Beginning in Nov. 2010, raw sprouts served on Jimmy John’s, sandwiches sickened 140 people, primarily in Indiana, with salmonella.

In January, 2011, Jimmy John’s owner Jimmy John Liautaud said his restaurants would replace alfalfa sprouts, effective immediately, with allegedly easier-to-clean clover sprouts.

This was one week after a separate outbreak of salmonella sickened eight people in Washington and Oregon in Jan. 2011 who had eaten at a Jimmy John’s that used clover sprouts. That’s a week after the salmonella-in-clover sprouts was publicly reported, yet the head of a large food franchise like Jimmy John’s was absolutely clueless about microbial risks associated with sprouts.

A year later, it’s happened again.

Raw clover sprouts served on Jimmy John’s sandwiches have sickened at least 12 people with E. coli O26; at least two people were sickened in my home state of Kansas, where I tell anyone who will listen why they might want to reconsider sprouts on sandwiches at Jimmy John’s, which are often catered in for meetings.

I won’t touch them.

A table of sprout-related outbreaks is available at http://bites.ksu.edu/sprouts-associated-outbreaks.

The U.S. Centers for Disease Control reported today that preliminary results of the epidemiologic and traceback investigations indicate eating raw clover sprouts at Jimmy John’s restaurants is the likely cause of this outbreak.

The number of ill persons identified in each state is as follows: Iowa (5), Missouri (3), Kansas (2), Arkansas (1), and Wisconsin (1).

Two ill persons have been hospitalized, and no deaths have been reported.

FDA’s traceback investigation is ongoing. Traceback information on sprouts has identified a common lot of clover seeds used to grow clover sprouts served at Jimmy John’s restaurant locations where ill persons ate.

The type of bacteria responsible for this outbreak are referred to as shiga-toxin producing E. coli (STEC). STEC bacteria are grouped by serogroups (e.g., O157 or O26). The STEC serogroup found most commonly in U.S. patients is E. coli O157. Other E. coli serogroups in the STEC group, including O26, are sometimes called "non-O157 STECs." Some types of STEC frequently cause severe disease, including bloody diarrhea and hemolytic uremic syndrome (HUS). Others, such as common strains of STEC O26, typically cause milder illness. Currently, there are limited public health surveillance data on the occurrence of non-O157 STECs, including STEC O26; therefore, STEC O26 infections may go undiagnosed or unreported. Because non-O157 STEC infections are more difficult to identify than STEC O157, many clinical laboratories do not test for them. The STEC O26 PFGE pattern in this outbreak has rarely been seen before in PulseNet.
Initial Case Count

Among persons for whom information is available, illness onset dates range from December 25, 2011 to January 15, 2012. Ill persons range in age from 9 years to 49 years old, with a median age of 25 years old. One hundred percent of ill persons are female. Among the 12 ill persons, 2 (17%) were hospitalized. None have developed HUS, and no deaths have been reported.

Epidemiologic and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies have linked this outbreak to eating raw clover sprouts. Among the 11 ill persons with information available, 10 (91%) reported eating at a Jimmy John’s sandwich restaurant in the 7 days preceding illness. Ill persons reported eating at 9 different locations of Jimmy John’s restaurants in 4 states in the week before becoming ill. One location was identified where more than one ill person reported eating in the week before becoming ill. Among the 10 ill persons who reported eating at a Jimmy John’s restaurant location, 8 (80%) reported eating a sandwich containing sprouts, and 9 (90%) reported eating a sandwich containing lettuce. Currently, no other common grocery stores or restaurants are associated with illnesses.

Preliminary traceback information has identified a common lot of clover seeds used to grow clover sprouts served at Jimmy John’s restaurant locations where ill persons ate. FDA and states conducted a traceback that identified two separate sprouting facilities; both used the same lot of seed to grow clover sprouts served at these Jimmy John’s restaurant locations. Preliminary distribution information indicates that sprouts grown from this seed lot were sold at a number of restaurant and grocery store locations in Iowa, Kansas, Missouri, and Wisconsin, and were likely distributed beyond these states. On February 10, 2012, the seed supplier initiated notification of sprouting facilities that received this lot of clover seed to stop using it. Investigations are ongoing to identify other locations that may have sold clover sprouts grown from this seed lot.

Based on previous outbreaks associated with sprouts, investigation findings have demonstrated that sprout seeds might become contaminated in several ways. They could be grown with contaminated water or improperly composted manure fertilizer. They could be contaminated with feces from domestic or wild animals, or with runoff from animal production facilities, or by improperly cleaned growing or processing equipment. Seeds also might become contaminated during harvesting, distribution, or storage. Many clover seeds are produced for agricultural use, so they might not be processed, handled, and stored as human food would. Conditions suitable for sprouting the seed also permit bacteria that might be present on seeds to grow and multiply rapidly.

In 1999, FDA released guidance to help seed producers and sprout growers enhance the safety of their products. Specific measures recommended in the guidelines include a seed disinfection step and microbiologic tests of water that has been used to grow each lot of sprouts. The microbiologic tests currently recommended under this guidance would not identify the presence of STEC O26.