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E. coli outbreak linked to raw flour consumption
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A 2016 outbreak of Shiga toxin-producing Escherichia coli has been attributed to raw flour from one American-based flour producer, according to findings published in The New England Journal of Medicine.
“Pediatricians should let their patients and patients’ parents know that flour can be contaminated with germs like E. coli,” Samuel Crowe, PhD, MPH, from the CDC Division of Foodborne, Waterborne and Environmental Diseases, told Infectious Diseases in Children. “Do not eat or play with raw dough or batters or allow children to do so. Even tasting a small amount could make you sick.”
To examine the role of Shiga toxin-producing E. coli in an outbreak attributed to domestically produced flour, specifically serogroup O121 and O26 infections, the researchers first defined positive cases associated with the outbreak. Crowe and colleagues described the condition as infection with one of the two strains with onset between Dec. 21, 2015, and Sept. 5, 2016.
Cases were later assessed compared with cases of non-Shiga toxin–producing E. coli enteric illness. These cases were matched for age group, sex and residential location. Testing for Shiga toxin-producing E. coli was conducted on products potentially carrying the bacteria to determine a point of contamination, and isolates from clinical and food samples were examined using whole-genome sequencing.
Of the 56 cases observed in 24 states, 22 matched sets assisted the researchers in determining that infection was significantly linked to one brand of flour (OR = 21.04; 95% CI, 4.69-94.37). Additionally, infection was specifically associated with tasting unbaked dough or batter (OR = 36.02; 95% CI, 4.63-280.17). The strains were defined through lab testing, and whole-genome sequencing revealed that isolates from clinical and food samples were genetically comparable. The flour-production facility was then identified by Crowe and colleagues.
“Playing with raw dough, such as homemade play dough, can make you or your children sick if it gets into the mouth,” Crowe said. “Even doughs and batters made without eggs can be contaminated.” – by Katherine Bortz
Disclosures: The researchers report that the findings and conclusion of the report do not necessarily represent the official position of the CDC or the FDA. Please see the full study for a list of relevant financial disclosures.
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