O157, romaine lettuce, fatality http://promedmail.org/post/20180502.5780249
E. coli EHEC - USA (09): O157, romaine lettuce http://promedmail.org/post/20180427.5771229
E. coli EHEC - USA (08): (CA) military outbreak, undercooked beef, 2017 http://promedmail.org/post/20180425.5769489
E. coli EHEC - USA (07): O157, romaine lettuce http://promedmail.org/post/20180425.5769488
E. coli EHEC - USA (06): O157, romaine lettuce http://promedmail.org/post/20180421.5761217
E. coli EHEC - USA (05): O157, romaine lettuce http://promedmail.org/post/20180418.5756056
E. coli EHEC - USA (04): O157, romaine lettuce http://promedmail.org/post/20180413.5745944
E. coli EHEC - USA (03): O157, expansion of NJ outbreak http://promedmail.org/post/20180411.5738813
E. coli EHEC - USA (02): (NJ) poss. restaurant chain link, RFI http://promedmail.org/post/20180405.5728398
E. coli EHEC - USA: O157, leafy greens http://promedmail.org/post/20180110.5550773]

Published 29-09-2017 in Focus on , last update 28-05-2019

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