Seventeen people are sick with E. coli infections and three have been hospitalized in an outbreak traced to flour recalled yesterday by the Aldi grocery chain.

The Rhode Island Department of Health has isolated the outbreak strain of E. coli O26 in an unopened bag of Baker’s Corner all-purpose flour. Aldi recalled some 5-pound bags of the flour this week after the state officials informed company officials about finding the pathogen. That was before federal officials announced the outbreak. The flour was produced and packaged for Aldi by ADM Milling Co., which is a subsidiary of the Archer Daniels Midland Co.

The flour may have been used to produce Aldi baking mixes. Some of the outbreak patients reported tasting raw batter made from such mixes in the days before becoming ill.

Consumers should not use or eat flour from 5-pound bags of Baker’s Corner all purpose flour packed for Aldi, including all lot codes and all best-by dates, that was distributed in Connecticut, Delaware, Massachusetts, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont and West Virginia, according to a public warning today from the Food ad Drug Administration. 

The FDA did not post a list of specific stores that received the flour. The agency did not indicate whether the flour could have been distributed to other states.

“FDA will work with the firms to determine whether other lots of flour made at that production facility may be potentially contaminated and need to be recalled, and on trying to determine the source of the contamination,” according to notices posted late this afternoon by the FDA and the Centers for Disease Control and Prevention.

No information has been made public about whether ADM Milling of Overland Park, KS, packaged any of the implicated flour under other brand names or for other customers. ADM produced the flour in a facility in Buffalo, NY. 

Public health officials are concerned that consumers may have the recalled flour in their homes and not know it because such products are usually taken out of their packages and stored in other containers.

“If you stored flour purchased from ALDI in another container without the packaging and don’t remember the brand or ‘better by’ date, throw it away,” the CDC warned in its outbreak alert this afternoon.

“Consumers should thoroughly wash the containers before using them again.”

On an undisclosed date, the Rhode Island Department of Health collected and analyzed an unopened sample of the flour and determined it contained E. coli O26. The department issued a public warning Wednesday to consumers not to eat the flour.

The first person confirmed with an infection from the outbreak strain of E. coli became ill on Dec. 11, 2018. The outbreak patients, who are spread across eight states, range in age from 7 to 86 years old. No confirmed deaths had been reported to the CDC as of the posting of the outbreak notice today. The most recent patient became ill on April 18. Additional patients could be identified because of a lag time of a few weeks between when a person becomes sick and when confirmed laboratory reports are made available to the CDC.

“Of seven people who were interviewed, four reported eating, licking, or tasting raw, homemade dough or batter. Two people with detailed information reported eating raw dough or batter made with flour or baking mixes from Aldi,” according to the CDC.

“Investigators with the Rhode Island Department of Health collected records and flour samples at a bakery wher an ill person reported eating raw dough. Records indicated that the bakery used Baker’s Corner All Purpose Flour from Aldi. The outbreak strain was isolated from an unopened bag of Baker’s Corner All Purpose Flour collected at the bakery.”

The outbreak patients mostly live in New England, but California and Missouri have both reported one patient each. Ohio has reported five patients, as have New York. Other states with confirmed outbreak patients are: Pennsylvania with two, and Connecticut, New Jersey and Rhode Island each with one patient.

The investigation is ongoing. FDA is working to determine whether other brands or lots of flour may be potentially contaminated and need to be recalled.

Information about E. coli infections
Anyone who has eaten or handled any of the suspect flour and developed symptoms of E. coli infection should seek medical attention and tell their doctors about the possible exposure to the pathogen. Specific tests are required to diagnose E. coli infections, which have symptoms that can mimic other illnesses and cause difficulties during diagnosis and treatment.

The symptoms of Shiga toxin-producing (STEC) E. coli infections vary for each person but often include severe stomach cramps and bloody diarrhea. If there is fever, it is usually less than 101 degrees F. Most people get better within a week.

about 5 percent to 10 percent of those who are diagnosed with E. coli infections develop a potentially life-threatening form of kidney failure known as hemolytic uremic syndrome (HUS).

Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. Most people with HUS recover within a few weeks, but some suffer permanent damage or die. People who experience these symptoms should seek emergency medical care immediately. Persons with HUS should be hospitalized because their kidneys may stop working. They may also develop other serious problems such as hypertension, chronic kidney disease, and neurologic problems.

This condition can occur among persons of any age but is most common in children under 5-years old and older adults. It is marked by easy bruising, pallor, and decreased urine output.