This is a complex and ongoing multistate investigation of listeriosis occurring over an extended period. Several strains of Listeria monocytogenes are involved in this outbreak. Information indicates that various Blue Bell brand products produced in facilities in Texas and Oklahoma are the source of this outbreak.
The outbreak consists of two clusters of people infected with several strains of Listeria monocytogenes that were also found in products made at two Blue Bell facilities in Texas and Oklahoma. Eight people with Listeria infections related to this outbreak have been confirmed from two states: Kansas (5) and Texas (3). Three deaths were reported from Kansas.
Cluster 1 consists of five patients reported from Kansas during January 2014 through January 2015 who were all hospitalized at a single hospital for unrelated problems before developing listeriosis. Of the four ill people for whom information is available on the foods eaten in the month before Listeria infection, all consumed milkshakes made at the hospital with a Blue Bell brand ice cream product called “Scoops.” Whole genome sequences of Listeria monocytogenes strains isolated from four of the patients were found to be highly related to sequences of Listeria strains isolated from “Scoops” and two other products made on the same line at the company’s Texas facility. These products were recalled by Blue Bell Creameries on March 13, 2015.
Cluster 2 consists of three patients reported from Texas during 2011 through 2014 who were all hospitalized for unrelated problems before developing listeriosis. Whole genome sequences of their Listeria monocytogenes strains were nearly identical to Listeria strains isolated from ice cream produced at the Blue Bell Creameries’ Oklahoma facility.
Three additional patients with listeriosis during 2010 through 2012 whose isolates have PFGE patterns similar to those of others in the cluster have been identified in the PulseNet database; further molecular laboratory testing is under way to determine whether these illnesses may be related to this outbreak. Results of this testing will be reported once they are available.
The Food and Drug Administration (FDA) recently isolated Listeria monocytogenes strains from a 1-pint container of Blue Bell brand banana pudding ice cream collected from the company’s Oklahoma production facility. This contaminated product was produced in the same facility but on a different line from the 3 oz. institutional/food service ice cream cups previously recalled.
On April 3, 2015, Blue Bell Creameries reported that they had voluntarily suspended operations at their Oklahoma production facility. On April 7, 2015, Blue Bell Creameries announced a third product recall that included banana pudding ice cream pints and other products made on the same line that were produced between February 12, 2015 and March 27, 2015 at their Oklahoma facility. Further testing of environmental and product samples from Blue Bell Creamery facilities is ongoing.
Blue Bell Creameries previously issued two other recalls. On March 13, 2015, the company removed from the market “Scoops” and other products made on the same line at their Texas facility. On March 23, 2015, the company recalled 3 oz. institutional/food service ice cream cups of chocolate, strawberry, and vanilla flavors made at their Oklahoma facility.
In an unrelated investigation, the South Carolina Department of Health and Environmental Control isolated Listeria monocytogenes from the following Blue Bell brand single-serving ice cream products collected from a distribution center in 2015: Chocolate Chip Country Cookie Sandwiches and Great Divide Bars. In response to the findings in South Carolina, the Texas Department of State Health Services collected product samples from the Blue Bell Creameries production facility in Brenham, Texas. These samples yielded Listeria monocytogenes from the same two products tested by South Carolina and also from the ice cream Scoops, which is made on the same production line. Listeria monocytogenes was not found in other Blue Bell brand ice cream products tested.
Three strains of Listeria monocytogenes isolated from the ice cream samples had PFGE patterns that were indistinguishable from those of Listeria bacteria obtained from samples from four patients. Listeria monocytogenes isolates with four other PFGE patterns were also isolated from the ice cream samples. Invoices provided by the hospital to the Kansas Department of Health and Environment indicate that the Blue Bell brand ice cream Scoops used in the patients’ milkshakes came from Blue Bell Creamery’s facility in Texas. Whole genome sequencing of the Listeria monocytogenes isolates obtained from the ice cream is in progress.
One patient’s Listeria monocytogenes strain has a PFGE pattern that does not match any identified in an ice cream sample. However, epidemiologic evidence, including acquiring infection at the same hospital as the other patients and consumption of the ice cream products, suggests that this illness may be related. CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify any additional ill persons whose illnesses may be related to this outbreak.
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