November 17, 2012 [Initial Announcement]: Multistate Outbreak of Shiga Toxin-producing Escherichia coli O157:H7 Infections

This particular outbreak appears to be over. However, E. coli is still an important cause of human illness in the United States. More information about E. coli, and steps people can take to reduce their risk of infection, can be found on the CDC E. coli Web Page.

CDC collaborated with public health officials in several states and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli O157:H7 (STEC O157:H7) infections. Results from this investigation linked this outbreak to pre-packaged leafy greens produced by State Garden of Chelsea, Massachusetts.

Public health investigators used DNA “fingerprints” of E. coli bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that were part of this outbreak. They used data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

The type of bacteria responsible for this outbreak was among those referred to as Shiga toxin-producing E. coli or STEC. STEC bacteria are grouped by serogroups (e.g., O157 or O145). The STEC serogroup found most commonly in U.S. patients is E. coli O157.

A total of 33 ill persons infected with the outbreak strain of STEC O157:H7 were reported from five states. The number of ill people identified in each state with the outbreak strain was as follows: Connecticut (2), Massachusetts (3), New York (26), Pennsylvania (1), and Virginia (1).

Among persons for whom information was available, illness onset dates ranged from October 18, 2012 to November 12, 2012. Ill persons ranged in age from 4 years to 66 years, with a median age of 24 years. Sixty-three percent of ill persons were female. Among 28 ill persons with available information, 13 (46%) were hospitalized. Two ill persons developed hemolytic uremic syndrome (HUS), a type of kidney failure. No deaths were reported.

This particular outbreak appears to be over. However, E. coli is still an important cause of human illness in the United States. More information about E. coli and steps people can take to reduce their risk for infection can be found on the CDC E. coli homepage.

Epidemiologic, laboratory, and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies linked this outbreak to pre-packaged leafy greens, produced by State Garden of Chelsea, Massachusetts.

State public health officials interviewed ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness. Thirty (97%) of 31 ill persons reported eating pre-packaged leafy greens. Fifteen (48%) of 31 ill persons for whom information was available reported eating Wegmans brand Organic Spinach and Spring Mix blend in the week before becoming ill. In total, 25 (81%) of 31 ill persons for whom information was available reported eating a variety of different brands of pre-packaged leafy greens produced by State Garden.

Testing conducted by the New York Department Health Wadsworth Center Laboratories isolated the outbreak strain of STECO157:H7 from four leftover packages of Wegmans brand Organic Spinach and Spring Mix blend collected from four ill persons’ homes.

Traceback investigations of pre-packaged leafy greens purchased by ill persons identified State Garden as a common producer, but a source of contamination was not identified. FDA continues its investigation into the source of the contamination.

On November 2, 2012, Wegmans voluntarily recalled its 5-ounce and 11-ounce clam shell packages of Organic Spinach and Spring Mix blend, a product produced by State Garden. State Garden issued a consumer advisory regarding the product packaged on October 12 and 13, 2012.

A total of 33 persons infected with the outbreak strain of Shiga toxin-producing E. coli O157:H7 were reported from five states. Five new cases were reported from two states: Massachusetts (1) and New York (4).

Among persons for whom information was available, illness onset dates ranged from October 18, 2012 to November 12, 2012. Ill persons ranged in age from 4 years to 66 years, with a median age of 24 years. Sixty-three percent of ill persons were female. Among 28 persons with available information, 13 (46%) patients were hospitalized. Two ill persons developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths were reported.

CDC is collaborating with public health officials in several states and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli O157 (STEC O157) infections. Preliminary results from this ongoing investigation indicate that Wegmans brand Organic Spinach and Spring Mix blend produced by State Garden of Chelsea, Massachusetts, is one likely source of this outbreak.

Public health investigators are using DNA “fingerprints” of E. coli bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may be part of this outbreak. They are using data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

The type of bacteria responsible for this outbreak is among those referred to as Shiga toxin-producing E. coli or STEC. STEC bacteria are grouped by serogroups (e.g., O157 or O145). The STEC serogroup found most commonly in U.S. patients is E. coli O157.

A total of 28 ill persons infected with the outbreak strain of STEC O157:H7 have been reported from five states. The number of ill people identified in each state with the outbreak strain is as follows: Connecticut (2), Massachusetts (2), New York (22), Pennsylvania (1), and Virginia (1).

Among persons for whom information is available, illness onset dates range from October 18, 2012 to November 3, 2012. Ill persons range in age from 4 years to 66 years, with a median age of 24 years. Sixty-eight percent of ill persons are female. Among 24 ill persons with available information, 10 (42%) reported being hospitalized. Two ill persons have developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

This PFGE pattern has very rarely been seen before in PulseNet. It has been seen only 7 times prior to this outbreak. Illnesses that occurred after October 30, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported. This outbreak can be visually described with a chart showing the number of persons who became ill each day. This chart is called an epi curve. Please see the Timeline for Reporting of E. coli Cases for more details on the reporting process.

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June 10, 2012 [Initial Announcement]: Multistate Outbreak of Shiga Toxin-producing Escherichia coli O145 Infections

This particular outbreak appears to be over. However, E. coli is still an important cause of human illness in the United States. More information about E. coli, and steps people can take to reduce their risk of infection, can be found on the CDC E. coli Web Page.

CDC collaborated with public health officials in 9 states to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli (STEC) O145 infections. Public health investigators used DNA “fingerprints” of STEC bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may have been part of this outbreak. They used data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

A total of 18 individuals infected with the outbreak strain of STEC O145 were reported from 9 states. The number of ill persons identified in each state with the outbreak strain was as follows: Alabama (2), California (1), Florida (1), Georgia (5), Kentucky (1), Louisiana (5), Maryland (1), Tennessee (1), and Virginia (1).

Among 18 persons for whom information was available, illness onsets ranged from April 15, 2012 to June 12, 2012. Ill persons ranged in age from 1 to 79 years, and the median age was 33 years. Seventy-eight percent of patients were female. Four patients were hospitalized. One death was reported in Louisiana.

CDC initiated an investigation into this outbreak of illnesses on May 14, 2012 when six ill persons had been reported to CDC PulseNet from two states. CDC and state public health officials interviewed ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness. Based on interviews of 15 ill persons, a source for these infections was not identified.

A total of 18 persons infected with the outbreak strain of STEC O145 were identified in 9 states: Alabama (2), California (1), Florida (1), Georgia (5), Kentucky (1), Louisiana (5), Maryland (1), Tennessee (1), and Virginia (1). Since the last update 3 new ill persons were identified in 3 states: Kentucky (1), Maryland (1), and Virginia (1).

Among persons for whom information was available, illness onset dates ranged from April 15, 2012 to June 12, 2012. Ill persons ranged in age from 1 year to 79 years, with a median age of 33 years; 78% were female. Four ill persons were hospitalized. One death was reported in Louisiana.

CDC and state public health officials interviewed ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness. Based on interviews of 15 ill persons, a source for these infections was not identified.

A total of 15 persons infected with the outbreak strain of STEC O145 infection have been identified in 6 states: Alabama (2), California (1), Florida (1), Georgia (5), Louisiana (5), and Tennessee (1). Since the last update one new ill person has been identified in Louisiana with a reported illness onset of April 21, 2012. This is during the same time period as other ill persons in this outbreak.

Among persons for whom information is available, illness onset dates range from April 15, 2012 to May 12, 2012. Ill persons range in age from 1 year to 79 years old, with a median age of 31 years old; 73% are female. Four ill persons have been hospitalized. One death has been reported in Louisiana.

Illnesses that occurred after May 5, 2012 might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported.

It has been approximately 6 weeks since the last illness onset among reported cases.  Although this indicates that the outbreak could be over, CDC continues to work with state public health officials to identify additional cases and the source of these STEC O145 infections.

State public health officials have been interviewing ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness.  Based on interviews of 12 ill persons to date, a source for these infections has not been identified.

CDC is collaborating with public health officials in multiple states to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli serogroup O145 (STEC O145) infections. Public health investigators are using DNA "fingerprints" of E. coli bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may be part of this outbreak. They are using data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

The type of bacteria responsible for this outbreak is among those referred to as Shiga toxin-producing E. coli or STEC.  STEC bacteria are grouped by serogroups (e.g., O157 or O145). The STEC serogroup found most commonly in U.S. patients is E. coli O157. Other E. coli serogroups in the STEC group, including O145, are sometimes called "non-O157 STECs." Some types of STEC frequently cause severe disease, including bloody diarrhea and hemolytic uremic syndrome (HUS) which is a type of kidney failure.  Currently, there are limited public health surveillance data on the occurrence of non-O157 STECs, including STEC O145; many STEC O145 infections may go undiagnosed or unreported. Compared with STEC O157 infections, identification of non-O157 STEC infections is more complex.  First, clinical laboratories must test stool samples for the presence of Shiga toxins. Then, the positive samples must be sent to public health laboratories to look for non-O157 STEC. Clinical laboratories typically cannot identify non-O157 STEC.  The STEC O145 PFGE pattern in this outbreak has not been seen in PulseNet before.

CDC initiated an investigation into this cluster of illnesses on May 14, 2012.  At that time, six ill persons had been reported to CDC PulseNet from two states during May 3, 2012 to May 9, 2012. Although the most recent report of an illness to CDC was on June 4, 2012, their onset of illness occurred before May 10, 2012  and was during same period as other ill persons in this outbreak.

A total of 14 persons infected with the outbreak strain of STEC O145 infection have been identified in 6 states: Alabama (2), California (1), Florida (1), Georgia (5), Louisiana (4), and Tennessee (1).  Among persons for whom information is available, illness onset dates range from April 15, 2012 to May 12, 2012. The time from the beginning of a patient's illness to the confirmation that he or she was part of an outbreak is typically about 2-3 weeks. Please see the E. coli Outbreak Investigations: Timeline for Reporting Cases for more details.  Ill persons range in age from 1 year to 79 years old, with a median age of 33 years old; 79% are female. Three ill persons have been hospitalized; one death has been reported in Louisiana.

It has been approximately 4 weeks since the last illness onset among reported cases.  Although this indicates that the outbreak could be over, CDC continues to work with state public health officials to identify additional cases and the source of these STEC O145 infections.

State public health officials have been interviewing ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness.  Based on interviews of 10 ill persons to date, a source for these infections has not been identified.

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March 29, 2013 [Initial Announcement]: Multistate Outbreak of Shiga toxin-producing Escherichia coli O121 Infections Linked to Farm Rich Brand Frozen Food Products

This particular outbreak appears to be over. However, E. coli is still an important cause of human illness in the United States. More information about E. coli, and steps people can take to reduce their risk of infection, can be found on the CDC E. coli Web Page.

CDC collaborated with public health officials in several states, the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS), and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli O121 (STEC O121) infections linked to Farm Rich brand frozen food products produced by Rich Products Corporation of Buffalo, New York.

Public health investigators used DNA "fingerprints" of E. coli bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis (PFGE) to identify cases of illness that were part of this outbreak. They used data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

A total of 35 individuals infected with the outbreak strain of STEC O121 were reported from 19 states. The number of ill persons identified in each state was as follows: Alabama (1), Arkansas (1), California (1), Colorado (1), Florida (2), Illinois (2), Indiana (2), Michigan (3), Missouri (1), Mississippi (1), New York (4), Ohio (6), Pennsylvania (1), South Dakota (1), Texas (3), Utah (1), Virginia (1), Washington (1), and Wisconsin (2).

Illness onset dates ranged from December 30, 2012 to April 15, 2013. Ill persons ranged in age from less than 1 year to 75 years, with a median age of 17 years. Eighty-two percent of ill persons were 21 years of age or younger. Sixty percent of ill persons were female. Among 29 persons for whom information was available, 9 (31%) were hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths were reported.

This outbreak appears to be over. However, many of these products have a long shelf-life, and they may still be in peoples’ freezers. Consumers unaware of the recall could continue to eat these products and potentially get sick.

E. coli is an important cause of human illness in the United States. More information about E. coli and steps people can take to reduce their risk for infection can be found on the CDC E. coli homepage.

Epidemiologic, laboratory, and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies linked this outbreak to Farm Rich brand frozen food products.

State and federal public health officials interviewed ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness. Twenty-four (100%) of 24 ill persons interviewed reported consuming frozen food products. Thirteen (68%) of 19 ill persons reported consuming Farm Rich brand frozen food products.

The outbreak strain of STEC O121 was identified in two different Farm Rich brand frozen products collected from the homes of two ill persons in New York and Texas.

On April 4, 2013, Rich Products Corporation recalled all of its Farm Rich, Market Day, and Schwan’s brand frozen food products produced at its Waycross, Georgia plant between June 1, 2011 and March 29, 2013 due to possible contamination with E. coli O121.

USDA-FSIS and FDA investigated suppliers of the common ingredients in the various types of Farm Rich brand frozen products consumed by ill persons, but the source of contamination was not identified. Rich Products Corporation is not currently producing products at its Waycross, Georgia plant, while the company continues to work with USDA-FSIS to develop a plan to make food safety improvements.

A total of 35 individuals infected with the outbreak strain of STEC O121 were reported from 19 states. There were no new illnesses reported since the last update.

Illness onset dates ranged from December 30, 2012 to April 15, 2013. Ill persons ranged in age from less than 1 year to 75 years, with a median age of 17 years. Eighty-two percent of ill persons were 21 years of age or younger. Sixty percent of ill persons were female. Among 29 persons for whom information was available, 9 (31%) were hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths were reported.

A total of 35 individuals infected with the outbreak strain of STEC O121 have been reported from 19 states. Three additional ill persons have been reported from Missouri (1) and Ohio (2).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to April 15, 2013. Ill persons range in age from one year to 75 years, with a median age of 17 years. Eighty-two percent of ill persons are 21 years of age or younger. Sixty percent of ill persons are female. Among 29 persons with available information, 9 (31%) reported being hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths have been reported.

Illnesses that occurred after April 10, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Twenty-four (100%) of 24 ill persons interviewed reported consuming frozen food products. Twelve (63%) of 19 ill persons reported consuming Farm Rich brand frozen food products. Investigations are ongoing to determine the specific types and sources of frozen food that might be linked with illness, as well as to determine which particular ingredients or components of these products may be contaminated.

A total of 32 individuals infected with the outbreak strain of STEC O121 have been reported from 18 states. Five additional ill persons have been reported from California (1), Colorado (1), Florida (2), and Ohio (1).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to April 2, 2013. Ill persons range in age from one year to 75 years, with a median age of 17 years. Eighty-one percent of ill persons are 21 years of age or younger. Fifty-six percent of ill persons are female. Among 26 persons with available information, 9 (35%) reported being hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths have been reported.

Illnesses that occurred after March 30, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

A total of 27 individuals infected with the outbreak strain of STEC O121 have been reported from 15 states. Three new cases have been reported from Illinois (1), Michigan (1) and New York (1).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to March 18, 2013. Ill persons range in age from 2 years to 75 years, with a median age of 17 years. Eighty-one percent of ill persons are 21 years of age or younger. Fifty-six percent of ill persons are female. Among 23 persons with available information, 8 (35%) reported being hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths have been reported.

Illnesses that occurred after March 10, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Twenty (100%) of 20 ill persons interviewed reported consuming frozen food products. Ten (63%) of 16 ill persons reported consuming Farm Rich brand frozen food products. Investigations are ongoing to determine the specific types and sources of frozen food that might be linked with illness, as well as to determine which particular ingredients or components of these products may be contaminated.

Testing conducted by the Outbreaks Section of the USDA-FSIS Eastern Laboratory identified the outbreak strain of STEC O121 from individually wrapped Farm Rich brand frozen mini pizza slices from an opened package collected from an ill person’s home in Texas. The frozen mini pizza slices were included in the products that were recalled on March 28, 2013.

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CDC is collaborating with public health officials in many states, the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS), and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli O121 (STEC O121) infections. Public health investigators are using DNA "fingerprints" of E. coli bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that could be part of this outbreak. They are using data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

The type of bacteria responsible for this outbreak is among those referred to as Shiga toxin-producing E. coli or STEC. Some types of STEC frequently cause severe disease, including bloody diarrhea and hemolytic uremic syndrome (HUS), which is a type of kidney failure. STEC bacteria are divided into serogroups (e.g., O157 or O121). E. coli O157 is the STEC serogroup found most commonly in U.S. patients. Other E. coli serogroups in the STEC group, including O121, are sometimes called "non-O157 STECs." Because clinical laboratories typically cannot directly identify non-O157 STEC serogroups, they must first test stool samples for the presence of Shiga toxins.  Then, the positive samples must be sent to public health laboratories to look for non-O157 STEC. In recent years, the number of clinical laboratories that test for Shiga toxin has increased greatly, but some laboratories still do not perform these tests. Because of these complexities, many non-O157 STEC infections are probably not identified. The STEC O121 PFGE pattern in this outbreak is rare. In the past it has been seen less than 30 times in PulseNet.

A total of 24 individuals infected with the outbreak strain of STEC O121 have been reported from 15 states. The number of ill persons identified in each state is as follows: Alabama (1), Arkansas (1), Illinois (1), Indiana (2), Michigan (2), Mississippi (1), New York (3), Ohio (3), Pennsylvania (1), South Dakota (1), Texas (3), Utah (1), Virginia (1), Washington (1), and Wisconsin (2).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to March 9, 2013. Ill persons range in age from 2 years to 75 years, with a median age of 17 years. Seventy-eight percent of ill persons are 21 years of age or younger. Sixty-three percent of ill persons are female. Among 21 persons with available information, 7 (33%) reported being hospitalized. One ill person developed HUS, and no deaths have been reported.

The outbreak can be visually described with a chart showing the number of people who became ill each day or week. This chart is called an epi curve. Illnesses that occurred after March 1, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 3 weeks. For more details, please see Timeline for Reporting E. coli Cases.

Epidemiologic, laboratory, and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies indicate that Farm Rich brand frozen food products are one likely source of this outbreak of STEC O121 infections.

In interviews, ill persons answered questions about food consumed and other exposures during the week before becoming ill. Eighteen (100%) of 18 ill persons interviewed reported consuming frozen food products. Eight (57%) of 14 ill persons reported consuming Farm Rich brand frozen food products. Investigations are ongoing to determine the specific types and sources of frozen food that might be linked with illness, as well as to determine which particular ingredients or components of these products may be contaminated.

The New York State Department of Health, Wadsworth Center Laboratory, identified the outbreak strain of E. coli O121 in an opened package of Farm Rich brand frozen mini chicken and cheese quesadillas from an ill person’s home.

CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill persons and to interview ill persons about foods eaten before becoming ill. FSIS and FDA are continuing to work closely with CDC and state partners during this investigation.

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May 30, 2013 [Final Update]: Multistate Outbreak of Shiga toxin-producing Escherichia coli O121 Infections Linked to Farm Rich Brand Frozen Food Products

This particular outbreak appears to be over. However, E. coli is still an important cause of human illness in the United States. More information about E. coli, and steps people can take to reduce their risk of infection, can be found on the CDC E. coli Web Page.

CDC collaborated with public health officials in several states, the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS), and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli O121 (STEC O121) infections linked to Farm Rich brand frozen food products produced by Rich Products Corporation of Buffalo, New York.

Public health investigators used DNA "fingerprints" of E. coli bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis (PFGE) to identify cases of illness that were part of this outbreak. They used data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

A total of 35 individuals infected with the outbreak strain of STEC O121 were reported from 19 states. The number of ill persons identified in each state was as follows: Alabama (1), Arkansas (1), California (1), Colorado (1), Florida (2), Illinois (2), Indiana (2), Michigan (3), Missouri (1), Mississippi (1), New York (4), Ohio (6), Pennsylvania (1), South Dakota (1), Texas (3), Utah (1), Virginia (1), Washington (1), and Wisconsin (2).

Illness onset dates ranged from December 30, 2012 to April 15, 2013. Ill persons ranged in age from less than 1 year to 75 years, with a median age of 17 years. Eighty-two percent of ill persons were 21 years of age or younger. Sixty percent of ill persons were female. Among 29 persons for whom information was available, 9 (31%) were hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths were reported.

This outbreak appears to be over. However, many of these products have a long shelf-life, and they may still be in peoples’ freezers. Consumers unaware of the recall could continue to eat these products and potentially get sick.

E. coli is an important cause of human illness in the United States. More information about E. coli and steps people can take to reduce their risk for infection can be found on the CDC E. coli homepage.

Epidemiologic, laboratory, and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies linked this outbreak to Farm Rich brand frozen food products.

State and federal public health officials interviewed ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness. Twenty-four (100%) of 24 ill persons interviewed reported consuming frozen food products. Thirteen (68%) of 19 ill persons reported consuming Farm Rich brand frozen food products.

The outbreak strain of STEC O121 was identified in two different Farm Rich brand frozen products collected from the homes of two ill persons in New York and Texas.

On April 4, 2013, Rich Products Corporation recalled all of its Farm Rich, Market Day, and Schwan’s brand frozen food products produced at its Waycross, Georgia plant between June 1, 2011 and March 29, 2013 due to possible contamination with E. coli O121.

USDA-FSIS and FDA investigated suppliers of the common ingredients in the various types of Farm Rich brand frozen products consumed by ill persons, but the source of contamination was not identified. Rich Products Corporation is not currently producing products at its Waycross, Georgia plant, while the company continues to work with USDA-FSIS to develop a plan to make food safety improvements.

A total of 35 individuals infected with the outbreak strain of STEC O121 were reported from 19 states. There were no new illnesses reported since the last update.

Illness onset dates ranged from December 30, 2012 to April 15, 2013. Ill persons ranged in age from less than 1 year to 75 years, with a median age of 17 years. Eighty-two percent of ill persons were 21 years of age or younger. Sixty percent of ill persons were female. Among 29 persons for whom information was available, 9 (31%) were hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths were reported.

A total of 35 individuals infected with the outbreak strain of STEC O121 have been reported from 19 states. Three additional ill persons have been reported from Missouri (1) and Ohio (2).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to April 15, 2013. Ill persons range in age from one year to 75 years, with a median age of 17 years. Eighty-two percent of ill persons are 21 years of age or younger. Sixty percent of ill persons are female. Among 29 persons with available information, 9 (31%) reported being hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths have been reported.

Illnesses that occurred after April 10, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Twenty-four (100%) of 24 ill persons interviewed reported consuming frozen food products. Twelve (63%) of 19 ill persons reported consuming Farm Rich brand frozen food products. Investigations are ongoing to determine the specific types and sources of frozen food that might be linked with illness, as well as to determine which particular ingredients or components of these products may be contaminated.

A total of 32 individuals infected with the outbreak strain of STEC O121 have been reported from 18 states. Five additional ill persons have been reported from California (1), Colorado (1), Florida (2), and Ohio (1).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to April 2, 2013. Ill persons range in age from one year to 75 years, with a median age of 17 years. Eighty-one percent of ill persons are 21 years of age or younger. Fifty-six percent of ill persons are female. Among 26 persons with available information, 9 (35%) reported being hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths have been reported.

Illnesses that occurred after March 30, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

A total of 27 individuals infected with the outbreak strain of STEC O121 have been reported from 15 states. Three new cases have been reported from Illinois (1), Michigan (1) and New York (1).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to March 18, 2013. Ill persons range in age from 2 years to 75 years, with a median age of 17 years. Eighty-one percent of ill persons are 21 years of age or younger. Fifty-six percent of ill persons are female. Among 23 persons with available information, 8 (35%) reported being hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths have been reported.

Illnesses that occurred after March 10, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Twenty (100%) of 20 ill persons interviewed reported consuming frozen food products. Ten (63%) of 16 ill persons reported consuming Farm Rich brand frozen food products. Investigations are ongoing to determine the specific types and sources of frozen food that might be linked with illness, as well as to determine which particular ingredients or components of these products may be contaminated.

Testing conducted by the Outbreaks Section of the USDA-FSIS Eastern Laboratory identified the outbreak strain of STEC O121 from individually wrapped Farm Rich brand frozen mini pizza slices from an opened package collected from an ill person’s home in Texas. The frozen mini pizza slices were included in the products that were recalled on March 28, 2013.

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CDC is collaborating with public health officials in many states, the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS), and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli O121 (STEC O121) infections. Public health investigators are using DNA "fingerprints" of E. coli bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that could be part of this outbreak. They are using data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

The type of bacteria responsible for this outbreak is among those referred to as Shiga toxin-producing E. coli or STEC. Some types of STEC frequently cause severe disease, including bloody diarrhea and hemolytic uremic syndrome (HUS), which is a type of kidney failure. STEC bacteria are divided into serogroups (e.g., O157 or O121). E. coli O157 is the STEC serogroup found most commonly in U.S. patients. Other E. coli serogroups in the STEC group, including O121, are sometimes called "non-O157 STECs." Because clinical laboratories typically cannot directly identify non-O157 STEC serogroups, they must first test stool samples for the presence of Shiga toxins.  Then, the positive samples must be sent to public health laboratories to look for non-O157 STEC. In recent years, the number of clinical laboratories that test for Shiga toxin has increased greatly, but some laboratories still do not perform these tests. Because of these complexities, many non-O157 STEC infections are probably not identified. The STEC O121 PFGE pattern in this outbreak is rare. In the past it has been seen less than 30 times in PulseNet.

A total of 24 individuals infected with the outbreak strain of STEC O121 have been reported from 15 states. The number of ill persons identified in each state is as follows: Alabama (1), Arkansas (1), Illinois (1), Indiana (2), Michigan (2), Mississippi (1), New York (3), Ohio (3), Pennsylvania (1), South Dakota (1), Texas (3), Utah (1), Virginia (1), Washington (1), and Wisconsin (2).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to March 9, 2013. Ill persons range in age from 2 years to 75 years, with a median age of 17 years. Seventy-eight percent of ill persons are 21 years of age or younger. Sixty-three percent of ill persons are female. Among 21 persons with available information, 7 (33%) reported being hospitalized. One ill person developed HUS, and no deaths have been reported.

The outbreak can be visually described with a chart showing the number of people who became ill each day or week. This chart is called an epi curve. Illnesses that occurred after March 1, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 3 weeks. For more details, please see Timeline for Reporting E. coli Cases.

Epidemiologic, laboratory, and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies indicate that Farm Rich brand frozen food products are one likely source of this outbreak of STEC O121 infections.

In interviews, ill persons answered questions about food consumed and other exposures during the week before becoming ill. Eighteen (100%) of 18 ill persons interviewed reported consuming frozen food products. Eight (57%) of 14 ill persons reported consuming Farm Rich brand frozen food products. Investigations are ongoing to determine the specific types and sources of frozen food that might be linked with illness, as well as to determine which particular ingredients or components of these products may be contaminated.

The New York State Department of Health, Wadsworth Center Laboratory, identified the outbreak strain of E. coli O121 in an opened package of Farm Rich brand frozen mini chicken and cheese quesadillas from an ill person’s home.

CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill persons and to interview ill persons about foods eaten before becoming ill. FSIS and FDA are continuing to work closely with CDC and state partners during this investigation.

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July 20, 2012 (Final Update): Multistate Outbreak of Shiga Toxin-producing Escherichia coli O145 Infections

This particular outbreak appears to be over. However, E. coli is still an important cause of human illness in the United States. More information about E. coli, and steps people can take to reduce their risk of infection, can be found on the CDC E. coli Web Page.

CDC collaborated with public health officials in 9 states to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli (STEC) O145 infections. Public health investigators used DNA “fingerprints” of STEC bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may have been part of this outbreak. They used data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

A total of 18 individuals infected with the outbreak strain of STEC O145 were reported from 9 states. The number of ill persons identified in each state with the outbreak strain was as follows: Alabama (2), California (1), Florida (1), Georgia (5), Kentucky (1), Louisiana (5), Maryland (1), Tennessee (1), and Virginia (1).

Among 18 persons for whom information was available, illness onsets ranged from April 15, 2012 to June 12, 2012. Ill persons ranged in age from 1 to 79 years, and the median age was 33 years. Seventy-eight percent of patients were female. Four patients were hospitalized. One death was reported in Louisiana.

CDC initiated an investigation into this outbreak of illnesses on May 14, 2012 when six ill persons had been reported to CDC PulseNet from two states. CDC and state public health officials interviewed ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness. Based on interviews of 15 ill persons, a source for these infections was not identified.

A total of 18 persons infected with the outbreak strain of STEC O145 were identified in 9 states: Alabama (2), California (1), Florida (1), Georgia (5), Kentucky (1), Louisiana (5), Maryland (1), Tennessee (1), and Virginia (1). Since the last update 3 new ill persons were identified in 3 states: Kentucky (1), Maryland (1), and Virginia (1).

Among persons for whom information was available, illness onset dates ranged from April 15, 2012 to June 12, 2012. Ill persons ranged in age from 1 year to 79 years, with a median age of 33 years; 78% were female. Four ill persons were hospitalized. One death was reported in Louisiana.

CDC and state public health officials interviewed ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness. Based on interviews of 15 ill persons, a source for these infections was not identified.

A total of 15 persons infected with the outbreak strain of STEC O145 infection have been identified in 6 states: Alabama (2), California (1), Florida (1), Georgia (5), Louisiana (5), and Tennessee (1). Since the last update one new ill person has been identified in Louisiana with a reported illness onset of April 21, 2012. This is during the same time period as other ill persons in this outbreak.

Among persons for whom information is available, illness onset dates range from April 15, 2012 to May 12, 2012. Ill persons range in age from 1 year to 79 years old, with a median age of 31 years old; 73% are female. Four ill persons have been hospitalized. One death has been reported in Louisiana.

Illnesses that occurred after May 5, 2012 might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported.

It has been approximately 6 weeks since the last illness onset among reported cases.  Although this indicates that the outbreak could be over, CDC continues to work with state public health officials to identify additional cases and the source of these STEC O145 infections.

State public health officials have been interviewing ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness.  Based on interviews of 12 ill persons to date, a source for these infections has not been identified.

CDC is collaborating with public health officials in multiple states to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli serogroup O145 (STEC O145) infections. Public health investigators are using DNA "fingerprints" of E. coli bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may be part of this outbreak. They are using data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

The type of bacteria responsible for this outbreak is among those referred to as Shiga toxin-producing E. coli or STEC.  STEC bacteria are grouped by serogroups (e.g., O157 or O145). The STEC serogroup found most commonly in U.S. patients is E. coli O157. Other E. coli serogroups in the STEC group, including O145, are sometimes called "non-O157 STECs." Some types of STEC frequently cause severe disease, including bloody diarrhea and hemolytic uremic syndrome (HUS) which is a type of kidney failure.  Currently, there are limited public health surveillance data on the occurrence of non-O157 STECs, including STEC O145; many STEC O145 infections may go undiagnosed or unreported. Compared with STEC O157 infections, identification of non-O157 STEC infections is more complex.  First, clinical laboratories must test stool samples for the presence of Shiga toxins. Then, the positive samples must be sent to public health laboratories to look for non-O157 STEC. Clinical laboratories typically cannot identify non-O157 STEC.  The STEC O145 PFGE pattern in this outbreak has not been seen in PulseNet before.

CDC initiated an investigation into this cluster of illnesses on May 14, 2012.  At that time, six ill persons had been reported to CDC PulseNet from two states during May 3, 2012 to May 9, 2012. Although the most recent report of an illness to CDC was on June 4, 2012, their onset of illness occurred before May 10, 2012  and was during same period as other ill persons in this outbreak.

A total of 14 persons infected with the outbreak strain of STEC O145 infection have been identified in 6 states: Alabama (2), California (1), Florida (1), Georgia (5), Louisiana (4), and Tennessee (1).  Among persons for whom information is available, illness onset dates range from April 15, 2012 to May 12, 2012. The time from the beginning of a patient's illness to the confirmation that he or she was part of an outbreak is typically about 2-3 weeks. Please see the E. coli Outbreak Investigations: Timeline for Reporting Cases for more details.  Ill persons range in age from 1 year to 79 years old, with a median age of 33 years old; 79% are female. Three ill persons have been hospitalized; one death has been reported in Louisiana.

It has been approximately 4 weeks since the last illness onset among reported cases.  Although this indicates that the outbreak could be over, CDC continues to work with state public health officials to identify additional cases and the source of these STEC O145 infections.

State public health officials have been interviewing ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness.  Based on interviews of 10 ill persons to date, a source for these infections has not been identified.

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April 26, 2013 [Investigative Update]: Multistate Outbreak of Shiga toxin-producing Escherichia coli O121 Infections Linked to Farm Rich Brand Frozen Food Products

This particular outbreak appears to be over. However, E. coli is still an important cause of human illness in the United States. More information about E. coli, and steps people can take to reduce their risk of infection, can be found on the CDC E. coli Web Page.

CDC collaborated with public health officials in several states, the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS), and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli O121 (STEC O121) infections linked to Farm Rich brand frozen food products produced by Rich Products Corporation of Buffalo, New York.

Public health investigators used DNA "fingerprints" of E. coli bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis (PFGE) to identify cases of illness that were part of this outbreak. They used data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

A total of 35 individuals infected with the outbreak strain of STEC O121 were reported from 19 states. The number of ill persons identified in each state was as follows: Alabama (1), Arkansas (1), California (1), Colorado (1), Florida (2), Illinois (2), Indiana (2), Michigan (3), Missouri (1), Mississippi (1), New York (4), Ohio (6), Pennsylvania (1), South Dakota (1), Texas (3), Utah (1), Virginia (1), Washington (1), and Wisconsin (2).

Illness onset dates ranged from December 30, 2012 to April 15, 2013. Ill persons ranged in age from less than 1 year to 75 years, with a median age of 17 years. Eighty-two percent of ill persons were 21 years of age or younger. Sixty percent of ill persons were female. Among 29 persons for whom information was available, 9 (31%) were hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths were reported.

This outbreak appears to be over. However, many of these products have a long shelf-life, and they may still be in peoples’ freezers. Consumers unaware of the recall could continue to eat these products and potentially get sick.

E. coli is an important cause of human illness in the United States. More information about E. coli and steps people can take to reduce their risk for infection can be found on the CDC E. coli homepage.

Epidemiologic, laboratory, and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies linked this outbreak to Farm Rich brand frozen food products.

State and federal public health officials interviewed ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness. Twenty-four (100%) of 24 ill persons interviewed reported consuming frozen food products. Thirteen (68%) of 19 ill persons reported consuming Farm Rich brand frozen food products.

The outbreak strain of STEC O121 was identified in two different Farm Rich brand frozen products collected from the homes of two ill persons in New York and Texas.

On April 4, 2013, Rich Products Corporation recalled all of its Farm Rich, Market Day, and Schwan’s brand frozen food products produced at its Waycross, Georgia plant between June 1, 2011 and March 29, 2013 due to possible contamination with E. coli O121.

USDA-FSIS and FDA investigated suppliers of the common ingredients in the various types of Farm Rich brand frozen products consumed by ill persons, but the source of contamination was not identified. Rich Products Corporation is not currently producing products at its Waycross, Georgia plant, while the company continues to work with USDA-FSIS to develop a plan to make food safety improvements.

A total of 35 individuals infected with the outbreak strain of STEC O121 were reported from 19 states. There were no new illnesses reported since the last update.

Illness onset dates ranged from December 30, 2012 to April 15, 2013. Ill persons ranged in age from less than 1 year to 75 years, with a median age of 17 years. Eighty-two percent of ill persons were 21 years of age or younger. Sixty percent of ill persons were female. Among 29 persons for whom information was available, 9 (31%) were hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths were reported.

A total of 35 individuals infected with the outbreak strain of STEC O121 have been reported from 19 states. Three additional ill persons have been reported from Missouri (1) and Ohio (2).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to April 15, 2013. Ill persons range in age from one year to 75 years, with a median age of 17 years. Eighty-two percent of ill persons are 21 years of age or younger. Sixty percent of ill persons are female. Among 29 persons with available information, 9 (31%) reported being hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths have been reported.

Illnesses that occurred after April 10, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Twenty-four (100%) of 24 ill persons interviewed reported consuming frozen food products. Twelve (63%) of 19 ill persons reported consuming Farm Rich brand frozen food products. Investigations are ongoing to determine the specific types and sources of frozen food that might be linked with illness, as well as to determine which particular ingredients or components of these products may be contaminated.

A total of 32 individuals infected with the outbreak strain of STEC O121 have been reported from 18 states. Five additional ill persons have been reported from California (1), Colorado (1), Florida (2), and Ohio (1).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to April 2, 2013. Ill persons range in age from one year to 75 years, with a median age of 17 years. Eighty-one percent of ill persons are 21 years of age or younger. Fifty-six percent of ill persons are female. Among 26 persons with available information, 9 (35%) reported being hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths have been reported.

Illnesses that occurred after March 30, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

A total of 27 individuals infected with the outbreak strain of STEC O121 have been reported from 15 states. Three new cases have been reported from Illinois (1), Michigan (1) and New York (1).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to March 18, 2013. Ill persons range in age from 2 years to 75 years, with a median age of 17 years. Eighty-one percent of ill persons are 21 years of age or younger. Fifty-six percent of ill persons are female. Among 23 persons with available information, 8 (35%) reported being hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths have been reported.

Illnesses that occurred after March 10, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Twenty (100%) of 20 ill persons interviewed reported consuming frozen food products. Ten (63%) of 16 ill persons reported consuming Farm Rich brand frozen food products. Investigations are ongoing to determine the specific types and sources of frozen food that might be linked with illness, as well as to determine which particular ingredients or components of these products may be contaminated.

Testing conducted by the Outbreaks Section of the USDA-FSIS Eastern Laboratory identified the outbreak strain of STEC O121 from individually wrapped Farm Rich brand frozen mini pizza slices from an opened package collected from an ill person’s home in Texas. The frozen mini pizza slices were included in the products that were recalled on March 28, 2013.

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CDC is collaborating with public health officials in many states, the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS), and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli O121 (STEC O121) infections. Public health investigators are using DNA "fingerprints" of E. coli bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that could be part of this outbreak. They are using data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

The type of bacteria responsible for this outbreak is among those referred to as Shiga toxin-producing E. coli or STEC. Some types of STEC frequently cause severe disease, including bloody diarrhea and hemolytic uremic syndrome (HUS), which is a type of kidney failure. STEC bacteria are divided into serogroups (e.g., O157 or O121). E. coli O157 is the STEC serogroup found most commonly in U.S. patients. Other E. coli serogroups in the STEC group, including O121, are sometimes called "non-O157 STECs." Because clinical laboratories typically cannot directly identify non-O157 STEC serogroups, they must first test stool samples for the presence of Shiga toxins.  Then, the positive samples must be sent to public health laboratories to look for non-O157 STEC. In recent years, the number of clinical laboratories that test for Shiga toxin has increased greatly, but some laboratories still do not perform these tests. Because of these complexities, many non-O157 STEC infections are probably not identified. The STEC O121 PFGE pattern in this outbreak is rare. In the past it has been seen less than 30 times in PulseNet.

A total of 24 individuals infected with the outbreak strain of STEC O121 have been reported from 15 states. The number of ill persons identified in each state is as follows: Alabama (1), Arkansas (1), Illinois (1), Indiana (2), Michigan (2), Mississippi (1), New York (3), Ohio (3), Pennsylvania (1), South Dakota (1), Texas (3), Utah (1), Virginia (1), Washington (1), and Wisconsin (2).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to March 9, 2013. Ill persons range in age from 2 years to 75 years, with a median age of 17 years. Seventy-eight percent of ill persons are 21 years of age or younger. Sixty-three percent of ill persons are female. Among 21 persons with available information, 7 (33%) reported being hospitalized. One ill person developed HUS, and no deaths have been reported.

The outbreak can be visually described with a chart showing the number of people who became ill each day or week. This chart is called an epi curve. Illnesses that occurred after March 1, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 3 weeks. For more details, please see Timeline for Reporting E. coli Cases.

Epidemiologic, laboratory, and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies indicate that Farm Rich brand frozen food products are one likely source of this outbreak of STEC O121 infections.

In interviews, ill persons answered questions about food consumed and other exposures during the week before becoming ill. Eighteen (100%) of 18 ill persons interviewed reported consuming frozen food products. Eight (57%) of 14 ill persons reported consuming Farm Rich brand frozen food products. Investigations are ongoing to determine the specific types and sources of frozen food that might be linked with illness, as well as to determine which particular ingredients or components of these products may be contaminated.

The New York State Department of Health, Wadsworth Center Laboratory, identified the outbreak strain of E. coli O121 in an opened package of Farm Rich brand frozen mini chicken and cheese quesadillas from an ill person’s home.

CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill persons and to interview ill persons about foods eaten before becoming ill. FSIS and FDA are continuing to work closely with CDC and state partners during this investigation.

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May 10, 2013 [Investigative Update]: Multistate Outbreak of Shiga toxin-producing Escherichia coli O121 Infections Linked to Farm Rich Brand Frozen Food Products

This particular outbreak appears to be over. However, E. coli is still an important cause of human illness in the United States. More information about E. coli, and steps people can take to reduce their risk of infection, can be found on the CDC E. coli Web Page.

CDC collaborated with public health officials in several states, the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS), and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli O121 (STEC O121) infections linked to Farm Rich brand frozen food products produced by Rich Products Corporation of Buffalo, New York.

Public health investigators used DNA "fingerprints" of E. coli bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis (PFGE) to identify cases of illness that were part of this outbreak. They used data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

A total of 35 individuals infected with the outbreak strain of STEC O121 were reported from 19 states. The number of ill persons identified in each state was as follows: Alabama (1), Arkansas (1), California (1), Colorado (1), Florida (2), Illinois (2), Indiana (2), Michigan (3), Missouri (1), Mississippi (1), New York (4), Ohio (6), Pennsylvania (1), South Dakota (1), Texas (3), Utah (1), Virginia (1), Washington (1), and Wisconsin (2).

Illness onset dates ranged from December 30, 2012 to April 15, 2013. Ill persons ranged in age from less than 1 year to 75 years, with a median age of 17 years. Eighty-two percent of ill persons were 21 years of age or younger. Sixty percent of ill persons were female. Among 29 persons for whom information was available, 9 (31%) were hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths were reported.

This outbreak appears to be over. However, many of these products have a long shelf-life, and they may still be in peoples’ freezers. Consumers unaware of the recall could continue to eat these products and potentially get sick.

E. coli is an important cause of human illness in the United States. More information about E. coli and steps people can take to reduce their risk for infection can be found on the CDC E. coli homepage.

Epidemiologic, laboratory, and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies linked this outbreak to Farm Rich brand frozen food products.

State and federal public health officials interviewed ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness. Twenty-four (100%) of 24 ill persons interviewed reported consuming frozen food products. Thirteen (68%) of 19 ill persons reported consuming Farm Rich brand frozen food products.

The outbreak strain of STEC O121 was identified in two different Farm Rich brand frozen products collected from the homes of two ill persons in New York and Texas.

On April 4, 2013, Rich Products Corporation recalled all of its Farm Rich, Market Day, and Schwan’s brand frozen food products produced at its Waycross, Georgia plant between June 1, 2011 and March 29, 2013 due to possible contamination with E. coli O121.

USDA-FSIS and FDA investigated suppliers of the common ingredients in the various types of Farm Rich brand frozen products consumed by ill persons, but the source of contamination was not identified. Rich Products Corporation is not currently producing products at its Waycross, Georgia plant, while the company continues to work with USDA-FSIS to develop a plan to make food safety improvements.

A total of 35 individuals infected with the outbreak strain of STEC O121 were reported from 19 states. There were no new illnesses reported since the last update.

Illness onset dates ranged from December 30, 2012 to April 15, 2013. Ill persons ranged in age from less than 1 year to 75 years, with a median age of 17 years. Eighty-two percent of ill persons were 21 years of age or younger. Sixty percent of ill persons were female. Among 29 persons for whom information was available, 9 (31%) were hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths were reported.

A total of 35 individuals infected with the outbreak strain of STEC O121 have been reported from 19 states. Three additional ill persons have been reported from Missouri (1) and Ohio (2).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to April 15, 2013. Ill persons range in age from one year to 75 years, with a median age of 17 years. Eighty-two percent of ill persons are 21 years of age or younger. Sixty percent of ill persons are female. Among 29 persons with available information, 9 (31%) reported being hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths have been reported.

Illnesses that occurred after April 10, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Twenty-four (100%) of 24 ill persons interviewed reported consuming frozen food products. Twelve (63%) of 19 ill persons reported consuming Farm Rich brand frozen food products. Investigations are ongoing to determine the specific types and sources of frozen food that might be linked with illness, as well as to determine which particular ingredients or components of these products may be contaminated.

A total of 32 individuals infected with the outbreak strain of STEC O121 have been reported from 18 states. Five additional ill persons have been reported from California (1), Colorado (1), Florida (2), and Ohio (1).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to April 2, 2013. Ill persons range in age from one year to 75 years, with a median age of 17 years. Eighty-one percent of ill persons are 21 years of age or younger. Fifty-six percent of ill persons are female. Among 26 persons with available information, 9 (35%) reported being hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths have been reported.

Illnesses that occurred after March 30, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

A total of 27 individuals infected with the outbreak strain of STEC O121 have been reported from 15 states. Three new cases have been reported from Illinois (1), Michigan (1) and New York (1).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to March 18, 2013. Ill persons range in age from 2 years to 75 years, with a median age of 17 years. Eighty-one percent of ill persons are 21 years of age or younger. Fifty-six percent of ill persons are female. Among 23 persons with available information, 8 (35%) reported being hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths have been reported.

Illnesses that occurred after March 10, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Twenty (100%) of 20 ill persons interviewed reported consuming frozen food products. Ten (63%) of 16 ill persons reported consuming Farm Rich brand frozen food products. Investigations are ongoing to determine the specific types and sources of frozen food that might be linked with illness, as well as to determine which particular ingredients or components of these products may be contaminated.

Testing conducted by the Outbreaks Section of the USDA-FSIS Eastern Laboratory identified the outbreak strain of STEC O121 from individually wrapped Farm Rich brand frozen mini pizza slices from an opened package collected from an ill person’s home in Texas. The frozen mini pizza slices were included in the products that were recalled on March 28, 2013.

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CDC is collaborating with public health officials in many states, the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS), and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli O121 (STEC O121) infections. Public health investigators are using DNA "fingerprints" of E. coli bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that could be part of this outbreak. They are using data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

The type of bacteria responsible for this outbreak is among those referred to as Shiga toxin-producing E. coli or STEC. Some types of STEC frequently cause severe disease, including bloody diarrhea and hemolytic uremic syndrome (HUS), which is a type of kidney failure. STEC bacteria are divided into serogroups (e.g., O157 or O121). E. coli O157 is the STEC serogroup found most commonly in U.S. patients. Other E. coli serogroups in the STEC group, including O121, are sometimes called "non-O157 STECs." Because clinical laboratories typically cannot directly identify non-O157 STEC serogroups, they must first test stool samples for the presence of Shiga toxins.  Then, the positive samples must be sent to public health laboratories to look for non-O157 STEC. In recent years, the number of clinical laboratories that test for Shiga toxin has increased greatly, but some laboratories still do not perform these tests. Because of these complexities, many non-O157 STEC infections are probably not identified. The STEC O121 PFGE pattern in this outbreak is rare. In the past it has been seen less than 30 times in PulseNet.

A total of 24 individuals infected with the outbreak strain of STEC O121 have been reported from 15 states. The number of ill persons identified in each state is as follows: Alabama (1), Arkansas (1), Illinois (1), Indiana (2), Michigan (2), Mississippi (1), New York (3), Ohio (3), Pennsylvania (1), South Dakota (1), Texas (3), Utah (1), Virginia (1), Washington (1), and Wisconsin (2).

Among persons for whom information is available, illness onset dates range from December 30, 2012 to March 9, 2013. Ill persons range in age from 2 years to 75 years, with a median age of 17 years. Seventy-eight percent of ill persons are 21 years of age or younger. Sixty-three percent of ill persons are female. Among 21 persons with available information, 7 (33%) reported being hospitalized. One ill person developed HUS, and no deaths have been reported.

The outbreak can be visually described with a chart showing the number of people who became ill each day or week. This chart is called an epi curve. Illnesses that occurred after March 1, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 3 weeks. For more details, please see Timeline for Reporting E. coli Cases.

Epidemiologic, laboratory, and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies indicate that Farm Rich brand frozen food products are one likely source of this outbreak of STEC O121 infections.

In interviews, ill persons answered questions about food consumed and other exposures during the week before becoming ill. Eighteen (100%) of 18 ill persons interviewed reported consuming frozen food products. Eight (57%) of 14 ill persons reported consuming Farm Rich brand frozen food products. Investigations are ongoing to determine the specific types and sources of frozen food that might be linked with illness, as well as to determine which particular ingredients or components of these products may be contaminated.

The New York State Department of Health, Wadsworth Center Laboratory, identified the outbreak strain of E. coli O121 in an opened package of Farm Rich brand frozen mini chicken and cheese quesadillas from an ill person’s home.

CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill persons and to interview ill persons about foods eaten before becoming ill. FSIS and FDA are continuing to work closely with CDC and state partners during this investigation.

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June 22, 2012 (Investigation Update): Multistate Outbreak of Shiga Toxin-producing Escherichia coli O145 Infections

This particular outbreak appears to be over. However, E. coli is still an important cause of human illness in the United States. More information about E. coli, and steps people can take to reduce their risk of infection, can be found on the CDC E. coli Web Page.

CDC collaborated with public health officials in 9 states to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli (STEC) O145 infections. Public health investigators used DNA “fingerprints” of STEC bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may have been part of this outbreak. They used data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

A total of 18 individuals infected with the outbreak strain of STEC O145 were reported from 9 states. The number of ill persons identified in each state with the outbreak strain was as follows: Alabama (2), California (1), Florida (1), Georgia (5), Kentucky (1), Louisiana (5), Maryland (1), Tennessee (1), and Virginia (1).

Among 18 persons for whom information was available, illness onsets ranged from April 15, 2012 to June 12, 2012. Ill persons ranged in age from 1 to 79 years, and the median age was 33 years. Seventy-eight percent of patients were female. Four patients were hospitalized. One death was reported in Louisiana.

CDC initiated an investigation into this outbreak of illnesses on May 14, 2012 when six ill persons had been reported to CDC PulseNet from two states. CDC and state public health officials interviewed ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness. Based on interviews of 15 ill persons, a source for these infections was not identified.

A total of 18 persons infected with the outbreak strain of STEC O145 were identified in 9 states: Alabama (2), California (1), Florida (1), Georgia (5), Kentucky (1), Louisiana (5), Maryland (1), Tennessee (1), and Virginia (1). Since the last update 3 new ill persons were identified in 3 states: Kentucky (1), Maryland (1), and Virginia (1).

Among persons for whom information was available, illness onset dates ranged from April 15, 2012 to June 12, 2012. Ill persons ranged in age from 1 year to 79 years, with a median age of 33 years; 78% were female. Four ill persons were hospitalized. One death was reported in Louisiana.

CDC and state public health officials interviewed ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness. Based on interviews of 15 ill persons, a source for these infections was not identified.

A total of 15 persons infected with the outbreak strain of STEC O145 infection have been identified in 6 states: Alabama (2), California (1), Florida (1), Georgia (5), Louisiana (5), and Tennessee (1). Since the last update one new ill person has been identified in Louisiana with a reported illness onset of April 21, 2012. This is during the same time period as other ill persons in this outbreak.

Among persons for whom information is available, illness onset dates range from April 15, 2012 to May 12, 2012. Ill persons range in age from 1 year to 79 years old, with a median age of 31 years old; 73% are female. Four ill persons have been hospitalized. One death has been reported in Louisiana.

Illnesses that occurred after May 5, 2012 might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported.

It has been approximately 6 weeks since the last illness onset among reported cases.  Although this indicates that the outbreak could be over, CDC continues to work with state public health officials to identify additional cases and the source of these STEC O145 infections.

State public health officials have been interviewing ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness.  Based on interviews of 12 ill persons to date, a source for these infections has not been identified.

CDC is collaborating with public health officials in multiple states to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli serogroup O145 (STEC O145) infections. Public health investigators are using DNA "fingerprints" of E. coli bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may be part of this outbreak. They are using data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

The type of bacteria responsible for this outbreak is among those referred to as Shiga toxin-producing E. coli or STEC.  STEC bacteria are grouped by serogroups (e.g., O157 or O145). The STEC serogroup found most commonly in U.S. patients is E. coli O157. Other E. coli serogroups in the STEC group, including O145, are sometimes called "non-O157 STECs." Some types of STEC frequently cause severe disease, including bloody diarrhea and hemolytic uremic syndrome (HUS) which is a type of kidney failure.  Currently, there are limited public health surveillance data on the occurrence of non-O157 STECs, including STEC O145; many STEC O145 infections may go undiagnosed or unreported. Compared with STEC O157 infections, identification of non-O157 STEC infections is more complex.  First, clinical laboratories must test stool samples for the presence of Shiga toxins. Then, the positive samples must be sent to public health laboratories to look for non-O157 STEC. Clinical laboratories typically cannot identify non-O157 STEC.  The STEC O145 PFGE pattern in this outbreak has not been seen in PulseNet before.

CDC initiated an investigation into this cluster of illnesses on May 14, 2012.  At that time, six ill persons had been reported to CDC PulseNet from two states during May 3, 2012 to May 9, 2012. Although the most recent report of an illness to CDC was on June 4, 2012, their onset of illness occurred before May 10, 2012  and was during same period as other ill persons in this outbreak.

A total of 14 persons infected with the outbreak strain of STEC O145 infection have been identified in 6 states: Alabama (2), California (1), Florida (1), Georgia (5), Louisiana (4), and Tennessee (1).  Among persons for whom information is available, illness onset dates range from April 15, 2012 to May 12, 2012. The time from the beginning of a patient's illness to the confirmation that he or she was part of an outbreak is typically about 2-3 weeks. Please see the E. coli Outbreak Investigations: Timeline for Reporting Cases for more details.  Ill persons range in age from 1 year to 79 years old, with a median age of 33 years old; 79% are female. Three ill persons have been hospitalized; one death has been reported in Louisiana.

It has been approximately 4 weeks since the last illness onset among reported cases.  Although this indicates that the outbreak could be over, CDC continues to work with state public health officials to identify additional cases and the source of these STEC O145 infections.

State public health officials have been interviewing ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness.  Based on interviews of 10 ill persons to date, a source for these infections has not been identified.

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December 10, 2012 [Final Announcement]: Multistate Outbreak of Shiga Toxin-producing Escherichia coli O157:H7 Infections

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