The U.S. Centers for Disease Control and Prevention (CDC), public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of E. coli O26 infections linked to flour. Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. As of May 24, 17 people infected with the outbreak strain of E. coli O26 have been reported from eight states.

Illnesses started on dates ranging from Dec. 11, 2018 to April 18, 2019. Ill people range in age from 7 to 86, with a median age of 23, and 65% are female. Of 17 people with information available, three have been hospitalized. No deaths have been reported.

Epidemiologic and laboratory evidence indicates that flour is a likely source of this outbreak. In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Of seven people who were interviewed, four (57%) reported eating, licking, or tasting raw, homemade dough or batter. Two people with detailed information reported eating raw dough or batter made with flour or baking mixes from ALDI.

Investigators with the Rhode Island Department of Health collected records and flour samples at a bakery where an ill person reported eating raw dough. Records indicated that the bakery used Baker’s Corner All Purpose Flour from ALDI. The outbreak strain was isolated from an unopened bag of Baker’s Corner All Purpose Flour collected at the bakery. Whole genome sequencing results showed that the E. coli O26 strain identified in the Baker’s Corner All Purpose Floursample was closely related genetically to the E. coli O26 strain identified in ill people.

On May 23, ADM Milling and Aldi recalled 5-lb bags of Baker’s Corner All Purpose Flour sold at retail locations in the following states because they may be contaminated with E. coli: Connecticut, Delaware, Massachusetts, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont, and West Virginia.

This investigation is ongoing. FDA is working to determine whether other brands or lots of flour may be potentially contaminated and need to be recalled.

Press release

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