CDC Report - 2016 Outbreak of Pathogenic E. coli O157:H7 Associated with Dough Mix

In this week's MMWR, CDC reviews the 2016 outbreak or E. coli O157:H7 associated with a dough mix.  There were 13 people in 9 different states who became ill.  Eight of those people were hospitalized, and two developed HUS (hemolytic uremic syndrome - a condition that can lead to loss of kidney function). 8 of these individuals ate a desert pizza made iwht the mix while one other ate bread sticks made with that dough.

Government inspectors sampled 88 samples of the dough mix at the restaurants and 6 samples of the dry dough mix at the manufacturer and did not find this strain of E. coli, (although strains of  identified non-O157 STEC were found.)

Flour is a raw agricultural commodity, and while level of pathogens such as E. coli and Salmonella are normally very low, there are times when sufficient pathogens can be present to cause illness.  While it seems not one was affected from eating the pizza with this dough, the investigators felt that the thicker desert pizza may not have been cooked as thoroughly.  And when people spread flour on surfaces, such as when working dough, this flour may then get upon other foods.

It is important for not only consumers, but also foodservice operations to treat flour as potentially contaminated.  This means cooking dough thoroughly, cleaning up spilled flour as well as flour spread on surfaces so that it does not come in contact with ready-to-eat foods, and of course, not eating raw dough.

CDC - MMWR
https://www.cdc.gov/mmwr/volumes/66/wr/mm6603a6.htm?s_cid=mm6603a6_e
Notes from the Field: Multistate Outbreak of Escherichia coli O157:H7 Infections Linked to Dough Mix — United States, 2016

Two Flavored Cake Mixes Recalled by GM Due to Potential E. coli O121 Contamination

Two flavors of cake mix under the Betty Crocker brand have been added to the flour recall by General Mills.   Betty Crocker Delights Super Moist Party Rainbow Chip Cake Mix and Betty Crocker Delights Super Moist Carrot Cake Mix have been recalled due to the potential for the flour to contain E. coli O121, a STEC strain.

The baking process will eliminate the organism, but of course there are those who are prone to eat raw cookie dough or offer it to children (this is worse because children would be more susceptible to infection.  FDA issued an Advisory against eating raw cookie dough.


General Mills News Release
http://www.generalmills.com/en/News/NewsReleases/Library/2016/July/betty-crocker-mix-recall/07382396-c01d-4b3a-b86b-ce8b7e556641
Jul 11, 2016
Two flavors of Betty Crocker cake mix recalled

Consumers reminded not to consume uncooked cake batter or raw flour products

MINNEAPOLIS, Minnesota - Out of an abundance of caution, two flavors of Betty Crocker cake mix sold in the U.S. and one flavor sold in Canada have been added to General Mills’ previously announced flour recall from July 1, 2016. No illnesses reported to date have been connected to cake mix. No other General Mills or Betty Crocker mixes are included in this recall.

Flour Recalled As Investigators Try to Link to E. coli Outbreak

General Mills is recalling 10 million pounds of raw flour as federal and state agencies are investing 38 occurrences of E.coli infections across 20 states between December 21, 2015, and May 3, 2016.  The specific type of E. coli is E. coli O121, a non-O157 STEC, that can cause bloody diarrhea, dehydration, and in more susceptible people, it can cause kidney damage.   In 2013, this organism was responsible for an outbreak linked to frozen chicken quesadilla, a product that required cooking.

The outbreak investigation showed that roughly half of the 38 people infected used flour, some of them stated using Gold Medal brand.  So far, the flour has not tested positive for the organism.

So how does E. coli get into flour?  Probably from the raw material.  One study looking at a large number of samples, found that 12.8% of flour samples found E. coli (not strain specific) in raw flour. 

Of course, if the products made from the flour are properly cooked, that cooking will destroy the organism. However, people do eat raw dough products, including cookie dough. Nestle raw cookie dough was involved in an E. coli outbreak in 2009 where people were probably eating raw cookie dough.   In a report of that incident, investigators were not able to find the actual source of the E. coli. And like that case, it is not likely that they will be able to find this strain of E. coli.From that report:

Despite extensive traceback and environmental investigations and testing by regulatory agencies and company A, the source and route of product contamination remains undetermined. Possible means of contamination include introduction of a contaminated ingredient during processing, a lapse in plant biosecurity measures, intentional contamination, or cross contamination with another food processed in the plant. Although the manufacturing plant is located in a rural area in the mid-Atlantic United States, investigators did not observe any obvious breach in biosecurity that would facilitate introduction of E. coli O157 into the facility from the outside. No significant food handling or safety violations were identified at the plant that could result in cross-contamination within the plant.

In the end, don't eat raw dough, including cookie dough.  Clean up as you go, washing up any spilt flour.




 FDA News Release
http://www.fda.gov/Safety/Recalls/ucm504235.htm
Gold Medal, Gold Medal Wondra, and Signature Kitchens Flour Recalled Due to Possible E. coli O121 Contamination