What Happens When You Eat Raw Cookie Dough

Federal report focuses on ongoing pathogen threat from raw flour

FOOD SAFETY NEWS – Warnings are now appearing on the flaps of flour packages. “Cook before sneaking a taste,” says one. Another says “Flour is raw. Please cook fully before enjoying.”

And the April 23 edition of Morbidity and Mortality Weekly Report (MMWR) turned its “Note from the Field” section to a closer look at outbreaks involving flour.

“Multistate Outbreak of Escherichia coli O26 infections linked to Raw Flour — the United States, 2019” examines one such instance.

Here’s how it came down, according to the MMWR authors:

PulseNet, the molecular subtyping network for foodborne disease surveillance, on Feb. 20, 2019, identified six Shiga toxin–producing Escherichia coli (STEC) O26:H11 infections with the same pulsed-field gel electrophoresis (PFGE) pattern combination.

...article continued below
- Advertisement -

The PFGE pattern combination matched that of infections from a July 2018 outbreak associated with ground beef. In response, CDC initiated an investigation with federal, state, and local partners to identify the outbreak source and implement prevention measures.

The CDC defined the case as STEC O26 infection with an isolate matching the outbreak strain by PFGE or related by core genome multilocus sequence typing scheme (cgMLST), with dates of illness onset from Dec. 11, 2018 – May 21, 2019.

Investigators initially hypothesized that ground beef was the outbreak cause because of the PFGE match to the July 2018 outbreak and because in early interviews, patients commonly reported eating ground beef and leafy greens.

Investigators used cgMLST to compare the genetic sequences of isolates from both outbreaks and determined that they fell into separate genetic clades, or groups, differing by 6–11 alleles, suggesting that something other than ground beef caused the illnesses in 2019.

The CDC noted that one patient consumed raw cookie dough and that most patients were young adult females, similar to demographic distributions of past flour-associated STEC outbreaks. Investigators developed a supplemental questionnaire focusing on beef, leafy greens and flour exposures.

...article continued below
- Advertisement -

Twenty-one cases were reported from nine states. The median age of patients was 24 years with a range of 7 to 86 years; 71 percent were female. Three patients were hospitalized, and none died.

Among 13 patients asked about flour exposures, six reported eating, licking, or tasting raw homemade dough or batter during the week before illness onset. Three patients reported eating raw dough or batter made with the same grocery store brand of all-purpose flour, including a patient who reported eating raw dough at a bakery in Rhode Island. Overall, of 18 patients with store information, 11 reported shopping at this same grocery store chain.

The Rhode Island Department of Health visited the bakery reported by the patient and collected flour for testing. On May 21, 2019, testing identified STEC O26 from an intact bag of all-purpose flour, which was the same grocery store brand reported by other patients.

PulseNet confirmed that the STEC O26 isolated from the flour was highly related to clinical isolates using cgMLST (0–1 alleles). Product distribution records collected by the Food and Drug Administration found six patients in three states purchased flour from a single milling facility in Buffalo, New York.

The flour brand was recalled from retail outlets in 11 states.

The milling company also recalled all lots of this product and several other lots of flour produced in that facility, resulting in the recall of additional brands and products distributed to multiple states.

The MMWR authors say flour is recognized as a cause of STEC outbreaks (1–5). Raw flour is not a ready-to-eat product, and this outbreak highlights the continuing risk for illness associated with the consumption of flour and raw dough or batter.

FIGURE. Number of patients* (N = 21) infected with the outbreak strain of Escherichia coli O26, by state of residence — United States, December 2018–May 2019
The figure is a map of the United States showing the states in which 21 patients who were infected with the outbreak strain of Escherichia coli O26 lived during December 2018–May 2019.

* California, one; Connecticut, one; Massachusetts, two; Missouri, one; New Jersey, one; New York, seven; Ohio, five; Pennsylvania, two; Rhode Island, one.

The authors: Vasser M, Barkley J, Miller A, et al. “Notes from the Field: Multistate Outbreak of Escherichia coliO26 Infections Linked to Raw Flour — the United States, 2019.” MMWR 2021;70:600–601. DOI: http://dx.doi.org/10.15585/mmwr.mm7016a4external icon.

(To sign up for a free subscription to Food Safety News, click here.)

- Advertisement -
- Advertisement -


CNN Anchor Reveals Cancer Diagnosis

Variety – Veteran CNN correspondent Christiane Amanpour told viewers Monday that she recently had surgery for ovarian cancer and will undergo chemotherapy for a...

No Studies Show Plastic Barriers Reduce Virus Spread

Not a single study has shown that plexiglass barriers actually control the virus, according to Joseph Allen of the Harvard T.H. Chan School of Public Health.

Serious Side Effects From COVID Vaccines: Here’s What We Know

Risks of rare allergic reactions, blood clots and maybe heart problems don’t outweigh benefits.

Disqualified Olympic Prospect Blames Bad Burrito

THE NEW YORK TIMES – Years of training and preparation to reach the Tokyo Olympics are out the window for Shelby Houlihan, an American...

Vaccinated Hawaiian Positive For Delta Variant

(AP) HONOLULU – Hawaii says a vaccinated Oahu resident who traveled to Nevada last month has tested positive for the delta variant of COVID-19. The...

Kamala: Vaccines “Safe, Free, Inspected”

GREENVILLE, S.C. (AP) — Vice President Kamala Harris visited South Carolina on Monday to kick off a nationwide push to vaccinate millions more Americans...

Florida Wildlife Manager Finds $1.2M In Cocaine

NBC NEWS  – More than 30 kilograms of cocaine with a value topping $1 million were seized after washing ashore last month at the...

Stress, Panic Attacks Face Migrant Kids

The conditions described by a federal volunteer who spent two weeks in May at the shelter at Fort Bliss Army Base in El Paso, Texas, highlight the desperation and stress of thousands of children held at unlicensed facilities, waiting to reunite with relatives.

How Covid Vaccine Affects Menstrual Cycles

HEALTHYWOMEN.ORG – When I got the alert that COVID-19 vaccines were available to people 16 and over in Los Angeles, I booked the soonest...

‘Bill Of Rights’ Promises Healthcare For Migrant Workers

KAISER HEALTH NEWS, SAN LUIS VALLEY, Colo. — A woman with pregnancy complications needed permission from her boss to visit a doctor. Community health volunteers...
- Advertisement -