Caramel Apple Listeria Outbreak
CDC collaborated with public health officials in several states and with the U.S. Food and Drug Administration (FDA) to investigate an outbreak of Listeria monocytogenes infections (listeriosis). Joint investigation efforts indicated that commercially produced, prepackaged caramel apples made from Bidart Bros. apples were the likely source of this outbreak.
Public health investigators used the PulseNet system to identify illnesses that were part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA “fingerprinting” is performed on Listeria bacteria isolated from ill people using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS).
The 35 ill people included in this outbreak investigation were reported from 12 states: Arizona (5), California (3), Colorado (1), Minnesota (4), Missouri (5), Nevada (1), New Mexico (6), North Carolina (1), Texas (4), Utah (1), Washington (1), and Wisconsin (3). Illness onset dates ranged from October 17, 2014, to January 6, 2015. Eleven illnesses were associated with a pregnancy (occurred in a pregnant woman or her newborn infant). One fetal loss was reported. Among people whose illnesses were not associated with a pregnancy, ages ranged from 7 to 92 years, with a median age of 62 years, and 33% were female. Three invasive illnesses (meningitis) occurred among otherwise healthy children aged 5–15 years. Thirty-four people were hospitalized, and listeriosis contributed to at least three of the seven deaths reported.
The Public Health Agency of Canada (PHAC) identified two cases of listeriosis in Canada with the same PFGE patterns as those seen in the U.S. outbreak. More detailed testing using WGS showed that the isolate from only one of the two cases was genetically related to the U.S. outbreak. That person reported eating a caramel apple.
Listeria monocytogenes is an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women. Approximately 2,500 cases of listeriosis are estimated to occur in the U.S. each year. About 200 in every 1,000 cases result in death.