Multistate Outbreak of E. coli O157:H7 Infections Linked to Eating Raw Refrigerated, Prepackaged Cookie Dough

Updated June 25, 2009

States Where Persons Infected with the Outbreak Strain of E. coli O157:H7 Live, United States, by State, March 1, 2009 to June 25, 2009

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Infections with the Outbreak Strain of E. coli O157:H7 By Date of Report to PulseNet

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CDC is collaborating with public health officials in many states, the United States Food and Drug Administration (FDA), and the United States Department of Agriculture Food Safety and Inspection Service (FSIS) to investigate an outbreak of E. coli O157:H7 infections.

As of Thursday, June 25, 2009, 69 persons infected with a strain of E. coli O157:H7 with a particular DNA fingerprint have been reported from 29 states. Of these, 46 have been confirmed by an advanced DNA test as having the outbreak strain; these 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), Iowa (2), Illinois (5), Kentucky (3), Massachusetts (4), Maryland (2), Maine (3), Minnesota (6), Missouri (1), 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 (6), and Wisconsin (1).

Ill persons range in age from 2 to 65 years; however, 64% are less than 19 years old; 73% are female. Thirty-four persons have been hospitalized, 9 developed hemolytic uremic syndrome (HUS); none have died. Reports of these infections increased above the expected baseline in May and continue into June.

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. CDC, the state health departments, and federal regulatory partners are working together in this ongoing investigation.

Clinical Features

Most people infected with E. coli O157:H7 develop diarrhea (often bloody) and abdominal cramps 2-8 days (average of 3-4 days) after swallowing the organism, but some illnesses last longer and are more severe. Infection is usually diagnosed by culture of a stool sample. Most people recover within a week, but some develop a severe infection. A type of kidney failure called hemolytic uremic syndrome (HUS) can begin as the diarrhea is improving; this can occur in people of any age but is most common in children under 5 years old and the elderly.

Advice to Consumers

The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention 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, restauranteurs, 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.

For More Information

• FDA press release*
• For more information on safe food handling practices, go to FDA - Eating Outdoors, Handling Food Safety: Food Facts*.
• Consumers who have additional questions about these products should contact Nestle consumer services at 1-800-559-5025 and/or visit their website at Nestlé Very Best Baking*.
• For a complete listing of the recalled products go to: Nestlé USA's Baking Division Initiates Voluntary Recall*
• For more information about E. coli O157:H7

Previous Updates

• June 19, 2009
• June 22, 2009

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