Pizza Ranch desserts containing flour dough have been linked to E. coli O157:H7 food poisonings in nine states, federal officials say. The outbreak started in December, mainly among people who’d eaten at the Iowa-based chain’s restaurants.  The CDC reports that 13 people were sickened in Illinois, Iowa, Kansas, Minnesota, North Carolina, Nebraska, New Jersey, South Dakota and Wisconsin. Minnesota. Nine of the people said they recently had eaten at Pizza Ranches.  Two children, in Kansas and Nebraska, suffered kidney failure (hemolytic uremic syndrome) and had to be hospitalized.

In an article in Clinical Infections Diseases dug a bit deeper into the Nestle Tollhouse Cookie Dough E. coli O157:H7 outbreak of 2009.  Seventy-seven patients with illnesses during the period 16 March–8 July 2009 were identified from 30 states; 35 were hospitalized, 10 developed hemolytic-uremic syndrome, and none died. Sixty-six percent of patients were <19 years; 71% were female. In the case-control study, 33 of 35 case patients (94%) consumed ready-to-bake commercial prepackaged cookie dough, compared with 4 of 36 controls (11%) (matched odds ratio = 41.3; P < .001); no other reported exposures were significantly associated with illness. Among case patients consuming cookie dough, 94% reported brand A. Three nonoutbreak STEC strains were isolated from brand A cookie dough. The investigation led to a recall of 3.6 million packages of brand A cookie dough and a product reformulation.

A more likely source of contamination is that a contaminated ingredient was used in the product. Ready-to-bake cookie dough is not a ready-to-eat food and contains several ingredients, including flour, pasteurized eggs, chocolate chips, molasses, sugar, margarine, baking soda, and vanillin/vanilla extract. The eggs used in brand A products were pasteurized, making eggs a less likely vehicle unless there was a pasteurization failure; this was not identified during the investigation. Molasses, sugar, baking soda, and margarine, which undergo pathogen kill steps during processing, were also considered less likely sources of contamination.

The possibility of contaminated chocolate chips was considered, because most patients reported consuming chocolate chip–containing varieties of brand A cookie dough. Although chocolate has never been linked to past E. coli O157 outbreaks, it has been implicated in Salmonella outbreaks, and Baylis et al, documented survival of E. coli O157 in artificially contaminated chocolate for up to 366 days. However, because chocolate chip varieties comprise the majority of cookie dough sales, it would not be unusual that chocolate chip varieties were reported by most patients. The chocolate chips that company A uses in its ready-to-bake cookie dough and the brand A chocolate chips sold to consumers for home baking are manufactured in the same facility, but there was no evidence of an E. coli O157 outbreak among consumers using these chocolate chips. Study results also support that chocolate chips were not the source of contamination: consumption of a chocolate chip variety of cookie dough was less strongly associated with illness compared with consumption of any cookie dough, whereas consumption of chocolate chips in non–cookie dough products was not significantly associated with illness. Flour, a raw agricultural product (ie, does not undergo processing to kill pathogens), was also considered as a possible source of contamination. Low levels of Salmonella contamination can occur in wheat flour, and flour and flour-based mixes have been implicated in foodborne Salmonella outbreaks. Generic E. coli species have also been found in flour; 1 US study found E. coli in 12.8% of commercial wheat flour samples examined. Although our investigation found no conclusive evidence that contaminated flour was the source of this outbreak, contaminated flour remains a prime suspect for introducing the pathogen to the product. Because flour is frequently purchased in large quantities by manufacturers for use in food products, if contaminated flour were responsible, a single purchase of contaminated flour might have been used to manufacture multiple lots and varieties of dough over a period of time. This would be consistent with UBDs on packages obtained from patients (23 June–11 August 2009), suggesting that product contamination occurred over several weeks.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of E. coli outbreaks and hemolytic uremic syndrome (HUS). The E. coli lawyers of Marler Clark have represented thousands of victims of E. coli and other foodborne illness infections and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our E. coli lawyers have litigated E. coli and HUS cases stemming from outbreaks traced to ground beef, raw milk, lettuce, spinach, sprouts, and other food products.  The law firm has brought E. coli lawsuits against such companies as Jack in the Box, Dole, ConAgra, Cargill, and Jimmy John’s.  We have proudly represented such victims as Brianne Kiner, Stephanie Smith and Linda Rivera.

If you or a family member became ill with an E. coli infection or HUS after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark E. coli attorneys for a free case evaluation.