Nestle Cookie Dough Recall, Suspected E.coli 0157:H7 Outbreak in 26+ States

Nestle USA today tacitly confirmed in a press release early reports that Nestle Toll House brand raw cookie dough was giving many people E.coli 0157:H7 infections by voluntarily recalling their entire line of products. Early reports from Bill Marler, food safety litigator, and a press release from the state of Colorado gave indications that a current rash of E.coli 0157:H7 cases across the country were tied to eating raw cookie dough (but this has still not been confirmed)

Items Recalled

The products involved in the voluntary recall include all varieties of Nestlé TOLL HOUSE refrigerated Cookie Bar Dough, Cookie Dough Tub; Cookie Dough Tube; Limited Edition Cookie Dough items; Seasonal Cookie Dough and Ultimates Cookie Bar Dough.

Nestle Toll House Cookie Dough Products, provided by NestleUSA

Nestle Toll House Cookie Dough Products, provided by NestleUSA

The product list includes:

Nestle Item Description Size/Quantity UPC Code
COOKIE & BROWNIE DOUGH BAR
Chocolate Chip bar 16.5oz 0 50000 62231 3
Chocolate Chip bar 16.5oz 0 50000 11308 8
Chocolate Chunk bar 16.5oz 0 50000 62235 1
Walnut Chocolate Chip bar 16.5oz 0 50000 62233 7
Jumbo Chocolate Chip bar 16.5oz 0 50000 62237 5
Oatmeal Raisin bar 16.5oz 0 50000 06219 5
Sugar Cookies bar 16.5oz 0 50000 62244 3
Sugar Cookies bar 16.5oz 0 5000012178 6
Mini Chocolate Chip bar 16.5oz 0 50000 62242 9
Mini Chocolate Chip bar 16.5oz 0 5000012188 5
Mini Brownie Bites bar 16oz 0 50000 62227 6
Fudgy Brownie With Peanut Butter Filling 19oz 0 50000 00820 9
COOKIE DOUGH TUB
Chocolate Chip tub 40oz 0 50000 62246 7
Chocolate Chip tub 80oz 0 50000 00934 3
Sugar tub 40oz 0 50000 62253 5
Gingerbread tub 40oz 40oz 0 50000 44060 3
Peanut Butter tub 40oz 0 50000 44062 7
TUBE (CHUB) DOUGH
Chocolate Chip tube 16.5oz 0 50000 62239 9
Chocolate Chip tube 32oz 0 50000 00400 3
ULTIMATES COOKIE BAR DOUGH
Ultimates Peanut Butter Cups, Chips & Chocolate Chunks bar 16oz 0 50000 00922 0
Ultimates White Chip Macadamia Nut bar 16oz 0 50000 00923 7
Ultimates Chocolate Chip & Chunks with Pecans bar 16oz 0 50000 00925 1
Ultimates Chocolate Chip Lovers 16oz 0 50000 00926 8
Ultimates Turtles bar 16oz 0 50000 00928 2
Ultimates Peanut Butter Lovers bar 16oz 0 50000 00507 9
Ultimates Chocolate Chip with Caramel Filling bar 16oz 0 50000 44066 5
Ultimates Chocolate Chip with Chocolate Filling bar 16oz 0 50000 44069 6
SEASONAL COOKIE & BROWNIE DOUGH
Valentine Hearts Sugar Cookie Shapes 15.5oz 0 50000 12009 3
Valentine Swirled Chocolate Chip bar 16oz 0 50000 00931 2
Fudgy Brownies With Raspberry Filling 19oz 0 50000 20090 0
Easter Eggs Sugar Cookie Shapes 15.5oz 0 50000 52009 1
Easter Swirled Chocolate Chip bar 16oz 0 50000 00932 9
Easter Swirled Mini Brownie Bites bar 18 oz 0 50000 20093 1
Red, White & Blue Swirled Choc Chip bar 16oz 0 50000 00937 4
Halloween Pumpkin Pals Sugar Cookies 13.5oz 0 50000 06217 1
Halloween Swirled Chocolate Chip bar 16oz 0 50000 00929 9
Halloween Swirled Fudgy Brownies bar 18oz 0 50000 00088 3
Christmas Shapes Sugar Cookies 15.5oz 0 50000 00505 5
Christmas Swirled Chocolate Chip bar 16oz 0 50000 00930 5
Christmas Swirled Fudgy Brownies bar 18oz 0 50000 00089 0
Limited Edition Mint Swirled Chocolate Chip 16oz 0 50000 00827 8
Discontinued Varieties
Valentine Hearts Sugar Cookies 13.5oz 0 50000 44056 6
Easter Brownie Bar 18oz 0 50000 00518 5
Easter Bunnies Sugar Cookies 13.5oz 0 50000 44058 0
Halloween Sugar Shapes 15.5oz 0 50000 00829 2
Christmas Sugar Cookie Tube 16oz 0 50000 00448 5
Oatmeal Cranberry Cookie Tub 48 oz 0 50000 62229 0

Preliminary Reports

According to Marler, his team has been investigating reports from a recent outbreak of E.coli 0157:H7 infections across 26 states in the US. Based on surveys between the infected, certain foodstuffs were singled out. From Marler:

Over the last few weeks we have been investigating E. coli O157:H7 illnesses in several states. All seemed unconnected. However, common food items were uncooked Nestles Toll House Cookie Dough, Strawberries, Fruit Roll-ups and Ground Beef. The vast majority reported eating Toll House Cookies. We now have reports that federal, state and local health officials are investigating a cluster of at least 63 cases of E. coli O157:H7 in 26 states. Reports indicate the ill people’s E. coli O157:H7 isolates share a common genetic pattern and likely a common source.

Suspects:

  • Nestles Toll House Cookie Dough
  • Strawberries
  • Fruit Roll-ups
  • Ground Beef

The common genetic pattern found in the cases is a huge hint that the outbreak is coming from a centralized source. With additional FDA investigation, the source was further refined to the Nestle Cookie Dough.

Update (July 8th, 2009): A CDC epidemiologist named Karen Neil gives us some hints into how they tracked the disease down to cookie dough (emphasis mine):

…In mid-May, CDC’s PulseNet Team alerted us about a cluster of E. coli O157 infections. We began working with state and local health departments to investigate these infections. We originally suspected ground beef, which is one of the “usual suspects” for E. coli O157, along with leafy greens and sprouts. As the labs in states and at CDC found more and more people infected with the same strain, the demographics shifted; patients were generally young and female, which isn’t what is normally seen with ground beef-associated outbreaks.

We got copies of the interviews on standard questionnaires that state investigators did with ill people and looked through them for other suspicious food sources, but nothing was conclusive. None of the food items implicated in past E. coli O157 outbreaks appeared to be associated with this one. Therefore, we decided to conduct what we call “open-ended hypothesis-generating interviews,” in which we call the people affected and just talk about everything that they had eaten and done the week before they became ill, looking for things in common among them. Standard questionnaires are useful, but they are only asking for answers to a series of questions. Sometimes something with a broader scope, like this sort of wide-ranging interview, is needed to find things that are unusual and might not be asked on our questionnaires.

Washington State was kind enough to let CDC do the interviews on their five patients. Mark Sotir and I reached the mother of the first patient on a Saturday. She mentioned that her child had eaten raw prepackaged cookie dough during the days before he got sick. On Sunday, I reached a second patient, and she told me she had eaten at an ice cream shop and had ice cream with cookie dough and brownie mix-ins.

Cookie dough? When cases three, four, and five all confirmed that they ate raw cookie dough, it appeared we had a surprising new possible culprit in our outbreak. (It wasn’t until later that we learned that the second patient also had eaten raw cookie dough at home.)

During an outbreak investigation, we hold a series of multistate conference calls in which CDC and affected states share what we’re finding. Representatives from many of the affected states were on our June 16, 2009 conference call, and I mentioned my cookie dough hypothesis. On the face of it, cookie dough was the most unlikely culprit, but epidemiologists in several other states said, “Oh, yes, I had a case mention that, too”. It became a “Eureka” moment for the group.

At the end of the call we agreed that cookie dough, strawberries, fruit roll-ups, apples, and ground beef were all possible causes. Time to go back to the cases and ask more questions!

A lot of our work is like that. Our branch chief, Patricia Griffin, sometimes says there is a certain “head banging quality” to what we do. It can take many, many interviews and requires a wide-ranging curiosity to consider all the possibilities.

There are no short cuts. We talk to the patients, we look at the combined information, and we generate hypotheses about the cause. Then we can refine our questions and go back to the patients again to see which hypothesis holds true.

After the conference call we created a short-form questionnaire and states quickly interviewed their case-patients. Within a day we had enough confirmatory responses that a case-control study was conducted. The state investigators interviewed people who were of similar age and gender as the cases but who weren’t sick with E. coli during the same time frame about what they had eaten, and we compared them with the people who were sick. We call these people “matched controls”. With each step, the association between cookie dough and illness became stronger and stronger. By the end of the week, there was a recall on Nestle Toll House refrigerated cookie dough….

Extent of Outbreak

UPDATE: As of June 24th, 2009, there are now 70 cases of e.coli suspected to be linked with the raw cookie dough. 41 of the cases have been confirmed to be associated with the outbreak strain of e.coli via DNA testing [1, 2]. The outbreak now covers 31 states by our count:

2009-06-24-nestle-outbreak-map

Nestle’s Response

We spoke with Laurie MacDonald of Nestle USA on the phone earlier today and she was very polite and forthcoming about Nestle’s approach to the situation. Nestle learned of the FDA investigation into the cookie dough products on Wednesday evening and internally made the decision to voluntarily recall the products by the end of business Thursday. On Friday morning, the recall was formally announced to the public for the entire line of Nestle Toll House raw cookie dough products.

Nestle, good job so far

Nestle, good job so far

According to MacDonald, all the cookie dough has come from one single plant, which will be the focus of the investigation into the matter. There still has been no official confirmation from the FDA or Nestle that the cookie dough itself caused the e.coli 0157:H7 infections. Right now, the recall was issued on guidance from the FDA that, in their preliminary questionnaires, many respondents infected with e.coli 0157:H7 indicated that they have eaten raw cookie dough in the past week.

Ms. MacDonald also warned against eating raw cookie dough, now or at any time in the future – emphasizing that their product needs to be properly baked according to the directions on the side of the package.

Impacts

In the coming days, it is likely more cases of E. coli O157:H7 in additional states, following a similar trajectory to the 2006 spinach recall or 2009 peanut butter recall of this year – unfortunate for a number of reasons. E.coil 0157:H7 can cause a condition known as Hemolytic Uremic Syndrome (HUS), often fatal in the young and old. Further, having such a widespread outbreak so close on the heels of the massive peanut butter situation is difficult to stomach and will likely lead to more apprehension about our food system – which is generally very safe on the macro scale.

Nestle should be applauded for quickly, although not immediately, recalling all of the product in question. As the FDA does not have mandatory recall authority under our current food safety system, it is up to companies to take the lead – and Nestle did. Still, the question looms large – how does E. coli O157:H7, a deadly super bacteria normally found in the intestines of cows, make it into cookie dough? We can speculate but only a thorough investigation will get us the answers.

Part of the reason these super bugs have come to be some common place has a lot to do with confinement animal feed operations (CAFOs). Johns Hopkins put together an outstanding article on the subject that explains how antibiotics given to farm animals has created incubation environments for super bugs.

How food production has concentrated, USDA

How food production has concentrated, USDA

The other side of the equation is that we have seen an increase in interconnectedness between firms that are now apart of the global food system. Many outbreaks can be nationwide in a matter of days with massive distribution facilities and global reach of companies like Nestle. With a different distribution should come a different safety system, which has just not been the case – for a variety of less than savory political decisions.

FDA Report

On July 11th, the FDA announced that they have conducted inspections at the Nestle factory in question and found no e.coli.  It is covered in report 483, due to be released ‘some day soon’.  It is still unknown how e.coli got into the cookie dough. See the report below:

Change is Near

Food safety is about to take a major step in the right direction with a new bill coming to vote in the House in the next couple of months. It gives the FDA recall authority, along with a host of other badly need enhancements to their policing powers. Hopefully this latest outbreak in cookie dough will give this legislation the final push through Congress that it needs.

  • Mimi Serrao

    Good article, good info. Very timely. Thanks.

  • Mimi Serrao

    Good article, good info. Very timely. Thanks.

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