Date Sent: 06/02/2016 10:47 AM EDT
Sender: Michigan Health Alert Network
Subject: Multistate outbreak of Shiga toxin-producing Escherichia coli O121 infections linked to flour
The Michigan Department of Health and Human Services (MDHHS) is collaborating with the Centers for Disease Control and Prevention (CDC), the Michigan Department of Agriculture and Rural Development (MDARD), and other state and local public health agencies to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli O121 (STEC O121) infections. The investigation has included a case-control study and an informational traceback of flour exposure reported by ill people. In response to the preliminary findings of the public health investigation, on May 31, 2016, General Mills announced a voluntary recall of a number of flour products.
Nationally 38 people in 20 states have been infected with the outbreak strain of STEC O121; these illnesses occurred between late December 2015 and early May 2016. Ill people range in age from 1 year to 95 years, with a median age of 18. Seventy-eight percent of the ill people are female. Ten people have been hospitalized; no one has developed hemolytic uremic syndrome and no deaths have been reported. Whole genome sequencing showed that the STEC bacteria from ill people are indistinguishable.
Four of the STEC O121 cases are residents of Michigan from the following counties: Ingham, Kent, Oakland, and Ottawa. Illness onset dates for MI cases range from January to early May. All are adult females. Two of the four cases were hospitalized.
Preliminary results of the national epidemiologic investigation indicate an association between the STEC O121 infection and someone in the household baking with Gold Medal flour or exposed to raw dough in restaurants. Traceback investigations show that the flour used by ill people or at the restaurant locations was produced at the General Mills facility in Kansas City, Missouri. On May 31, 2016, General Mills recalled several sizes and varieties of Gold Medal Flour, Gold Medal Wondra Flour, and Signature Kitchens Flour due to possible E coli contamination.
A list of the recalled flours can be found here: http://www.cdc.gov/ecoli/2016/o121-06-16/advice-consumers.html
The CDC is recommending the following:
Consumers, restaurants, and retailers should not use, serve, or sell the recalled flour products
Do not eat or taste raw dough or batter, whether made from recalled flour or any other flour. Flour or other ingredients used to make raw dough or batter might be contaminated
Restaurants and retailers should not serve raw dough to customers or allow children or other guests to play with raw dough
This investigation is still ongoing. Due to the long shelf-life of flour, local public health investigators should consider asking about flour use in routine follow-up of STEC cases. A joint press release will be forthcoming from MDHHS and MDARD. The CDC weblink on the investigation is given: http://www.cdc.gov/ecoli/2016/o121-06-16/index.html
MDHHS Communicable Disease Division: 517-335-8165