FDA Investigates Multistate Outbreak of E. coli O121 Infections Linked to Consumption of Raw Clover Sprouts
August 1, 2014
- What was the Problem and What was Done?
- What are the Symptoms of E. coli O121?
- Who is at Risk?
- What Do Consumers Need To Do?
- Who Should be Contacted?
The U.S. Food and Drug Administration (FDA) along with the Centers for Disease Control and Prevention (CDC) and state and local officials investigated a multi-state outbreak of Escherichia coli (E. coli) O121 infections.
What was the Problem and What was Done?
The U.S. Food and Drug Administration (FDA) along with the Centers for Disease Control and Prevention (CDC) and state and local officials are investigating a multi-state outbreak of Escherichia coli (E. coli) O121 infections linked to the consumption of raw clover sprouts from Evergreen Fresh Sprouts LLC of Moyie Springs, Idaho.
According to the CDC , as of July 31, 2014, a total of 19 persons infected with the outbreak strain of E. coli O121 were reported from five states. The number of ill persons identified in each state was as follows: California (1), Idaho (3), Michigan (1), Montana (2), Utah (1), and Washington (11). Forty-four percent (44%) of ill persons were hospitalized. No ill persons developed hemolytic uremic syndrome (HUS), and no deaths were reported.
Results from state and local epidemiologic investigations indicate a strong link to eating raw clover sprouts. In interviews, 13 (81%) of 16 ill persons reported eating raw clover sprouts in the week before becoming ill. This proportion is significantly higher than results from a survey of healthy persons in which 8% reported eating raw clover sprouts in the week before they were interviewed.
On May 21 and May 22, the FDA, the Washington State Department of Health (WDOH), and the Idaho Department of Health and Welfare (IDHW) warned consumers not to eat raw clover sprouts from Evergreen Fresh Sprouts LLC. According to state authorities, five cases were reported in Spokane County, Washington; two in King County, Washington; and three in Kootenai County, Idaho.
WDOH reported that initial investigations indicate a strong link to eating raw clover spouts produced by Evergreen Fresh Sprouts, LLC of Idaho. Sprouts were eaten in sandwiches at several food establishments located in the states of Washington and Idaho, including Jimmy John’s Gourmet Sandwiches locations in King and Spokane counties, as well as two Pita Pit locations in Spokane County, and a Jimmy John’s location and Daanen’s Deli in Kootenai County. The restaurants where the cases reported eating raw clover sprouts have voluntarily suspended serving sprouts.
As part of the investigation, the FDA performed a traceback analysis and determined that Evergreen Sprouts LLC, in the time frame prior to the outbreak, supplied sprouts to seven restaurants at which 9 people who became ill during the outbreak reported eating before they became ill. Eight of the people who became ill recalled eating sprouts. This analysis used documents collected directly from the distributors and the grower, Evergreen Fresh Sprouts LLC, as well as documents collected by the states from the points of service.
The FDA also conducted an inspection of Evergreen Fresh Sprouts LLC’s operation on May 22-23, 2014; May 27-30, 2014, and June 6, 2014. At the time of the inspection, Evergreen Fresh Sprouts had already ceased the production of clover sprouts, but mung bean sprouts and alfalfa sprouts were still being produced. During the inspection, FDA investigators observed:
- Dead leg pipe ends which cannot be flushed, located inside the sprout growing/harvesting room. The pipes provide water to rinse and mist sprouts in the room.
- Apparent mold growth and dripping condensate on a water pipe that had separated from the drywall and was attached to the watering system in the sprout growing/harvesting room.
- Condensate dripping directly into sprouting vats containing growing sprouts.
- A rusty and corroded mung bean room watering system located directly above the mung beans, with a pipe attached to the system with an orange build up, being used to water the mung beans on at least four occasions.
- Two employees using tennis rackets with scratches, chips, frayed plastic, and sponge-type handles to scoop mung bean sprouts from the water in the harvester onto the belt which fed the sprouts into finished product storage bins and using the same rackets the following day in the bubbler during alfalfa sprout harvesting.
- An employee using a pitchfork with visible corroded metal and rough welds to transfer mung bean sprouts into plastic tubs, and the same pitchfork being stored in direct contact with mung bean sprouts during the harvesting process.
- Mung bean sprouts in direct contact with rusty and corroded clamps used to hold the growing cabin together during sprout growth in the mung bean room.
- Rough welds, debris, and apparent corroded areas inside the mung bean seed soak vat. An employee was using a squeegee with visible corroded metal and non-treated wood to agitate mung beans soaking inside the mung bean seed soak vat.
- Cracked, damaged, and chipped food contact surfaces on sprouting vats that contained growing sprouts, on storage bins that contained finished broccoli and alfalfa sprouts, and on mung bean growing cabins with mung beans present.
On June 26, 2014, the FDA and CDC held a meeting with the owner of Evergreen Fresh Sprouts LLC to advise the firm of FDA’s concerns that the seed lot used to grow clover sprouts linked to this outbreak may have been contaminated and to encourage Evergreen Fresh Sprouts to discontinue using that seed lot for producing clover sprouts for people to eat. At the end of the June 26th meeting, the owner of Evergreen Fresh Sprouts LLC informed the FDA that the firm planned to discontinue using the seed lot that was used to grow the sprouts linked to the outbreak.
On June 27, 2014, the FDA and CDC warned consumers not to eat raw clover sprouts produced by Evergreen Fresh Sprouts LLC. FDA and CDC stated that sprouts grown by this firm were linked to a multi-state outbreak of E.Coli O121 in May, and that the firm had reported further production and distribution of sprouts grown from the same seed lot that was associated with the outbreak.
FDA has received independent confirmation that, as of July 1, Evergreen Fresh Sprouts LLC no longer had the seed lot associated with the outbreak, and had received a new clover seed lot for sprouting purposes. It normally takes approximately one week to sprout the clover seed.
Seeds are considered the most likely source of contamination in most sprout-associated outbreaks. Microbial contamination in seed is not expected to be uniform but rather clustered and localized. When contamination occurs sporadically and at low levels, a negative test result is not a guarantee of the absence of disease causing germs in the seed lot. If there is reason to believe that a specific seed lot has been associated with foodborne illness, there is reason to believe that other parts of that lot may be contaminated. It is important to note that the environmental conditions that promote sprout growth will also promote the growth of disease-causing germs.
In sprout outbreaks where seed was considered to be the likely source of contamination, FDA has recommended that the firm no longer use the implicated seed lot for producing sprouts for people to eat. This recommendation is consistent with current sprout industry best practices.
On July 31, 2014, the CDC announced the outbreak appeared to be over.
- People usually get sick from STEC (Shiga toxin-producing E. coli) 2-8 days (average of 3-4 days) after swallowing the organism (germ).
- Most people infected with STEC develop diarrhea (often bloody) and abdominal cramps.
- Most people recover within a week.
- Some illnesses last longer and can be more severe, resulting in a type of kidney failure called hemolytic uremic syndrome (HUS).
- HUS can occur in people of any age, but is most common in young children under 5 years, older adults, and people with weakened immune systems.
- Symptoms of HUS can include fever, abdominal pain, pale skin tone, fatigue and irritability, small, unexplained bruises or bleeding from the nose and mouth, and decreased urination.
- People who experience these symptoms should seek emergency medical care immediately.
- STEC infection is usually diagnosed by testing of a stool sample for Shiga toxins.
- Clinical laboratories are required in some states to send Shiga toxin-positive specimens from ill people to the state public health laboratory for identification of STEC and PulseNet testing.
Who is at Risk?
People of any age can become infected. Very young children and the elderly are more likely than others to develop severe illness and HUS, but even healthy older children and young adults can become seriously ill. In this particular outbreak, the age range of ill patients is 22 – 45 years.
What Do Consumers Need To Do?
Consumers should always practice safe food handling and preparation measures. At home, keep raw meat, poultry, and seafood separate from produce and ready-to-eat foods, cook foods to the proper temperature; and refrigerate perishable foods (including sprouts) promptly. Wash hands, utensils, and surfaces with hot, soapy water before and after handling food.
Like any fresh produce that is consumed raw or lightly cooked, sprouts that are served on salads, wraps, sandwiches, and other foods may contain bacteria that can cause foodborne illness. Unlike other fresh produce, the warm and humid conditions used for sprouting are also ideal for the growth of bacteria, including Salmonella, Listeria, and E. coli. Any bacteria present can multiply dramatically during the sprouting process. (Organic or locally-grown sprouts are not necessarily less risky, and neither are sprouts grown at home.) Washing sprouts may reduce risk, but will not eliminate it.
- Children, older adults, pregnant women, and persons with weakened immune systems should avoid eating raw sprouts of any kind.
- Cooking sprouts thoroughly will kill any bacteria present and reduce the risk of illness.
- Persons who think they might have become ill from eating potentially contaminated sprouts should consult their health care provider.
- Consumers can request that raw sprouts not be added to food. If you purchase a sandwich or salad at a restaurant or delicatessen, and want to avoid sprouts, check to make sure that raw sprouts have not been added.
Who Should be Contacted?
Contact your healthcare provider if you have diarrhea that lasts for more than 3 days, or is accompanied by high fever, blood in the stool, or so much vomiting that you cannot keep liquids down and you pass very little urine.
The FDA encourages consumers with questions about food safety to call 1-888-SAFEFOOD Monday through Friday between 10 a.m. and 4 p.m. Eastern time, or to consult the fda.gov website: www.fda.gov.
The information in this release reflects the FDA’s best efforts to communicate what it has learned from the manufacturer and the state and local public health agencies involved in the investigation. The agency will update this page as more information becomes available.
- CDC: Multistate Outbreak of Shiga toxin-producing Escherichia coli O121 Infections Linked to Raw Clover Sprouts
- Foodsafety.gov: Food Poisoning - E. coli
- CDC: CDC E. coli homepage
- Foodsafety.gov: Sprouts: What You Should Know
- FDA: Safe Eats – Fruits, Veggies & Juices