Purpose: The purpose of this study was to analyze the outbreaks of dough and flour-associated STEC infections, and identify additional prevention efforts.
Methods: FDA’s Coordinated Outbreak Response and Evaluation Network (CORE) collected and compared surveillance information, epidemiological and laboratory data, and establishment inspectional information from these four outbreaks. By analyzing this information, CORE identified similarities and differences among the outbreaks.
Results: Observed differences included the type of product (e.g. flour, raw cookie dough, and undercooked dough products) and routes of exposure. It was determined that contamination has the potential to occur not only in multi-ingredient dough products, but also in flour. The exposure routes in these outbreaks included consumption of raw cookie dough and undercooked dough products, as well as improper handling of raw dough at the consumer and retail food service levels. FDA issued web postings notifying the public of the recalls and informing consumers and the of retail food service industry about the risk of consuming or improperly handling flour, raw dough, and undercooked dough products.
Significance: These outbreaks provided evidence of STEC exposure via consumption or improper handling of flour, raw and undercooked dough products and identified the need to further inform consumers and retail food service industry about safe handling of these products. The outbreak information suggests that educational outreach and expanded consumer messaging may prevent another similar outbreak. In response to this documented health risk, CORE began evaluating prevention options and efforts to coordinate the development and implementation of prevention initiatives.