Tag Archives: O121

E. coli O121 outbreak in U.S. source unknown

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The following is from a list of outbreak investigations being managed
by FDA’s CORE Response Teams. The investigations are in a variety of
stages, meaning that some outbreaks have limited information, and
others may be near completion. 

A public health advisory will be issued for outbreak investigations
that have resulted in specific, actionable steps for consumers to take
to protect themselves. Please direct your attention to those pages for
the most up to date information on the investigation and for consumer
protection information. 

Outbreak investigations that do not result in specific, actionable
steps for consumers may or may not conclusively identify a source or
reveal any contributing factors. If a source and/or contributing
factors are identified that could inform future prevention, the FDA
commits to providing a summary of those findings. 

Date Posted – 14 Jul 2021 
Reference No – 1010 
Pathogen – _E. coli_ O121 
Product(s) Linked to Illnesses – Not Yet Identified 
Total Case Count – 15 
Investigation Status – Active 
Outbreak Status – Ongoing 

E. coli O26 and (O121) loves flour

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I wrote this in May, and it’s still relevant:

I used to be a lick-the-batter-off-the-spoon kind of guy. I stopped doing that a few years ago. I don’t eat raw cookie dough, or let my kids eat it. I’m probably not the most fun dad, but outbreaks recalls like what is going on right now is why.

General Mills announced today a voluntary national recall of five-pound bags of its Gold Medal Unbleached All Purpose Flour with a better if used by date of September 6, 2020. The recall is being issued for the potential presence of E. coli O26 which was discovered during sampling of the five-pound bag product. This recall is being issued out of an abundance of care as General Mills has not received any direct consumer reports of confirmed illnesses related to this product.

This recall only affects this one date code of Gold Medal Unbleached All Purpose Flour five-pound bags. All other types of Gold Medal Flour are not affected by this recall.

Guidance from the Food and Drug Administration (FDA) and the Centers for Disease Control (CDC) continues to warn that consumers should refrain from consuming any raw products made with flour. E. coli O26 is killed by heat through baking, frying, sautéing or boiling products made with flour. All surfaces, hands and utensils should be properly cleaned after contact with flour or dough.

I think they mean cleaned and sanitized.

There’s something about O26 and O121 and flour that we’re all gonna have to figure out.

Here’s the outbreak from May 2019. Here’s a Canadian outbreak from 2017. Oh, here’s another outbreak from 2016.

Raw isn’t rad, it’s risky: Radagast Pet Food, Inc. voluntarily recalls three lots of rad cat raw diet free-range chicken recipe and one lot of pasture-raised venison recipe because of possible health risk

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Radagast Pet Food, Inc. of Portland, OR is recalling three lots of Rad Cat Raw Diet Free-Range Chicken Recipe because testing results indicate they have the potential to be contaminated with Listeria monocytogenes.

The Company is also recalling one lot of Rad Cat Raw Diet Pasture-Raised Venison Recipe because testing results indicate it has the potential to be contaminated with Shiga Toxin producing E. coli O121.  This recall is being conducted out of an abundance of caution.  Due to Radagast Pet Food’s commitment to food safety and quality, The Company is conducting this voluntary recall.

Uh-huh.

E. coli: Flour fights not such a good idea

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In June, 2009, an outbreak of shiga-toxin producing E. coli (primarily O157:H7) in Nestle Toll House cookie dough sickened at least 77 people in 30 American states. Thirty-five people were hospitalized – from cookie dough.

The researchers could not conclusively implicate flour as the E. coli source, but it remains the prime suspect. They pointed out that a single purchase of contaminated flour might have been used to manufacture multiple lots and varieties of dough over a period of time as suggested by the use-by dates on the contaminated product.

The study authors concluded that “foods containing raw flour should be considered as possible vehicles of infection of future outbreaks of STEC.”

So it wasn’t much of a surprise when 56 people fell sick from with the outbreak strain of E. coli O121 from Dec. 2015 to Sept. 2016 were linked to raw General Mills flour.

The peer-reviewed summary of the outbreak investigation was published last week in The New England Journal of Medicine.

Abstract below:

In 2016, a multijurisdictional team investigated an outbreak of Shiga toxin–producing Escherichia coli (STEC) serogroup O121 and O26 infections linked to contaminated flour from a large domestic producer.

Methods

A case was defined as infection with an outbreak strain in which illness onset was between December 21, 2015, and September 5, 2016. To identify exposures associated with the outbreak, outbreak cases were compared with non-STEC enteric illness cases, matched according to age group, sex, and state of residence. Products suspected to be related to the outbreak were collected for STEC testing, and a common point of contamination was sought. Whole-genome sequencing was performed on isolates from clinical and food samples.

Results

A total of 56 cases were identified in 24 states. Univariable exact conditional logistic-regression models of 22 matched sets showed that infection was significantly associated with the use of one brand of flour (odds ratio, 21.04; 95% confidence interval [CI], 4.69 to 94.37) and with tasting unbaked homemade dough or batter (odds ratio, 36.02; 95% CI, 4.63 to 280.17). Laboratory testing isolated the outbreak strains from flour samples, and whole-genome sequencing revealed that the isolates from clinical and food samples were closely related to one another genetically. Trace-back investigation identified a common flour-production facility.

Conclusions

This investigation implicated raw flour as the source of an outbreak of STEC infections. Although it is a low-moisture food, raw flour can be a vehicle for foodborne pathogens.

Shiga toxin–producing E. coli infections associated with flour

N Engl J Med 2017; 377:2036-2043, November 23, 2017, DOI: 10.1056/NEJMoa1615910

Samuel J. Crowe, Ph.D., M.P.H., Lyndsay Bottichio, M.P.H., Lauren N. Shade, B.S., Brooke M. Whitney, Ph.D., Nereida Corral, M.P.H., Beth Melius, M.N., M.P.H., Katherine D. Arends, M.P.H., Danielle Donovan, M.S., Jolianne Stone, M.P.H., Krisandra Allen, M.P.H., Jessica Rosner, M.P.H., Jennifer Beal, M.P.H., Laura Whitlock, M.P.H., Anna Blackstock, Ph.D., June Wetherington, M.S., Lisa A. Newberry, Ph.D., Morgan N. Schroeder, M.P.H., Darlene Wagner, Ph.D., Eija Trees, D.V.M., Ph.D., Stelios Viazis, Ph.D., Matthew E. Wise, M.P.H., Ph.D., and Karen P. Neil, M.D., M.S.P.H.

http://www.nejm.org/doi/full/10.1056/NEJMoa1615910

29 sick: An outbreak of Shiga toxin-producing Escherichia coli O121 infections associated with flour- Canada, 2016-2017

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On December 29, 2016, PulseNet Canada identified a cluster of six Escherichia coli non-O157 isolates with a matching pulsed-field gel electrophoresis (PFGE) pattern combination that was new to the PulseNet Canada database. The patients resided in three geographically distinct provinces. In January 2017, the Public Health Agency of Canada (PHAC) initiated an investigation with local, provincial, and federal partners to investigate the source of the outbreak.

A case was defined as isolation of E. coli non-O157 with the outbreak PFGE pattern or closely related by whole genome sequencing (WGS) in a Canadian resident or visitor with onset of symptoms of gastroenteritis on or after November 1, 2016. Patients’ illness onset dates ranged from November 2016 to April 2017 (Figure). As of May 23, 2017, a total of 29 cases were identified in six provinces (Alberta, British Columbia, Newfoundland and Labrador, Ontario, Quebec, and Saskatchewan). One additional case was identified in a U.S. resident who traveled to Canada during the exposure period. Patients’ ages ranged from 2–79 years (median = 23.5 years) and 50% were female. Eight patients were hospitalized, and one developed hemolytic uremic syndrome. Clinical isolates were typed as E. coli O121:H19 (one case was typed as E. coli O121:H undetermined) with Shiga toxin 2–producing genes by in silico toxin testing and had closely related PFGE patterns and WGS.

Initial investigation into the source of the outbreak did not identify any clear hypotheses; common exposures were ground beef, sausage style deli-meats, pizza, and pork, but the data did not converge on any specific products. Patients were reinterviewed by PHAC using an open-ended approach. Knowledge of a recent E. coli O121 flour-associated outbreak prompted interviewers to ask about baking and exposure to raw flour or dough (1). Patients were also asked if any food items of interest, including flour, were available for testing.

In March 2017, E. coli O121 with the outbreak PFGE pattern was isolated from an open flour sample from a patient’s home and a closed sample collected at a retail store, both of the same brand and production date. The clinical and flour isolates grouped together, with only 0–6 whole genome multilocus sequence typing allele differences. As a result of these findings, a product recall was issued. Based on possible connections to the recalled lot of flour, market sampling of flour within certain periods was initiated. The investigation led to additional recalls of flour and many secondary products (2).

As of May 23, 2017, 22 patients had been asked about flour exposure in the 7 days before illness onset; 16 (73%) reported that the implicated brand of flour was used or probably used in the home during the exposure period. Comparison data on the expected proportion with exposure to this brand of flour were not available. Eleven of these sixteen patients reported they ate or probably ate raw dough during their exposure period.

This is the first national outbreak of non-O157 Shiga toxin–producing E. coli infections identified in Canada and the first Canadian outbreak linked to flour. An open-ended interview approach and flour sampling were used to implicate flour as the source. Because of the recent emergence of E. coli outbreaks linked to flour, public health professionals should consider flour as a possible source in E. coli outbreaks and communicate the risk associated with exposure to flour, raw batter, and dough in public health messaging.

Going public: about E. coli O121 in Rogers Flour: Why a 17-day difference between feds and province?

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In April 2017, health-types in Canada said E.coli O121 had sickened 26 people that was linked to Robin Hood All Purpose Flour, Original.

On May 26, 2017, the Canadian Food Inspection Agency said Ardent Mills is recalling various brands of flour and flour products due to possible E. coli O121 contamination.

On May 21, 2017 the B.C. Centre for Disease Control (BCCDC) alerted British Columbians after six people in B.C. were infected with the same strain of E. coli O121 between February and April, 2017.

Now, CFIA has gotten in on the act – 17 days after BCCDC –announcing on June 7, 2017 that Rogers Foods Ltd. is recalling Rogers brand All Purpose flour from the marketplace due to possible E. coli O121 contamination.

The following product has been sold from Costco warehouse locations in British Columbia.

Brand Name: Rogers, Common Name: All Purpose Flour, Size: 10 kg, Code(s) on Product: MFD 17 JAN 19 C, UPC: 0 60179 10231 8

This recall was triggered by findings by the CFIA during its investigation into a foodborne illness outbreak. The CFIA is conducting a food safety investigation, which may lead to the recall of other products.

There have been reported illnesses that may be associated with the consumption of this product. Further lab testing is underway to confirm the link.

Handle flour like raw meat: More Canadian flour and people sickened with E. coli O121

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In April 2017, health-types in Canada said E.coli O121 had sickened 26 people that was linked to Robin Hood All Purpose Flour, Original.

On May 26, 2017, the Canadian Food Inspection Agency said Ardent Mills is recalling various brands of flour and flour products due to possible E. coli O121 contamination. Consumers should not consume the recalled products described below.

This recall was triggered by findings by the CFIA during its investigation into a foodborne illness outbreak. The CFIA is conducting a food safety investigation, which may lead to the recall of other products. If other high-risk products are recalled, the CFIA will notify the public through updated Food Recall Warnings.

The CFIA is verifying that industry is removing recalled products from the marketplace.

There have been reported illnesses associated with flour; however, at this time, there have been no confirmed illnesses associated with the products identified in this Food Recall Warning.

But there have been with Roger flour in B.C.

On May 21, 2017 the B.C. Centre for Disease Control (BCCDC) alerted British Columbians after six people in BC were infected with the same strain of E. coli O121 between February and April, 2017.

A sample of flour from one of the ill people was tested by the BCCDC Public Health Laboratory and found positive for the same strain of E. coli O121 as seen in all the illnesses.

While it is unknown at this time whether the other ill people consumed the same flour, the BCCDC recommends consumers:

Dispose of Rogers all-purpose flour in a 10kg bag with the lot number MFD 17 Jan 19 C.  This flour was available to Costco customers in B.C. beginning in January 2017.

Although this outbreak is occurring at the same time as a national outbreak involving a different strain of E. coli O121 that has been linked to various flours and flour products, it is unclear whether there is a link between the two outbreaks.

The national outbreak has affected 30 people from six provinces: British Columbia (13), Saskatchewan (4), Alberta (5), Ontario (1), Quebec (1) and Newfoundland and Labrador (5). One of the 30 cases was a visitor to Canada. The illness onset dates range from November 2016 to April 2017.

These are the questions that remain about the interactions between Robin Hood, Ardent, Rogers and their flour: Do you folks all get your flour from the same place and slap your name on it like Trump slaps his name on towers? If so, where is the common processor, and why the fuck is there E. coli O121 in it? What are companies prepared to do, like offering pasteurized flour, especially so the medically vulnerable can continue to bake without fretting about flour dust?And when will the Public Health Agency of Canada move beyond boilerplate fairy tales like wash hands, and offer something meaningful to Canadians who bake?

Overpaid bureacrats, worried about their retirement savings rather than a nasty bug like E. coli O121.

Inhale the dust, assholes.

The outpouring of compassion for the victims is underwhelming.

‘Handle raw flour like raw meat’ 26 sick with E. coli O121 linked to Robin Hood All Purpose Flour

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E.coli O121 has sickened 26 people that has now been linked to Robin Hood All Purpose Flour, Original, in Canada.

Health types advise Canadians not to use or eat any Robin Hood All Purpose Flour, Original sold in 10 kilogram bags with a code containing BB/MA 2018 AL 17 and 6 291 548 as these products may be contaminated with E. coli. For additional recall details, please consult CFIA’s recall notice. Restaurants and retailers are also advised not to sell or serve the recalled product, or any items that may have been prepared or produced using the recalled product.

This outbreak is a reminder that it is not safe to taste or eat raw dough or batter, regardless of the type of flour used as raw flour can be contaminated with harmful bacteria such as E. coli.

But what do the health types really know?

Free from the shackles of government PRery, someone from Health Canada told ProMed a few days ago, a sample of Robin Hood flour was collected from one case’s home. The sample tested positive for E. coli O121 and had matching PFGE to the clinical  cases. Subsequently, a sample of Robin Hood flour collected from a retail location also tested positive for E. coli O121. Several cases reported contact with Robin Hood flour.
Isolates from the 2016 U.S. outbreak have been compared to the current outbreak in Canada by whole genome sequencing (via PulseNet  International); the Canadian outbreak strain is not similar to the U.S. outbreak. Comparisons will continue to be made on an ongoing basis throughout the outbreak investigation in Canada. 

Profs. Keith Warriner and Jeff Farber of the University of Guelph told CBC uncooked flour, such as that found in raw cookie dough, can host E. coli bacteria, and we may need to handle flour in the same way that we handle uncooked meat.

 

24 sick: E. coli O121 outbreak shows failures of food safety safety net

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Chapman was always the kinder, gentler version of me, and he goes too easy on Canadian boffins who announced today there are now 24 people sick with E. coli O121 in British Columbia (12), Saskatchewan (4), Alberta (3) and Newfoundland and Labrador (5).

That the outbreak missed Manitoba, Ontario, Quebec, Nova Scotia, New Brunswick and PEI should give epidemiologists solid clues, ones that the Public Health Agency of Canada is not ready to divulge.

The initial public announcement was Jan. 12, 2017.

A couple of months later, the case count has doubled, and the only advice PHAC has is wash your fucking hands.

The last two major North American outbreaks of E. coli O121 were in flour, last year, and in sprouts, a few years earlier (please, let it be sprouts, please).

Five months into the outbreak, I’m sure the dedicated Canadian public servants have had time to match the genetic fingerprint of the outbreak strain with the U.S.-based outbreaks, but don’t expect PHAC to answer such simple questions.

They could have done whole genome sequencing in the time it took to have miniions craft a press release that said … nothing.

“The Government of Canada is committed to food safety. The Public Health Agency of Canada leads multi-jurisdictional human health investigations of outbreaks and is in regular contact with its federal and provincial partners to monitor and take collaborative steps to address outbreaks.”

Eat me completely.

12 sick: E. coli O121 outbreak in Canada

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This is my dog chewing on kangaroo ribs.

ted-kangeroo-rib-jan-17Go with the protein that is available.

It’s about the same amount of effort the boffins at Public Health Agency of Canada put into announcing an outbreak of E. coli O121 that has sickened at least 12 people from B.C. to Newfoundland.

kangeroo-rib-ted-jan-17There have been 12 cases of E. coli O121 with a matching genetic fingerprint reported in three provinces: British Columbia (4), Saskatchewan (4), and Newfoundland and Labrador (4). The illness onset dates range from November to December 2016. Four individuals have been hospitalized. These individuals have recovered or are recovering. The investigation into the source of the outbreak is ongoing.

I’ll continue to bond with my dog.