Epidemiologic Notes and Reports Illness Associated with Elevated Levels of Zinc in Fruit Punch -- New Mexico

On November 19, 1982, a group of students in a Grant County, New Mexico, junior high school became ill, with symptoms of headache, chills, dizziness, nausea, and vomiting. An investigation by the New Mexico Health and Environment Department (NMHED) showed that illness was confined to students who attended the 9:30 and 11:15 a.m. home economics classes on November 19, where fruit punch and cookies prepared the previous evening were served.

Thirty-one (25 females and six males) of the 47 students attending those classes were interviewed. Eighteen (58%) reported at least one symptom, including nausea (83%), abdominal cramps (61%), metallic taste (33%), headache (33%), dizziness (22%), vomiting (11%), and chills (11%).

Eighteen (69%) of 26 students who drank punch reported illness, but none of the five who did not drink punch reported illness (p = 0.007). The percentage of illness was higher among those who drank 4 or more ounces of punch (89%) than those who drank less than 4 ounces (40%) (p = 0.046). Illness was not associated with eating cookies.

Onset of illness ranged from 5 minutes to 2 hours after the punch--a mixture of two brands of commercial fruit punch, lemonade, and ginger ale--was consumed. The mixture was stored overnight in three 5-gallon water containers that had galvanized metal linings, with large areas of corrosion. The punch was transferred to plastic pitchers immediately before it was served.

The NMHED Scientific Laboratory Division analyzed samples of implicated punch for heavy metals. The analyses showed elevated levels of zinc and slightly elevated levels of iron (Table 1). No other metals, including cadmium, showed elevated levels. Because of its low pH, the punch was not examined for microorganisms. Reported by S Lapham, MD, R Vanderly, R Brackbill, PhD, M Tikkanen, New Mexico Health and Environment Dept; Special Studies Br, Div of Chronic Diseases, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Zinc is a major constituent of galvanized metal. On contact with acidic foods and beverages, it is converted to zinc salts, which are readily absorbed by the body.

Outbreaks of illness mainfested by fever, nausea, vomiting, abdominal cramps, and diarrhea have been reported after consumption of foods or beverages prepared or stored in galvanized containers (1-3). Onset of symptoms has ranged from a few minutes to 24 hours, with the shorter periods associated with ingestion of liquids (3). In previously reported outbreaks, zinc levels found in contaminated foods or beverages have exceeded 1,000 parts per million. The emetic dose of zinc is 225-450 mg for adults (4), but may be lower for teenagers with lower body weights. Although only two students in this episode vomited, 83% complained of nausea.

The Food and Drug Administration considers galvanized metal an unacceptable surface material for equipment and utensils used with food and beverages (other than water) (5).

References

1. Callender GR, Gentzkow CJ. Acute poisoning by the zinc and antimony content of limeade prepared in a galvanized iron can. Milit Surg 1937;80:67-71.

2. Dornickx CG. Zinc as cause of food poisoning (abstract). JAMA 1938;111:1887.

3. Brown MA, Thom JV, Orth GL, Cova P, Juarez J. Food poisoning involving zinc contamination. Arch Environ Health 1964;8:657-60.

4. Sollman TH. Manual of pharmacology, 8th ed. Philadelphia: Saunders, 1957;1303-4.

5. Food and Drug Administration. Consumer memo: cooking utensils . . . some facts about their safety. Rockville, Maryland: Food and Drug Administration (HHS publication no. (FDA) 80-2123). Reissued November 1979.

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