A Novel Vehicle for Transmission of Escherichia coli O157:H7 to Humans: Multistate Outbreak of E. coli O157:H7 Infections Associated With Consumption of Ready-to-Bake Commercial Prepackaged Cookie Dough-United States, 2009

ArticleinClinical Infectious Diseases 54(4):511-8 · December 2011with21 Reads
DOI: 10.1093/cid/cir831 · Source: PubMed
Abstract
 Escherichia coli O157:H7 is a Shiga toxin-producing E. coli (STEC) associated with numerous foodborne outbreaks in the United States and is an important cause of bacterial gastrointestinal illness. In May 2009, we investigated a multistate outbreak of E. coli O157:H7 infections.  Outbreak-associated cases were identified using serotyping and molecular subtyping procedures. Traceback investigation and product testing were performed. A matched case-control study was conducted to identify exposures associated with illness using age-, sex-, and state-matched controls.  Seventy-seven patients with illnesses during the period 16 March-8 July 2009 were identified from 30 states; 35 were hospitalized, 10 developed hemolytic-uremic syndrome, and none died. Sixty-six percent of patients were <19 years; 71% were female. In the case-control study, 33 of 35 case patients (94%) consumed ready-to-bake commercial prepackaged cookie dough, compared with 4 of 36 controls (11%) (matched odds ratio = 41.3; P < .001); no other reported exposures were significantly associated with illness. Among case patients consuming cookie dough, 94% reported brand A. Three nonoutbreak STEC strains were isolated from brand A cookie dough. The investigation led to a recall of 3.6 million packages of brand A cookie dough and a product reformulation.  This is the first reported STEC outbreak associated with consuming ready-to-bake commercial prepackaged cookie dough. Despite instructions to bake brand A cookie dough before eating, case patients consumed the product uncooked. Manufacturers should consider formulating ready-to-bake commercial prepackaged cookie dough to be as safe as a ready-to-eat product. More effective consumer education about the risks of eating unbaked cookie dough is needed.
    • "Cattle are major carriers of enterohemorrhagic E. coli (EHEC) and contamination of beef by EHEC has caused massive recalls and economic loss to the food industry [2, 3]. Also, EHEC contamination has been implicated in foods other than beef, such as cookie dough, unpasteurized apple juice [4], and spinach [5][6][7]. There were 5 outbreaks of E. coli O157:H7, the most important EHEC strain, associated with beef products in 29 states reported by the Centers for Disease Control and Prevention from 2006–2011 [8]. "
    [Show abstract] [Hide abstract] ABSTRACT: Standard methods to detect Escherichia coli contamination in food use the polymerase chain reaction (PCR) and agar culture plates. These methods require multiple incubation steps and take a long time to results. An improved rapid flow-cytometry based detection method was developed, using a fluorescence-labeled oligonucleotide probe specifically binding a16S rRNA sequence. The method positively detected 51 E. coli isolates as well as 4 Shigella species. All 27 non-E. coli strains tested gave negative results. Comparison of the new genetic assay with a total plate count (TPC) assay and agar plate counting indicated similar sensitivity, agreement between cytometry cell and colony counts. This method can detect a small number of E.coli cells in the presence of large numbers of other bacteria. This method can be used for rapid, economical, and stable detection of E. coli and Shigella contamination in the food industry and other contexts.
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    • "Relying only on consumers' education about the health risks associated with eating raw dough may not guarantee the absence of food safety incidents. Therefore, even though label statements warn consumers against the danger of such risky eating practices, manufacturers should implement the use of heat-treated flour in ready-to-cook or ready-to-bake products to make them as safe as ready-to-eat products (Neil et al. 2011). Moreover, to ensure safety, the prevention of microbial establishment and growth within the mill and throughout the production chain, sanitation of production equipment, stringent temperature control during baking, testing of incoming wheat and the resulting flour, and hygienic packaging and shipping procedures should be part of the control procedures used to reduce microbial load and mycotoxins in flour and flour-based products. "
    [Show abstract] [Hide abstract] ABSTRACT: Throughout history, wheat-based foods have been considered among the safest of all foods produced for human consumption. In part, this claim reflects both the low risk profile of low-moisture foods and the thermal processes used to produce the finished product. Nevertheless, raw flour contains a number of potential hazards, which, if not properly managed, may have the potential to result in serious public health consequences. These hazards are mostly microbiological in origin and arise mainly during production and distribution through the wheat supply chain. The physical processes carried out during milling have minimal impact on the level of contamination present on grain; therefore, the initial microbiological quality of wheat grain has a strong influence on the ultimate quality and safety of milling end products. Although most flour-based foods are processed and consumed in forms that are less likely to be contaminated with pathogens, refrigerated dough products have the potential to be a safety hazard to consumer health because they could be consumed raw or undercooked. The risk for exposure to pathogenic microorganisms present in raw flour by eating uncooked baking mixture has been demonstrated by several outbreaks. Such food safety incidents have led to heightened manufacturer and consumer awareness about safety related to flour-containing foods.
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    • "Regrowth of surviving bacterial pathogens is also possible following hydration with water or milk as regrowth of Salmonella surviving in low numbers on dry cereal flakes after addition of milk have been reported (Ui et al. 2009). Salmonellosis outbreaks have been linked to the consumption of cereal-based products (Zhang et al. 2007; Neil et al. 2012; McCallum et al. 2013 ). Such foods include uncooked breakfast cereals (e.g. "
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