Outbreak of Escherichia coli O157:H7 Infections Associated
with Drinking Unpasteurized Commercial Apple Juice -- British
Columbia, California, Colorado, and Washington, October 1996
On October 30, 1996, the Seattle-King County Department of
Public Health and the Washington State Department of Health
reported an outbreak of Escherichia coli O157:H7 infections
epidemiologically associated with drinking Odwalla brand
unpasteurized apple juice or Odwalla juice mixtures containing
apple juice from a coffee shop chain, grocery stores, or other
locations. A case was defined as hemolytic uremic syndrome (HUS) or
a stool culture yielding E. coli O157:H7 in a person who became ill
after September 30, 1996, and drank Odwalla juice within 10 days
before illness onset. As of November 6, British Columbia,
California, Colorado, and Washington had reported a total of 45
cases.
The median age of the 28 case-patients for whom information
was reported was 5.0 years (range: 1-41 years); 15 (54%) were male.
HUS was diagnosed in 12 persons; none have died. One case of E.
coli O157:H7 infection occurred in a child who had onset of illness
in Illinois after drinking implicated juice in Washington. Another
patient with E. coli O157:H7 infection, not included in the total,
acquired illness by secondary transmission from a patient with
juice-associated infection. E. coli O157:H7 isolates cultured from
a previously unopened container of Odwalla apple juice had a DNA
"fingerprint" pattern (restriction fragment length polymorphism)
indistinguishable from case-related isolates.
Odwalla, Inc., has completed a voluntary nationwide recall of
all its products containing apple juice. Odwalla juice was
distributed to British Columbia, California, Colorado, Idaho,
Montana, Nevada, New Mexico, Oregon, Texas, and Washington.
Reported by: Dept of Environmental Health, Univ of Washington,
Seattle; Seattle-King County Dept of Public Health, Seattle;
Washington State Dept of Health. California State Dept of Health
Svcs. Colorado Dept of Public Health and Environment. British
Columbia Centre for Disease Control, Vancouver; Laboratory Centre
for Disease Control, Health Canada, Ottawa, Ontario. Center for
Food Safety and Applied Nutrition and Office of Regulatory Affairs,
Food and Drug Administration. Foodborne and Diarrheal Diseases Br,
Div of Bacterial and Mycotic Diseases, National Center for
Infectious Diseases, CDC.
Editorial Note
Editorial Note: Investigations are ongoing to determine the extent
of the outbreak and the specific mechanisms of contamination.
Health-care providers should consider infection with E. coli
O157:H7 in patients with diarrheal illness who were residents of or
travelers to British Columbia, California, Colorado, Idaho,
Montana, Nevada, New Mexico, Oregon, Texas, or Washington during
October and may have consumed Odwalla brand apple juice or Odwalla
juice mixtures containing apple juice. Possible cases should be
reported to local and state health departments.
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