Multistate Outbreak of E. coli O157:H7 Infections Linked to Totino’s and Jeno’s Frozen Pizza (FINAL UPDATE)

Posted November 1, 2007

Outbreak Summary

The Tennessee State Department of Health and CDC are collaborating with public health officials in multiple states and the U.S. Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS) to investigate an ongoing multistate outbreak of E. coli O157:H7 infections in humans. A study comparing foods eaten by ill persons to foods eaten by well persons showed that eating frozen pizza that contained pepperoni and was produced by the General Mills Company under the brand names of Totino's or Jeno's was the likely source of the illness.

As of November 1st, at least 21 isolates of E. coli O157:H7 with an indistinguishable genetic fingerprint have been collected from ill persons in 10 states: Illinois (1 person), Kentucky (3), Missouri (2), New York (2), Ohio (1), Pennsylvania (1), South Dakota (1), Tennessee (8), Virginia (1), and Wisconsin (1). Persons became ill between July 20, 2007, and October 10, 2007. The age of ill persons’ ranges from 1 to 65 years with a median age of 9; 53% of ill persons are female. At least 8 people have been hospitalized, and 4 have developed a type of kidney failure known as hemolytic-uremic syndrome, or HUS. No deaths have been reported.

The Tennessee State Department of Health, working with CDC and health officials in several other states, coordinated a study to identify the source of these infections. Eating a Totino's or Jeno's brand frozen pizza containing pepperoni was significantly associated with illness. The source of contamination of the pizzas is not known at this time. Company officials are working closely with CDC, USDA-FSIS, the Food and Drug Administration (FDA), and state health and agricultural departments to identify the source of the contamination. General Mills has ceased shipment of all frozen pizza products that contain pepperoni and has announced a voluntary recall.

Most people infected with E. coli O157:H7 develop severe bloody diarrhea and abdominal cramps 2-8 days (average of 3-4 days) after infection. Infection is usually diagnosed by culture of a stool sample. Most people recover completely within 5-10 days, although some people, particularly young children and the elderly, are at increased risk for severe illness. In severe infection, E. coli O157:H7 can cause a type of kidney failure known as hemolytic uremic syndrome, or HUS.

Consumers should not eat recalled Totino's or Jeno's brand frozen pizzas that contain pepperoni as a topping. Anyone who has eaten the product but did not become ill need not take any special action. People who are ill with diarrhea within a week of consuming this type of frozen pizza should seek medical care and let their doctor know about the exposure. Consumers with questions about the recall should contact the company at 1-800- 949- 9055. Representatives will provide information about how to contact the company for a full refund. Consumers are reminded to always thoroughly cook all products that are not ready-to-eat, such as frozen pizzas, according to package instructions.

Final Case Count Map

Persons infected with the outbreak strain of E. coli O157:H7, by state of residence, as of October 31, 2007 (n=21)

As of November 1st, at least 21 isolates of E. coli O157:H7 with an indistinguishable genetic fingerprint have been collected from ill persons in 10 states: Illinois (1 person), Kentucky (3), Missouri (2), New York (2), Ohio (1), Pennsylvania (1), South Dakota (1), Tennessee (8), Virginia (1), and Wisconsin (1).

How many people were affected?

As of 2 PM (EST) October 31, 2007, 21 persons infected with this strain of E. coli O157:H7 have been reported to CDC from 10 states. Persons became ill between July 20 and October 10, 2007. For current information, please visit the E.coli O157:H7 outbreak website.

Which brands of frozen pizza were associated with illness?

Products implicated in the outbreak include Totino's and Jeno's brand frozen pizzas, produced by the General Mills Company, that contain pepperoni products.

Should I return purchased frozen pizzas to the store where I bought them?

General Mills has issued a recall of these pizzas. Consumers should not eat Totino's or Jeno's brand frozen pizzas that contain pepperoni as a topping. Consumers with questions about the recall should contact the company at 1-800- 949- 9055. Representatives will provide information about how to contact the company for a full refund. Consumers are reminded to always thoroughly cook all products that are not ready-to-eat, such as frozen pizzas, according to package instructions.

Are other frozen products, including frozen pizzas from other brands, safe to eat?

At this time only the Totino and Jeno brands of frozen pizzas are implicated in this outbreak. No other brands of frozen pizza, other pizza products, or other pepperoni products have been implicated.

Consumers should always practice safe food handling and preparation measures. This includes properly cooking all non-ready-to-eat foods according to the package instructions and washing hands, utensils, and surfaces with hot, soapy water before and after handling uncooked food items.

How long does it take for symptoms to show up after E. coli O157:H7 infection?

On average, symptoms from E. coli O157:H7 infection develop within 3 to 4 days of eating contaminated food, with a range of 1 to 10 days. Symptoms usually include severe bloody diarrhea and abdominal cramps; sometimes the infection causes non-bloody diarrhea or no symptoms. Usually little or no fever is present, and the illness resolves in 5 to 10 days. In severe infection, E. coli O157:H7 can cause a type of kidney failure known as hemolytic uremic syndrome, or HUS.

How is E. coli O157:H7 illness treated?

Most people recover without specific treatment within 5 to 10 days. Antibiotics should not be used to treat this infection, and it is thought that treatment with some antibiotics could lead to kidney complications. Antidiarrheal agents, such as loperamide (Imodium®), should also be avoided.

In some people, E. coli O157:H7 infection can cause a complication called hemolytic uremic syndrome (HUS), a serious condition that is usually treated in an intensive care unit. Blood transfusions and kidney dialysis are often required.

Can E. coli O157:H7 be passed to a baby or other members of my family?

Bacteria in diarrheal stools of infected persons can be passed from one person to another if the patient and family members do not properly wash their hands with soap and water before eating and using the bathroom or otherwise maintain good hygiene. This is particularly likely among toddlers who are not toilet trained. Family members and playmates of these children may be at high risk of becoming infected. Young children typically shed the organism in their feces for a week or two after their illness resolves. Older children rarely carry the organism without symptoms. To prevent transmission to a baby, infected individuals should avoid direct contact with infants and toddlers.

What should I do if I or someone in my family ate Totino's or Jeno's brand pizza with pepperoni?

Anyone who has eaten the product but did not become ill need not take any special action. People who are ill with diarrhea within a week of consuming this type of frozen pizza should seek medical care and let their doctor know about the exposure.

Where do I go for more information?

For more information on E.coli O157:H7, please visit the CDC E.coli general information page.