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Archive Number 20090623.2291
Published Date 23-JUN-2009
Subject PRO/AH/EDR> E. coli O157 - USA (02): refrigerated cookie dough
E. COLI O157 - USA (02): REFRIGERATED COOKIE DOUGH
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A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
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Date: Mon 22 Jun 2009
Source: CDC [edited]
<http://www.cdc.gov/ecoli/2009/0622.html>


The Centers for Disease Control and Prevention (CDC) is collaborating 
with public health officials in many states, the USA Food and Drug 
Administration (FDA) and Department of Agriculture Food Safety and 
Inspection Service (FSIS) to investigate an outbreak of _E. coli_ 
O157:H7 infections.

As of Mon 22 Jun 2009, 70 persons infected with a strain of _E. coli_ 
O157:H7 with a particular DNA fingerprint have been reported from 30 
states. Of these, 41 have been confirmed by an advanced DNA test as 
having the outbreak strain; the confirmatory test results are pending 
on the others. The number of ill persons identified in each state is 
as follows: Arizona (2), California (3), Colorado (5), Connecticut 
(1), Delaware (1), Georgia (1), Hawaii (1), Iowa (2), Illinois (5), 
Kentucky (3), Massachusetts (4), Maryland (2), Maine (3), Minnesota 
(6), Missouri (2), Montana (1), North Carolina (2), New Hampshire 
(2), New Jersey (1), Nevada (2), Ohio (3), Oklahoma (1), Oregon (1), 
Pennsylvania (2), South Carolina (1), Texas (3), Utah (2), Virginia 
(2), Washington (5), and Wisconsin (1).

Ill persons range in age from 2 to 65 years; however, 66 percent are 
less than 19 years old; 75 percent are female. 30 persons have been 
hospitalized, 7 developed hemolytic uremic syndrome (HUS); none have 
died. Reports of these infections increased above the expected 
baseline in May 2009 and continue into June 2009.

Investigation of the Outbreak
------------------------------
In an epidemiologic study, ill persons answered questions about foods 
consumed during the days before becoming ill and investigators 
compared their responses to those of persons of similar age and 
gender previously reported to State Health Departments with other 
illnesses. Preliminary results of this investigation indicate a 
strong association with eating raw prepackaged cookie dough. Most 
patients reported eating refrigerated prepackaged Nestle Toll House 
cookie dough products raw.

_E. coli_ O157:H7 has not been previously associated with eating raw 
cookie dough. The CDC, the state health departments, and federal 
regulatory partners are working together in this ongoing investigation.

Advice to Consumers
-------------------
The FDA and the CDC are warning consumers not to eat any varieties of 
prepackaged Nestle Toll House refrigerated cookie dough due to the 
risk of contamination with _E. coli_ O157:H7. If consumers have any 
prepackaged, refrigerated Nestle Toll House cookie dough products in 
their home they should throw them away. Cooking the dough is not 
recommended because consumers might get the bacteria on their hands 
and on other cooking surfaces. The recall does not include Nestle 
Toll House morsels, which are used as an ingredient in many home-made 
baked goods, or other already baked cookie products.

Individuals who have recently eaten prepackaged, refrigerated Toll 
House cookie dough and have experienced any of these symptoms should 
contact their doctor or health care provider immediately. Any such 
illnesses should be reported to state or local health authorities.

Consumers should be reminded they should not eat raw food products 
that are intended for cooking or baking before consumption. Consumers 
should use safe food-handling practices when preparing such products, 
including following package directions for cooking at proper 
temperatures; washing hands, surfaces, and utensils after contact 
with these types of products; avoiding cross contamination; and 
refrigerating products properly.

Advice to Retailers, Restaurateurs, and Food-service Operators
----------------------------------------------------------------
Retailers, restaurateurs, and personnel at other food-service 
operations should not sell or serve any Nestle Toll House 
prepackaged, refrigerated cookie dough products subject to the recall.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[A map of the states with cases can be found at the original URL. The 
source of the outbreak strain in the product is not clear at this 
point and it is also not known when during the manufacture that the 
contamination occurred. Generic cookie dough (according to my wife) 
contains flour, sugar, eggs and either butter or margarine.

This moderator would like also to mention that his son, 
daughter-in-law and 6-year-old granddaughter had eaten most of a 
container of the now recalled product prior to the recall. No 
illness, fortunately, occurred. - Mod.LL]

[see also:
E. coli O157 - USA: refrigerated cookie dough  20090619.2259
2008
----
E. coli O157 - USA (09): (WA), susp.  20081021.3336
E. coli O157 - USA (08): (CA), cooked beef  20081007.3181
E. coli O157, university students - USA (06): California lettuce  20081015.3266
E. coli O157, university students - USA: (MI)  20080922.2987
E. coli O157 - USA (07): (MA) alert  20080811.2475
E. coli O157 - USA: (OH, MI), unknown source  20080624.1947
E. coli O157, lettuce - USA: (WA)  20080606.1807
E. coli O157, restaurant - USA: (HI)  20080228.0811
2007
----
E. coli O157, ground beef - USA (multistate) (09)  20071126.3823
E. coli O157, ground beef - USA (multistate) (08): Canada  20071029.3511
E. coli O157, ground beef - USA (multistate) (04): 2nd 
manufacturer  20071007.3304
E. coli O157, ground beef - USA (multistate) (03): CDC report  20071003.3272
E. coli O157, ground beef - USA (multistate): alert, recall  20070927.3201
E. coli O157, ground beef - USA (NY): alert, recall  20070926.3190
E. coli O157, ground beef - USA (WA, OR): alert  20070830.2855
E. coli O157, ground beef - USA (NY)  20070725.2387
E. coli VTEC, prisoners - USA (CO) (02)  20070714.2263
E. coli VTEC, prisoners - USA (CO): RFI  20070712.2236
E. coli O157, ground beef - USA (west) (03): expanded recall  20070611.1902
E. coli O157, ground beef - USA (west): recall  20070606.1831
E. coli O157, ground beef - USA (multistate): recall  20070514.1532
E. coli O157, steak - USA (PA): recall  20070426.1362
E. coli O157, restaurant - USA (CA) (03)  20070410.1204
E. coli O157, restaurant - USA (CA)  20070403.1131
E. coli O157, spinach - USA (multistate): 2006, FDA report  20070326.1051
E. coli O157, bagged salad greens - USA (multistate)  20070121.0288
E. coli O157, lettuce - USA (multistate): 2006  20070112.0158
2006
----
E. coli O157, fast food - USA (multistate) (05): lettuce  20061214.3516
E. coli O157, fast food - USA (IA, MN): lettuce  20061214.3515
E. coli O157, fast food - USA (multistate): green onions  20061206.3441
E. coli O157 - USA (NJ, NY)  20061205.3425
E. coli O157 - USA (NJ)  20061203.3415
E. coli O157, spinach - USA (multistate) (20)  20061027.3067
E. coli O157, spinach - USA (multistate): alert  20060915.2608
E. coli O157 - USA (multistate): unknown source  20060410.1068
E. coli O157, unpasteurized milk - USA (OR, WA) (04)  20060121.0199]
....................ll/ejp/dk

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