A multistate outbreak of E. coli O121 infections, first reported around Oct. 7, is over, the federal Centers for Disease Control and Prevention Thursday (Dec. 1) reported. Epidemiologic, laboratory, and traceback data showed that Earth Grown brand frozen falafel sold at ALDI stores made people sick.

A total of 24 people infected with the outbreak strain of E. coli O121 were reported from 6 states.

Illnesses started on dates ranging from July 13, 2022, to October 24, 2022. Sick people ranged in age from under 1 to 71 years, with a median age of 30, and 74 percent were female. Of 22 people with information available, 5 were hospitalized and one developed hemolytic uremic syndrome (HUS), a serious condition that can cause kidney failure. No deaths were reported.

The true number of sick people in this outbreak is likely much higher than the number reported, and this outbreak may not have been limited to the states with known illnesses. This is because many people recover without medical care and without being tested for E. coli.

State and local public health officials interviewed people about the foods they ate in the week before they got sick. Of the 18 people interviewed, 15 (83 percent) reported shopping at ALDI stores. Among these 15 ALDI shoppers, 14 (93 percent) reported eating Earth Grown brand frozen falafel purchased from ALDI in the week before getting sick.

Laboratory Data and Traceback Data

Public health investigators used the PulseNet system to identify illnesses that were part of this outbreak. CDC PulseNet manages a national database of DNA fingerprints of bacteria that cause foodborne illnesses. DNA fingerprinting is performed on bacteria using a method called whole genome sequencing (WGS).

WGS showed that bacteria from sick people’s samples were closely related genetically. This suggests that people in this outbreak got sick from the same food.

On October 7, 2022, the Michigan Department of Agriculture and Rural Development collected Earth Grown frozen falafel for testing from a sick person’s home. WGS done at the Michigan Department of Health & Human Services showed that the E.coli in the falafel was closely related to bacteria from sick people. This means that people likely got sick from eating frozen falafel.

WGS analysis of bacteria from 24 people’s samples and one food sample did not predict resistance to any antibiotics. Standard antibiotic susceptibility testing by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory is currently underway. These findings do not affect treatment guidance since antibiotics are not recommended for patients with  E. coli O121 infections.

On October 7, 2022, Cuisine Innovations of Lakewood, New Jersey, recalled Earth Grown Vegan Traditional Falafel and Garlic & Herb Falafel. According to ALDI, Cuisine Innovations is the sole supplier of Earth Grown brand frozen falafel sold in ALDI stores.

CDC advises people to not eat, sell, or serve recalled frozen falafel.