Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

E. Coli Outbreak Is Traced Back To Ready-To-Bake Cookie Dough

The investigation of a multistate outbreak of Shiga toxin-producing Escherichia coli O157:H7 (STEC) that sickened 77 people and hospitalized 35 was traced back to ready-to-bake cookie dough, prompting infectious disease specialists to ask for stronger pasteurization and more consumer warnings.

like smack by Robert S. Donovan via Flickr and a Creative Commons licenseA report in Clinical Infectious Diseases outlined the outbreak and the work done by national and local health officials to track down the source.

No single source could be identified for certain for the outbreak. But one brand of dough was present in 94% of cases, and three nonoutbreak STEC strains were isolated from it, leading to a recall of 3.6 million packages of the cookie dough.

The detective work began with May 19, 2009, through PulseNet, the network of public health and food regulatory agency laboratories coordinated by the CDC. It identified a cluster of 17 identical cases of E. coli O157:H7 from 13 states. This exceeded the baseline average of six to seven isolates typically submitted each month.

National, state and local public health officials launched a matched case-control study between patients sickened by E. coli and from other enteric illnesses such as Salmonella and Campylobacter. A questionnaire focused on 20 food items, including ready-to-bake cookie dough, and product information, including lot numbers and use-by dates from packages of suspected products.

Seventy-seven cases from 30 states met the case definition between March 16, 2009 and July 8, 2009. Patients aged 5 to 19 years comprised 55% of patients; the median age was 15 (range, 2 to 65); 71% were female. Thirty-five of 64 (55%) patients with available information were hospitalized and 10 of 57 (18%) developed hemolytic-uremic syndrome; none died.

Health officials entered 36 case patients and 36 matched controls from 18 states and questioned them about 20 foods. Cookie dough was the only exposure significantly associated with illness; 33 of 35 case patients (94%) versus 4 of 36 controls (11%) reported consuming cookie dough during the 7 days before becoming sick, and one brand of cookie dough was eaten by 31 of the 33 case patients (94%).

The Food and Drug Administration inspected two facilities that made the implicated dough but they came up empty. Unopened packages of the brand of dough were clear of E. coli, and four opened packages linked to illnesses were free of the specific strain that had caused the outbreak. Despite the lack of a link to the outbreak and the lack of any safety violations, the other contaminations found in the product led to the recall.

Researchers concluded that possible means of contamination include a contaminated ingredient during processing, a lapse in plant biosecurity measures, intentional contamination, or cross contamination with another food processed in the plant.

Flour, which isn’t pasteurized or treated with a “kill step” like other ingredients, is the prime suspect in the outbreak, the authors concluded. Because flour is frequently bought in large quantities, a single purchase of contaminated flour might have been used to make multiple lots and varieties of dough over a long time. This was consistent with the use-by dates on packages obtained from patients, which suggested that product contamination occurred over several weeks.

If flour is the culprit, it got off scot-free. Still, the researchers noted, foods containing raw flour should be considered as possible vehicles of infection of future STEC outbreaks. After the recall, the product manufacturer switched to heat-treated flour and enhanced warning labels about eating raw dough.

All manufacturers should consider using heat-treated or pasteurized flour, researchers said. Manufacturers should consider making ready-to-bake prepackaged cookie dough as safe as a ready-to-eat food. They noted that several patients bought the raw dough with no intention of baking it, leading researchers to conclude that making the snacks safer may be the best possible outcome.

*This blog post was originally published at ACP Internist*

You may also like these posts

    None Found

Read comments »

Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »

Commented - Most Popular Articles