Jun 19, 2009 (CIDRAP News) The US Food and Drug Administration (FDA) warned consumers today not to eatNestle Toll House refrigerated raw cookie dough, as state and federal officialsinvestigate 66 Escherichia coliO157:H7 illnesses, many of them children, across 28 states that they suspectare linked to the product.
The FDA, in a statement,advised consumers that cooking the dough could still present across-contamination risk and that they should throw away any prepackaged Nestledough they have in their homes.
A few hours before the FDAwarning, Nestle issued a voluntary recall of its Toll House refrigerated doughproducts. Company officials said that, though the E coli outbreak strain has not been detected in any of itsproducts, it recalled the dough out of an abundance of caution.
The recall applies to all varieties of its Toll houserefrigerated cookie, brownie, and bar dough that is packaged in rectangularpackages, tubes, and tubs.
The FDA statement didn'tspecify the states that are reporting illnesses, but some statesincludingColorado, Minnesota, Texas, and Washingtonhave confirmed they have sickpatients and are involved in the outbreak investigation.
E coli O157:H7 outbreaks are most often associated withground beef and, in recent years, fresh produce. The strain produces a toxinthat causes diarrheaoften bloodyand abdominal cramps but typically no fever.The illness usually resolves in 5 to 10 days, but it can cause hemolytic uremicsyndrome (HUS), a potentially fatal kidney condition, in 2% to 7% of patients.
The FDA said that, of the 66illnesses reported, 25 people were hospitalized and 7 developed HUS. Nofatalities have been reported.
Patients tend to be young
Officials from the ColoradoDepartment of Public Health and Environment (CDPHE) released a statementyesterday saying five cases from three counties have been linked to theoutbreak. Two patients were hospitalized, and one developed HUS. Four of thepatients interviewed so far by Colorado authorities reported eating the rawcookie dough the week before they got sick.
The Minnesota Department ofHealth (MDH) said today in a press release that it is investigating sixillnesses, all caused by E coliO157:H7 with the same genetic fingerprint that it identified during routinemonitoring. The patients range from 2 to 18 years old and became ill betweenMay 3 and Jun 11. All reported eating raw Nestle Toll House cookie dough. Onepatient was hospitalized, and all recovered.
Two other states havereported cases, according to media reports. Washington reported 5, and Texasreported 3.
Carlota Medus, PhD, MPH, anepidemiologist in the MDH foodborne illness unit, said in the statement thatthe outbreak illustrates the risk of eating any raw cookie dough. "Cookiedough, whether purchased in a tub from the store, or made at home from scratch,should not be eaten raw," she said.
Medus told CIDRAP News thatthe US Centers for Disease Control and Prevention (CDC) and the state of Washingtonwere the first groups to pick up on the connection between sick patients andthe exposure many of them had to the Nestle raw cookie dough. As more statesbecame involved in the investigation, the connection to the dough became evenmore striking, she said.
The younger age of thepatients also stood out as an unusual outbreak feature, she said. However, sheadded that age range nationally is a little broader and more skewed towardfemale patients.
Contamination sourceunknown
Minnesota officials saidinvestigators haven't determined how E coli contaminated the cookie dough, but the FDA is workingwith Nestle to identify the source. The Minnesota Department of Agriculture istesting Nestle dough collected from stores and the homes of sick patients.
Craig Hedberg, PhD, afoodborne disease expert at the University of Minnesota, told CIDRAP News thatpublic health officials are puzzled how E coli O157:H7 could contaminate refrigerated cookie dough.
"In looking at the ingredients, there are not any obvioussources of potential O157 contamination, but as we saw with PCA [PeanutCorporation of America], this may be difficult to rule out," he said.
Though FDA officials haven't revealed many details abouttheir investigation, Hedberg said they will probably explore if the processingplant or plants are located near dairy or beef feedlots that could present arisk of contamination through water, dust, flies, infected workers, orcross-contamination from hands and clothes.
Nestle didn't specify in its recall notice where it makesthe cookie dough products. However, the Virginia-based Danville Register Bee quoted a company spokeswoman who said Nestle makesthe majority of its refrigerated cookie dough at a plant in Danville, whichalso makes refrigerated pasta. She said Nestle has stopped production of thedough, but not the pasta products.
Because the infectious agent and food product combinationis so unusual, FDA investigators might consider the possibility of intentionalcontamination, Hedberg said. "Whether it were a disgruntled employee or anattack on an iconic American product, the potential needs to beconsidered," he said.
Hedberg said investigators are also likely to weigh otherpossibilities such as potentially contaminated flour, untreated groundwaterentering the plant, or dust from a cattle facility that can serve as a transfermechanism for E coli O157:H7.
Medus added that E coli O157:H7 can sometimes survive in dry environments such as flour, orperhaps there was a breakdown in pasteurizing the milk fat used to make thedough.
"There are so many possibilities; it's just too earlyto know," she said. "But something went really wrong, whether it wasintentional or not."
See also:
Jun 19 FDApress release
Jun 19 Nestlerecall notice
Jun 18 CDPHE press release
