The following is a highlight list of outbreaks in recent years that were caused by E. coli O103 and E. coli O121.

E. coli O121 outbreaks

2017 Outbreak of STEC O121 at an Athletic Center, Colorado

• Organism:
• Non-O157 STEC
• Vehicle:
• Recreational water

In September 2017 Colorado public health officials investigated an outbreak of E. coli O121 associated with recreational swimming at Villa Sport Athletic Center located in Colorado Springs. Three confirmed cases and three primary cases all went to the pool on the same day, September 9, 2017. Two cases were hospitalized. Both developed the hemolytic uremic syndrome. No one died.

2015-2016 Outbreak of E. coli O121 linked to General Mills’ Flour

• Organism:
• Non-O157 STEC
• Vehicle:
• flour

In June 2016 the CDC announced that public health officials were investigating a multistate outbreak of E. coli O121 linked to flour produced at the General Mills’ Kansas City, Missouri facility. In interviews with ill persons, sixteen (76%) reported that they or someone in their household used flour in the week before they became ill. Twelve (55%)of 22 people reported using Gold Medal brand flour. On September 29, 2016, the outbreak was declared to be over. There were 63 ill people reported by 24 states. Seventeen people were hospitalized. One person developed the hemolytic uremic syndrome. No one had died. Illness onset dates ranged from December 21, 2015, to September 5, 2016. The FDA identified STEC O121 in an open sample of General Mills flour collected from the homes of ill persons in Colorado, Arizona, and Oklahoma. On May 31, 2016, General Mills recalled several sizes and varieties of Gold Medal Flour, Gold Medal Wondra Flour, and Signature Kitchens Flour. On July 1 General Mills expanded the recall. the recall was expanded again on July 25, 2016.

2014 Outbreak of E. coli O121 linked to Raw Clover Sprouts from Evergreen Fresh Sprouts

• Organism:
• Non-O157 STEC
• Vehicle:
• Vegetables, Sprouts, Clover Sprouts

On May 21, 2014, an outbreak of E. coli O121 linked to consumption of clover sprouts was announced by health officials in Washington and Idaho. On August 1, 2014, the CDC declared the outbreak over. In total 19 patients had been confirmed with E. coli O121. Patients resided in California, Idaho, Michigan, Montana, Utah, and Washington. Among those persons with information, seven (44%) of 16 were hospitalized. No ill persons developed HUS, and no deaths were reported. Epidemiologic and traceback investigations conducted by local, state, and federal officials indicated that contaminated raw clover sprouts produced by Evergreen Fresh Sprouts, LLC of Idaho was the most likely source of the outbreak. Sprouts were eaten in sandwiches at several food establishments including Jimmy John’s Gourmet Sandwich locations in King and Spokane counties as well as two Pita Pit locations in Spokane County. In Kootenai county, case-patients had eaten raw clover sprouts at Jimmy John’s and Daanen’s Deli. The producer also distributed sprouts to other restaurants and retail grocery stores in the northwest.

2012-2013 E. coli O121 linked to Farm Rich Products Frozen Mini Meals and Snack Items

• Organism:
• Non-O157 STEC
• Vehicle:
• Frozen Snacks, poultry, chicken

On March 28, 2013, Farm Rich Products Corporation announced a recall of 196,222 pounds of frozen chicken quesadilla and various other heat-treated, not fully cooked frozen mini meals and snack items because of possible contamination with E. coli O121. The recall was initiated after patients residing in 16 states were identified by public health investigators. As of May 30, 2013, 35 patients had been identified. Eighty-two percent of ill persons were 21 years of age or younger, 31% were hospitalized. Among persons for whom information was available, illness onset dates ranged from December 30, 2012, to April 15, 2013. Two people developed the hemolytic uremic syndrome. A sample of Farm Rich frozen chicken mini quesadilla collected from a patient’s home was positive for the outbreak strain of E. coli O121. On April 4, 2013, the recall was expanded to all products produced at its Waycross, Georgia plant with “Best By” dates ranging from January 1, 2013, to September 29, 2014, due to possible contamination with Escherichia coli O121 bacteria (“E. coli O121”). In addition to Farm Rich brand products, Market Day brand products are being recalled.

2009 E. coli O157: H7 and Non-O157 E. coli linked to Dungeness Valley Creamery Raw Whole Milk, Washington

• Organism:
• coli O157: H7, Non-O157 STEC
• Vehicle:
• Dairy, Milk, Unpasteurized, Raw Milk

An outbreak was linked to the consumption of raw, unpasteurized, whole milk produced by the Dungeness Valley Creamery. There were a total of three cases. There were two E. coli strains implicated. One strain was confirmed as E. coli O121. The other strain was suspected and was E. coli O157: H7. Raw milk was legal to sell and buy in Washington, provided the dairy underwent a series of inspections and was licensed. This dairy had been licensed since 2006.

2007 non-O157 E. Coli at a Jefferson County Jail linked to Pasteurized American Cheese or Margarine

• Organism:
• Non-O157 STEC
• Vehicle:
• Dairy, American Cheese Fats or Oils, Margarine

An outbreak attributed to three non-O157 strains of E. coli bacteria, occurred at the Jefferson County Jail, in Colorado. The strains of E. coli associated with this outbreak were: O121; O26; O84. A report from the Centers for Disease Control and Prevention named pasteurized, American style, cheese, or margarine, as the vehicles for this outbreak.

2006 Utah Wendy’s Restaurant Lettuce

• Organism:
• Non-O157 STEC
• Vehicle:
• Vegetable, Leafy greens, Unknown Iceberg lettuce

Iceberg lettuce that had been prepared and served to patrons of the Wendy’s Restaurant, in Ogden, Utah, and to attendees of a catered teachers’ conference at a junior high school(CORE academy) was implicated in an outbreak of E.coli O121: H19. This is a rare strain of E.coli. Three people developed kidney failure. Lettuce was the only food that all of the sickened people had eaten. The lettuce was not available for testing after the outbreak was recognized.

2006 Nebraska Day Care

• Organism:
• Non-O157 STEC
• Vehicle:
• Person-to-Person

An outbreak of E. coli O121 occurred among children who attended a Nebraska daycare program. The infection was spread from person-to-person. All cases required hospitalization.

E. coli O103 outbreaks

2019 Multistate Outbreak of E. coli O103 Infections linked to Ground Beef

• Organism:
• Non-O157 STEC
• Vehicle:
• ground beef

In April 2019 public health officials announced a multistate outbreak of Escherichia coli O103 infections. Preliminary epidemiologic information suggests that ground beef is the source of this outbreak. On June 19, 2019, the outbreak appeared to be over. In total 209 people infected with the outbreak strain had been reported by 10 states: Florida, Georgia, Illinois, Indiana, Kentucky, Minnesota, Mississippi, Ohio, Tennessee, and Virginia. Twenty-nine people had been hospitalized. Two cases of hemolytic uremic syndrome were reported. There were no deaths. Illnesses started on dates from March 1, 2019, to May 1, 2019. Ill people in this outbreak ate ground beef from many sources. Some ground beef was recalled but investigators were not sure if all producers had been identified. On April 24, 2019, Grant Park Packing in Franklin Park, Illinois recalled approximately 53,200 pounds of raw ground beef products. K2D Foods, doing business as Colorado Premium Foods in Carrollton, Georgia recalled approximately 113,424 pounds of raw ground beef products on April 23, 2019.

2015 Outbreak of Gastrointestinal Illness linked to Unpasteurized Apple Cider, Illinois

• Organism:
• Cryptosporidium, non-O157 STEC
• Vehicle:
• unpasteurized apple cider

In November 2015 public health officials in Illinois investigated an outbreak of gastrointestinal illness among individuals who attended the Pike County Fall Color Drive. An estimated 30,000 people attended the festival. One-hundred-four cases were identified. Consumption of apple cider was a significant risk factor for diarrheal illness. The cider was produced by Yoder Brothers Dairy Farm. Ten samples of cider were tested for Cryptosporidium and E. coli. Subtype Cryptosporidium parvum IIaA17G2R2 as identified in one cider sample and in all five stool specimens submitted for Cryptosporidium subtyping. E. coli O130: H11 was identified in 6 cider samples. Two of eight stool specimens that tested positive for Shiga Toxin E. coli. Serotypes were identified as E. coli O103 and O111. Investigators determined that cider production took place outdoors on a farm within 200 feet of a calf pen. Individuals involved in cider production handled cattle and did not change or disinfect clothes and boots between cattle operations and cider processing. Cider was unpasteurized and containers were unlabeled.

2010 Outbreak of E. coli O103 E. coli O145: NM linked to Consumption of Venison, Minnesota

• Organism:
• Non-O157 STEC
• Vehicle:
• Game, Venison

An outbreak of non-O157 Shiga toxin-producing Escherichia coli occurred among students at a high school in Minnesota, in November 2010. The students had handled and consumed venison from a wild white-tailed deer in a high school class. Consuming undercooked venison and not washing hands after handling raw venison were associated with illness. E. coli O103: H2 2 isolates) and non-Shiga toxin-producing E. coli O145: NM 1 isolate) were isolated from ill students and the venison.

2004 Outbreak of E. coli O26: H11 and E. coli O103: H2, Wyoming

• Organism:
• Non-E.coli O157: H7
• Vehicle:
• Unknown

Between July and November 2004, in Lincoln County, Wyoming, six reported cases of enterohemorrhagic E. coli were identified. An extensive food history questionnaire was conducted with the cases along with enhanced laboratory testing through the Wyoming Public Health Laboratory. Five of the six isolates were serotyped as E.coli O26: H11, the sixth was O103: H2. No common exposures were discovered.

2000 Outbreak of E. coli O103 linked to Consumption of Punch, Washington

• Organism:
• Non-O157 STEC
• Vehicle:
• Beverage, Drink, Punch

An outbreak of E. coli O103 occurred in Washington state on July 2000. The implicated vehicle was contaminated fruit punch. Illnesses were confirmed by the use of serology (blood work). Eighteen people were ill. Two were hospitalized. There were no deaths.

about E. coli infections

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and bloody diarrhea. If there is fever, it is usually not lower than 101 degrees F (38.5 degrees C). Most patients recover within five to seven days. Others can develop severe or even life-threatening symptoms and complications.

about 5 percent to 10 percent of those who are diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as a 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. 

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among persons of any age but is most common in children younger than 5 years old because of their immature immune systems. Older adults are also at higher risk because of deteriorating immune systems. Other people with compromised immune systems such as transplant recipients, HIV patients, and cancer patients. 

People who experience HUS symptoms should seek emergency medical care immediately. People with HUS should be hospitalized because it can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.