E. coli 021 and 026 infection linked to Flour

The FDA  and CDC are investigating a multiple state infection due to Shiga toxin producing E. coli. According to the CDC update of July 25, 2016, 46 people in 21 states were infected by this outbreak. Thirteen ill people have been hospitalized, with one case of hemolytic-uremic syndrome. The common denominator is the eating or handling of raw dough from General Mills flours. E. coli 021 was found in open samples of flour and in infected people. The characterized 026 isolate (whole genome sequencing) from General Mills returned retail flour is closely related genetically to a clinical isolate that was subsequently added to the outbreak cluster. The first illness reports are from December 21, 2015, with the most recent illnesses reported on June 25, with cases keep coming up. The ages of the patients range from 1 -95 years. Ten million pound of a variety of General Mills flours was recalled by the company at the end of May.  The flours were produced between Nov. 14 and Dec. 4, and include three brand names: Gold Medal, Signature Kitchens and Gold Medal Wondra. CDC in February of 2016 identified the string of illnesses that begun in December of 2015 and was associated with E. coli 021, a strain much less common that the better known E. coli 0157. It was determined that the common denominator among the sick individuals were people had been baking at home, and many of them said they used Gold Medal flour (Food Safety News). Many also mentioned eating raw homemade cookie dough. Outbreaks were also linked to restaurants that supplied raw dough for children to play with. This case brings to focus that a food that is normally not a likely source of infection can become one.  Flour is not recognized by the public as a potential source of food borne pathogens, and is not associated with infection because usually it is cooked prior to consumption and E. coli is sensitive to heat.  Better public education is needed to understand the danger of raw cookie dough and its use as a homemade “play dough”.