E. coli: Flour fights not such a good idea

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

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?

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

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

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

 

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

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.

Clear Spring Foods recalls sun-dried tomato & roasted garlic trout due to E. coli O121

Clear Spring Foods has recalled Sun-Dried Tomato & Roasted Garlic Trout because an ingredient (wheat flour) in the breading has the potential to be contaminated with E. coli O121.

clear-spring-foods-recalls-sun-dried-tomato-roasted-garlic-troutTo date, there have been no reports of illness associated with consumption of this product.

Schnucks customers who purchased any Sun-Dried Tomato & Roasted Garlic Trout filets between May 27, 2016 and Oct. 6, 2016 from the store’s seafood department should return any unused portions to their nearest store for a full refund.

More STEC found: Multistate outbreak of Shiga toxin-producing Escherichia coli infections linked to flour

On July 25, 2016, General Mills expanded its recall to include more production dates. A list of all the recalled flours and how to identify them is available on the Advice to Consumers page.

sorenne.doug.usa.today.jun.11Four more ill people have been reported from two states. The most recent illness started on June 25, 2016.

An infection with another serotype, Shiga toxin-producing Escherichia coli (STEC O26), has been added to this outbreak investigation. STEC O26 was isolated from a sample of General Mills flour (pic, left, from 2011; Sorenne did not eat the flour and awareness of cross-contamination was robust).

One person has developed hemolytic uremic syndrome, a type of kidney failure.

The U.S. Centers for Disease Control, multiple states, and the U.S. Food and Drug Administration(FDA) are investigating a multistate outbreak of Shiga toxin-producing Escherichia coli (STEC) infections.

46 people infected with the outbreak strains of STEC O121 or STEC O26 have been reported from 21 states.

Thirteen ill people have been hospitalized. One person developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

Epidemiologic, laboratory, and traceback evidence indicate that flour produced at the General Mills facility in Kansas City, Missouri is a likely source of this outbreak.

Several recalls and recall expansions have been announced as a result of this investigation.

In July 2016, laboratory testing by General Mills and FDA isolated STEC O26 from a sample of General Mills flour. Whole genome sequencing (WGS) showed that the STEC O26 isolated from the flour sample was closely related genetically to isolates from an ill person. The flour tested was not included in the earlier General Mills recalls.

On July 25, 2016, General Mills further expanded its flour recall to include additional lots.

CDC recommends that consumers, restaurants, and retailers do not use, serve, or sell the recalled flours.

Do not eat raw dough or batter, whether made from recalled flour or any other flour. Flour or other ingredients used to make raw dough or batter can be contaminated with STEC and other pathogens.

Consumers should bake all items made with raw dough or batter before eating them. Do not taste raw dough or batter.

Restaurants and retailers should not serve raw dough to customers or allow children and other guests to play with raw dough.

This investigation is ongoing, and we will update the public when more information becomes available.

 

 

Do food producers have any idea what goes in their products? Traceability, another fairytale

For all the food companies that brag about traceability, why does it take so long to figure out that your suppliers are in a recall and maybe you should be too?

HT_betty_crocker_recall_as_160712_12x5_1600The lingering, lasting recalls involving products that contain E. coli O121- tainted wheat from General Mills, Listeria-tainted frozen produce from CRF Frozen Foods in Pasco, Wash, and Listeria-tainted sunflower kernels from SunOpta, pile up daily.

Yesterday, the girlfriend of my much younger youth, Betty Crocker, recalled cake mix in Canada because it possibly contained E. coli flour from General Mills.

But how could I not lick her spoon, or sample her beater, as a child or an adult?

Randy Shore of the Vancouver Sun asked me those questions the other night during a conversation about risk, cookie dough and preaching.

I said I don’t preach, I provide information, people can do what they like, but it really sucks if your kid gets a Shiga-toxin producing E. coli like O121 because it’s a serious illness, often with lifelong consequences.

And it’s a scam that for all the prowess and profits of these companies, from Betty, to Golden Dipt brand Jalapeño Breader, to Planters Sunflower Kernels, they can’t figure out who is supplying their shit ingredients.

Markets/local/sustainable/whatever adjective are no better.

It’s food fraud.

Rick Holley, a professor emeritus of food safety at the University of Manitoba in Winnipeg (that’s in Canada) told CBC News that eating foods that aren’t well cooked is sorta like the risks people take when they jaywalk and don’t cross the street at a traffic light or stop sign.

“We know only too well that there are folks who like to eat food that’s not well cooked or isn’t cooked and against the best advice, because the food we eat is not sterile — there are risks associated with it. Having said that, I enjoy my salad in the summer time. Uncooked.

“Where we need also to do some work is on maintaining and improving the levels of sanitation in all parts of the food system, food processing plants. We know from investigations that have been done both in Canada and the United States that when there are lapses in sanitation, problems occur in food processing plants. We can see it now happening in mills.”

UCM511108According to Shore at the Vancouver Sun, the U.S. Food and Drug Administration has warned people not to eat raw cookie dough, effectively killing the fun of making cookies.

1.) How serious is the cookie dough threat?

In 2009, at least 71 people in 31 states were sickened by Nestle Tollhouse cookie dough contaminated with E. coli O157: H7. While nobody died, 11 people suffered serious complications. Nestle now uses heat-treated flour.

2.) What about homemade cookie dough?

The flour you use at home to make cookies has likely not been treated to kill salmonella and E.coli, so it should not be eaten raw. Irradiation is used to control insects in flour, not bacteria, so don’t depend on it for food safety.

3.) What about cookie dough ice cream?

Cookie dough ice cream is a guilty pleasure, but you can eat it without risk. Ben & Jerry’s cookie dough is made with pasteurized eggs and heat-treated flour. Most manufacturers, including Dreyer’s and Haagen-Dazs, use similar methods. 

4.) What will happen to me?

According to the Canadian Food Inspection Agency, rainbow bits contaminated with E. coli O121 may not look or smell spoiled but can still make you sick. Symptoms can include nausea, vomiting, mild to severe abdominal cramps and watery to bloody diarrhea. In severe cases of illness, people may die.

5.) Should I panic?

While the CFIA is so far silent on the issue, the FDA warns that you should not eat or allow your children to play with raw flour products, including homemade PlayDoh. If you make cake, cookies or pancakes, don’t lick the beaters.

Julia Calderone of Consumer Reports lists her own five ways you could get an E. coli infection from flour.

They’re not that surprising to microbiology-types.

Be the bug. Follow the bug (especially animal poop).

Since December 2015, 42 people across 21 states have developed an E. coli infection after eating uncooked flour. The outbreak is caused by a potentially dangerous strain of E. coli called O121.

Like E. coli O157, which has been responsible for food poisoning outbreaks from undercooked ground beef, O121 is a toxin-producing bacteria that may cause abdominal cramps, bloody diarrhea, and possibly life-threatening kidney damage. Fortunately, so far no one who has become ill from flour or flour-based products has developed kidney damage or died, but 11 people have been hospitalized. 

Products produced at a General Mills plant in Kansas City, Missouri, in November 2015 are the culprits behind these cases of E. coli infection. The company voluntarily recalled 10 million pounds of possibly contaminated flour, including their Gold Medal, Signature Kitchens, and Gold Medal Wondra flour brands. Several cake and pancake mixes that may have used General Mills flour have also been recalled.

The U.S. Food and Drug Administration and the Centers for Disease Control and Prevention are currently investigating these cases of E. coli infection, and are advising consumers not to eat flour and flour-containing foods that have not been cooked or baked. Consuming raw flour is a potential hazard, says the FDA, since it isn’t meant to be a ready-to-eat product.

Some of the ways you could ingest uncooked flour may not be so obvious. Here are five sources of potentially tainted flour that you should watch out for if you want to prevent a possible associated E. coli infection. 

  1. Raw doughs and batters.Of course, cookie doughs, pizza doughs, and cake and pancake batters are risky, so you should be careful not to accidentally or intentionally eat them before they’re cooked.

But raw dough can also make you sick even if you don’t intend to eat it. For example, kneading bread dough often leaves you with floury hands. Some restaurants give children balls of uncooked dough to play with, and they could stick either the tainted ball or their contaminated fingers into their mouth. Even storing uncooked dough next to other foods could cause a problem, so be sure to handle and stash it carefully.

  1. Arts and crafts materials.Websites devoted to pantry-based projects offer recipes for modeling clays, play doughs, spray glue, paper mache, and ornaments with flour as the main ingredient. For now, avoid making these mixtures with kids, and be sure to wash your hands and work surfaces thoroughly afterward if you decide to work with them.
  2. No-cook dishes.Some flour-containing recipes for truffles, icing, and even cookies don’t involve heating or baking. So if the recipe doesn’t call for the dish to be thoroughly cooked, skip it.
  3. Contaminated cooking and eating surfaces.Flour is light and powdery, and can easily fly everywhere in your kitchen if you aren’t careful. Even miniscule amounts of tainted flour can make you sick, so be sure that foods that will be eaten raw don’t come into contact with flour-dusted counters, cutting boards, plates, and the like. Wash these—as well as your hands—in hot soapy water after using them. Be careful if you’re dredging meat or chickenin flour before cooking, so the flour doesn’t go all over the place.
  4. Containers you use to store flour.When you purchase a new bag of flour, you might dump the new flourinto a flour bin or canister that has some old, recalled flour already in it, unwittingly contaminating your new stash. If you’re not sure if the flour you currently have has been recalled, throw it out. Make sure that you thoroughly clean your storage container before using it again.