The FDA and CDC, in collaboration with state and local partners, are investigating a multi-state, multi-year outbreak of Listeria monocytogenes infections potentially linked to requeson, a soft cheese similar to ricotta.  

Based on epidemiological information collected by CDC, a total of 8 people infected with the outbreak strain of Listeria have been reported from 3 states. Sick people’s samples were collected on dates ranging from March 6, 2023, to May 9, 2026. Of the 7 people interviewed, 5 reported eating any cheese. Two people (29%) reported eating requeson made by Clover Hill Dairy. There have been 7 hospitalizations, and one death reported.

On May 13, 2026, the Suffolk County Health Department (SCHD) notified the New York State Department of Agriculture & Markets (NYS AGM) of two related Listeria monocytogenes illnesses from the same family, who had purchased food from a local retailer in Brentwood, NY. The following day, the New York State Department of Health (NYS DOH) confirmed that both cases had consumed requeson cheese purchased at that retailer. NYS AGM investigators tested five cheese samples collected from the retailer. One sample of requeson that had been repacked by the retailer tested positive for Listeria monocytogenes, and whole genome sequencing (WGS) confirmed the strain of Listeriafound in the requeson cheese matches the strain of Listeria causing illnesses in the two New York cases who reported purchasing cheese from this retailer. 

On May 27, 2026, NYS AGM conducted an inspection at the retailer’s cheese distributor, which identified Clover Hill Dairy, LLC of Mechanicsville, MD as the requeson cheese manufacturer. A sample collected from an unopened 18-pound sealed bucket of requeson manufactured by Clover Hill Dairy, LLC also tested positive for Listeria monocytogenes; WGS analysis is pending. 

On June 3, 2026, Clover Hill Dairy, LLC issued a voluntary recall of its requeson/soft ricotta products. Consumers and retailers should not eat, serve, or sell recalled requeson cheese.

Due to the public health risk, the Maryland Department of Health has suspended the Clover Hill Dairy LLC’s operating license, issued a Consumer Advisory, and is conducting a follow up evaluation in cooperation with the facility.  

FDA is in the early stages of this investigation, additional products may be impacted, and further testing by FDA and state partners is underway. The FDA will provide updates as new information becomes available.

Case Count Map Provided by CDC

A map of the United States showing the number of sick people by state. Most states are shaded gray, indicating no reported cases. New York and Virginia, Maryland are shaded in green, indicating sick people in those states.

Product Distribution Map 

Distribution of recalled products has been confirmed for states shown below, but product could have been distributed further, reaching additional states.

Map of the United States, including Alaska, Hawaii, and Puerto Rico, with all states labeled by their two-letter abbreviations. Maryland (MD), New York (NY), and Virginia (VA) are highlighted in blue, while all other states and territories are shown in gray.”

The FDA yesterday quietly put up a new page describing its “post-outbreak response activities” for the Clostridium botulinum illnesses tied to ByHeart powdered infant formula. I have read it more than once. I represent more than twenty of the families behind the numbers on that page, so let me say a few things the agency’s careful prose does not.

Start with the count. Forty-eight infants sickened across seventeen states. Twenty-eight confirmed, twenty probable. Zero deaths — and I am grateful for that every single day, because infant botulism is the kind of illness that takes a healthy baby and, within hours, leaves a parent watching a ventilator breathe for their child. But look at the other line on that ledger: forty-eight hospitalized. Every last one of them. There is no version of “zero deaths” that makes a forty-eight-for-forty-eight hospitalization rate a clean record. These were newborns and infants whose parents fed them a product they had every reason to believe was safe.

The FDA’s page leads with ingredients — incoming powdered milk, a lot of organic whole milk powder, Dairy Farmers of America, Organic West Milk — However, the FDA also tells us the root-cause investigation continues “with a focus on ingredients.” 

Here is what the agency’s own whole genome sequencing showed: C. botulinum type A matching across a clinical isolate, a closed can of ByHeart finished formula, and the ingredient. That is not only an ingredient problem that happened to pass through ByHeart. That is ByHeart’s product, in ByHeart’s can, with ByHeart’s name on it, fed to a baby. Sourcing, verifying, and testing what goes into infant formula is the job.

And spare me the suggestion — built carefully into the bottom of that page — that spore-forming bacteria are simply too resilient, too hard to detect, too slow to culture for anyone to have prevented this. It is all true as a matter of microbiology, and it is also beside the point. The risk of C. botulinum spores in commercial powdered infant formula is not a surprise the science just delivered. Barash, Hsia, and Arnon published soil-dwelling clostridia in commercial powdered infant formulas in the Journal of Pediatrics in 2010. That is sixteen years ago. “It is hard to test for” is an argument for more vigilance from the people selling the product, not a pre-written excuse for the next outbreak.

To the FDA, I will give credit where it is due, and I do not give it often. Unlike the November 2024 romaine outbreak, I have spent the last year prying names out of, the agency named ByHeart, named Dairy Farmers of America, and named Organic West Milk. That is how it is supposed to work. Naming the responsible parties during an outbreak is not punishment; it is the whole point of public reporting. So, I will say to the FDA: good. Now finish the job.

Finishing the job means not letting “we have transitioned to post-outbreak response activities” become the sound of a door closing. A risk assessment from JEMRA and a request to the Codex Committee on Food Hygiene are fine things. They are also years away, and they will not look a single one of my clients’ children in the eye. What those families need is a root cause stated plainly, an accounting of how contaminated formula reached forty-eight babies in seventeen states, and a regulatory posture that treats infant formula as exactly what it is — the only food some of the most vulnerable people in this country eat.

The Idaho Department of Health and Welfare (DHW) is working with local and state partners to investigate a recent increase in illnesses after consumption of unpasteurized (raw) milk. Since May 19, 2026, nearly 60 people have been identified who became ill after consuming raw milk. At least 45 of those people tested positive for campylobacteriosis, a bacterial infection, although not everyone who is sick was tested. Investigation and interviews of people reported as ill are ongoing and additional illness may be identified. 

The Idaho Division of Public Health is collaborating with Panhandle District Health, Southwest District Health, Central District Health, Southeastern Idaho Public Health, South Central Public Health, and Eastern Idaho Public Health on the investigation.

Most people who were sick reported consuming raw milk from two different milking operations – one in northern Idaho and one in southern Idaho. 

Investigation is ongoing to identify potential batches of concern and test milk samples.

Raw, unpasteurized dairy products can contain bacteria that make people sick, particularly young children, pregnant women, the elderly, and those who are immunocompromised. Pasteurization kills nearly all the germs that can exist in raw milk while maintaining nutritional benefits. 

Common symptoms of campylobacteriosis infection include diarrhea (sometimes bloody), fever, stomach cramps, nausea and/or vomiting. Symptoms usually start two to five days after exposure and last about one week; some people may develop complications that last longer. Anyone who is experiencing symptoms after consuming raw milk or raw milk products is encouraged to promptly seek medical care. 

For over thirty years, I have been beating the same drum, and the last few days were no exception (some argue a bit too loudly and self-serving). 

I have been posting about public health officials — and the FDA — sending out outbreak documents with the names of companies, growers, processors, and retailers blacked out behind gray boxes I do not think belong there. My position has not changed in three decades: most of those redactions should never have been made in the first place. Not surprisingly, my readers wrote back.

I welcome the pushback. Some of it is thoughtful. A little of it I even agree with. So rather than let the arguments for secrecy sit unanswered in my inbox, let me put them all on the table — every justification for non-disclosure I have heard over the years — and tell you exactly what I think of each.

“There is no written policy, but it is the way we have done things for years.”

I keep hearing my mother’s voice: “just because so-and-so does it does not mean you should too.” A practice is not a policy, and “we have always done it this way” is not a reason — it is the absence of one. Like all government habits (and, frankly, like neckwear), change is good.

“The outbreak is over, so there is no immediate public health threat.”

Frankly, that is true in most foodborne illness outbreaks. In nearly every outbreak I have ever seen, the source is figured out long after the peak of illnesses has passed. But that misses the point of disclosure. Telling the public who grew, processed, and sold the contaminated food is not only about stopping today’s outbreak — it is about giving consumers a track record, so they can see which companies have a strong food safety record and which keep turning up in the same sad story.

“Naming the company jeopardizes its cooperation in this and future outbreaks.”

If a company will cooperate only in exchange for a spot in the witness protection program and a promise of permanent anonymity, that tells you everything you need to know about its commitment — and our government’s commitment — to safe food. Cooperation purchased with secrecy is not cooperation. It is a hostage negotiation in which the public never gets a seat at the table.

“Bad publicity may cause economic hardship for the company.”

True. But here is a better business practice than avoiding bad press: not poisoning your customers. The economic hardship of an outbreak belongs to the company that caused it — not to the consumers left guessing.

“The source was an unknown supplier, so naming the point of service unfairly blames that business.”

This one actually makes some sense, and I will give it its due. But ask the obvious follow-up questions. Is this the first time this restaurant or retailer was burned by a faulty supplier, or is it a pattern? And even if it is the first time, is some of that unnamed product still sitting on shelves or in walk-in coolers somewhere? Fairness to the point of service cannot come at the expense of the people it serves.

“The product is perishable, so by the time we announce, it has already been eaten.”

I have heard this one a “bunch” of times, especially in leafy green outbreaks, and it is the one I find most cynical. Yes, the romaine is long gone. But why should the public be left in the dark about the kind of product that sickened people, and about the grower and shipper behind it, when that is precisely the information they need to decide who to buy from next time? “It’s already been eaten” is a reason to disclose, not a reason to hide.

“Going public with the point of service before the investigation is complete compromises the epidemiology.”

I completely agree with this one. This is the hard call — the one I suspect causes public health officials the most genuine angst. They are balancing the need to have enough data to go public and protect people against the risk of pointing the finger too soon. We have all lived through “it’s the tomatoes — no, wait, it’s the peppers.” The answer is not to stay silent forever. The answer is simple: do not go forward until the investigation is complete. Then go forward and go forward fully.

“We are afraid of making an investigation mistake — the tomatoes-then-peppers problem.”

This is exactly why the law gives public health officials immunity from liability for the good-faith decisions they make to protect the public. The system already accounts for honest error. Fear of an honest mistake is not a license for permanent silence.

“Surveillance is underfunded, and there simply are not the resources to finish investigations.”

There is no question this is true, and it is the argument that worries me most — because it is not really an argument for secrecy at all. It is a confession. I have watched investigations get dropped over the last few years. Labs that are not doing the genetic fingerprinting that links sick people to a common source. Tracebacks that stall out for lack of the people needed to find the root cause. That is a scandal in its own right, and the answer is to fund the work — not to redact our way out of admitting it is not getting done.

And now let me say the part the FDA never will. We do not have to guess whether transparency would cause the sky to fall, because we have already run the experiment. For the better part of twenty years, the USDA’s Food Safety and Inspection Service has named the manufacturers of contaminated meat — and, since 2008, the retailers who sold it. The trade secrets of the beef and poultry industries did not collapse. Consumer confidence went up, not down. Chicken Little, the sky did not fall.

The FDA, which oversees roughly eighty percent of the food supply, could have learned that lesson from its sister agency two decades ago. Instead, it still hides behind “confidential commercial information.” And the line is not hard to draw. Formulations, ingredients, and how a product is made — those are trade secrets. Who supplied the tainted raw material, who made the tainted product, and where the tainted product was sold are not, especially during an outbreak. The most egregious example I know of remains the 2017 outbreak tied to I.M. Healthy soy nut butter — a great name for a product carrying a pathogen — which sickened dozens, some of them children, seriously. A recall was announced. No retailers were named. The company went bankrupt and was in no position to help. The public was left to fend for itself.

I have just watched the same instinct play out again. In the fall of 2024, a multistate E. coli O157:H7 outbreak tied to romaine lettuce hospitalized dozens, sent children into kidney failure, and killed someone. The FDA logged a few lines in a table, closed the file, and never issued the named, complete public notice it had issued for every comparable romaine outbreak before it. The processor and the grower sat behind gray boxes while they were free to tell anyone who asked that the evidence did not point to them. It did. The records said so, by name — once someone bothered to make the agency take the boxes off.

So where does that leave me, after over thirty years and more redacted documents than I care to count? Right where I started. Strip away the budget excuses, the cooperation worries, and the trade-secret theater, and you are left with a single question: who gets to decide what the public is allowed to know about the food that can kill them?

For me, the answer is easy. The public has a right to know, and to use that information however it sees fit. And people — especially government employees — have no business deciding for the rest of us what we should and should not be allowed to find out.

A new outbreak of Listeria monocytogenes (ref #1380) linked to a not yet identified product has been added to the table. FDA has initiated traceback and onsite inspections.

A new outbreak of Cyclospora (ref #1375) linked to a not yet identified product has been added to the table. FDA has initiated traceback.

For the outbreak of Salmonella Typhimurium (ref #1377) linked to moringa leaf powder, FDA has initiated sampling. 

A little over a year ago, in January 2025, I wrote in this space asking a simple question about the November 2024 E. coliO157:H7 romaine outbreak: why would the FDA not tell the public who grew, processed, and sold the lettuce that sickened 89 people across 15 states, hospitalized 36, gave 7 of them hemolytic uremic syndrome, and killed one? The agency had quietly announced the outbreak was over, called the vehicle a “common supplier” of romaine lettuce, and left it there. No grower. No processor. No names.

I said then that I would weigh in where the FDA would not. I have now spent the months since doing exactly that — staying on the agency until it unredacted the documents it should never have hidden in the first place. The documents are now in hand, and they tell the story the gray boxes were built to keep from you.

Here is the short version of how this played out.

When the FDA first released its traceback investigation summary for this outbreak (CARA #1280), nearly every name that mattered was blacked out under the (b)(4) exemption — the part of the Freedom of Information Act meant to shield genuine confidential commercial information and trade secrets. The processor was a gray box. The grower was a gray box. The ranch was a gray box. The distribution centers, the brokers, the lot codes — all gray boxes. What the public was left with was a document that confirmed romaine lettuce as the vehicle but told you absolutely nothing about whose romaine it was or where it came from.

So, I did what I always do. I stayed on them. And the FDA, in stages, unredacted the document.

The fully unredacted version now identifies, in plain text, what the (b)(4) boxes were hiding:

  • Taylor Farms of California (Salinas, CA; FEI 3012342127) was the sole processor. The summary states that Taylor Farms “supplied all the romaine lettuce that would have been available at all points of sale during the timeframe of interest.”
  • Anthony Costa & Sons LLC (Soledad, CA) was the single grower.

The records also fill in the other end of the chain, and that too was originally redacted. The unredacted summaries name Andre’s Banquets and Catering of St. Louis, Missouri (1 of the 15 states) as the caterer at the center of the largest cluster of illnesses — the events where many of these people actually ate the lettuce. The traceback ties Andre’s to three separate catered events with meal dates of November 6 through 8, 2024, including a marching band banquet and a Veteran’s Day luncheon at a St. Louis-area high school, with twenty-two cases linked to that point of service alone. The lettuce blend Andre’s served was supplied through its distributor and traced straight back up the chain to Taylor Farms and Anthony Costa & Sons. But the public had no way to know any of that while the caterer’s name, the school events, and the supplier above them all sat behind the same gray boxes — which meant the families who got sick at those events could not see, in the agency’s own records, how the lettuce on their plate connected to the field it came from.

None of that is a trade secret. The identity of the company that processed lettuce that killed someone is not confidential commercial information. The name of the farm that grew it is not a trade secret. A harvest date is not a proprietary formula. These are the basic facts of a public health disaster, and the only thing the redactions accomplished was to delay the moment when the public — and the families of the people who were hospitalized — could learn who was responsible.

I have been making this same point for years, and I will make it again here, because the FDA keeps forcing me to. Formulations, ingredients, and how products are made are trade secrets. Who supplied the tainted raw material, who made the tainted product, and where the tainted product was sold are not — especially during an outbreak. That line is not hard to draw. The agency simply refuses to draw it.

This matters for a reason that goes well beyond my own irritation. While those names sat behind gray boxes, the companies were free to take the position, in the investigation and elsewhere, that the evidence did not point to them. I have watched that move many times: a processor reviews its own internal traceability, announces it “determined there were no commonalities identified,” and lets the redactions do the rest of the work. But the FDA’s own records told a different story. The agency’s traceback identified a single processor and a single grower, found that the implicated product was available at every point of service, and tied it to specific lots. The unredacted document does not leave room for “it wasn’t us.” It was them. The records say so, by name.

That is exactly why over-redaction is not a harmless bureaucratic habit. When the FDA blacks out the name of the processor and the grower in a fatal outbreak, it is not protecting a trade secret — it is handing the responsible companies a period of deniability they did not earn, and the public did not consent to. The (b)(4) exemption was written to protect genuine competitive information, not to spare a lettuce processor the embarrassment of being named in connection with the produce it sold.

We do not have to guess whether transparency would cause the sky to fall, because we have already run the experiment. For most of the 2000s the USDA’s Food Safety and Inspection Service would name the manufacturer of E. coli-contaminated meat but refused to reveal where it was sold. I still remember people sickened in the 2002 ConAgra outbreak telling investigators they had heard about the recall but figured it did not apply to them because “we bought our meat at Safeway, not at ConAgra.” In 2008, after years of industry hand-wringing about distribution lists, FSIS finally concluded that naming retailers would not cause substantial competitive harm and began releasing the lists. Retailers of USDA-regulated products survived. Trade secrets did not collapse. Consumer confidence went up, not down. Chicken Little, the sky did not fall.

The FDA, which oversees roughly 80 percent of the food supply, could have learned that lesson from its sister agency two decades ago. Instead, it is still hiding behind “confidential commercial information,” and consumers are still left confused — not by too much information, but by too little. The most egregious example I know of remains the 2017 outbreak tied to I.M. Healthy soy nut butter — a great name for a product carrying a pathogen — which sickened dozens, some of them children, seriously. A recall was announced but no retailers were named, the company went bankrupt and had no interest in helping, and the product stayed on shelves and online for months after the recall. That is what secrecy buys you: contaminated product still within reach of the next family while the agency guards a “secret” that protects no one but the seller.

Years ago, a senior CDC official defended withholding company names by saying the practice protects not only public health but also “the bottom line of businesses that could be hurt by bad publicity.” I have a great deal of respect for the people in the diarrheal trenches, but that explanation has always had it exactly backwards. The government does not exist to protect a company’s bottom line from the consequences of selling food that hurts people. Protecting the public sometimes means the responsible company takes a reputational hit. That is not a bug in transparency. That is the point of it.

I would put the principle simply. When people are hospitalized and someone dies, the public’s interest in knowing who grew and processed the food is at its highest, and the commercial interest in staying anonymous is at its lowest. The FDA’s redaction practice in cases like this one inverts that balance. It treats the names of the firms as the secret most in need of protection, when the names are the single most important thing the public is entitled to know.

I am glad the FDA eventually unredacted this one. I should not have had to ask. The next family should not have to wait for a lawyer to pry the names loose months after the outbreak is over and the lettuce is long gone. If the agency genuinely wants to rebuild public trust in how it handles foodborne illness, it can start by drawing the (b)(4) line where the statute actually puts it — and by remembering that the public reporting on an outbreak is supposed to inform the public, not shield the companies.

The lettuce in this outbreak was grown by Anthony Costa & Sons and processed by Taylor Farms. The FDA’s own records say so. There was never a good reason for anyone to have to guess.

When ten people die in a Listeria outbreak traced to a single plant with a documented, years-long record of filth, I pay attention to what the government promises to do about it. And I keep a calendar.

By that calendar, it has now been roughly twenty months since the Department of Justice was formally asked to decide whether Boar’s Head should face criminal charges. It has been roughly twenty months since the USDA Inspector General opened a review of how its own inspectors let the Jarratt, Virginia plant keep running for years while the noncompliance’s piled up. The plant has since closed, been “rebuilt from the inside out,” and reopened. The news cycle has moved on.

And from the two investigations that actually matter for accountability — the DOJ’s and the IG’s — we have heard essentially nothing.

Let me be precise, because precision is the whole point. I am not claiming the investigation was dropped. I do not know that, and neither does anyone outside a grand jury room. What I know is what the public record shows, and what it shows is a long, deliberate silence.

We know there was a real law-enforcement investigation, not just a request for one. When the Associated Press asked USDA for the inspection and enforcement records on Jarratt and eight other Boar’s Head facilities, the agency refused to hand them over. Its stated reason was that the records had been compiled for a law-enforcement purpose covering “both civil and criminal statutes,” and that releasing them could interfere with the investigation. You do not invoke a law-enforcement FOIA exemption over a matter that does not exist. That refusal, in writing, is the strongest confirmation we have that someone with a badge was looking hard at this company.

We know two members of Congress — Senator Richard Blumenthal and Representative Rosa DeLauro — referred the matter to the Attorney General and the Secretary of Agriculture in September 2024 and asked, in plain language, whether criminal charges were warranted. We know the IG opened a review of FSIS’s conduct. We know that as recently as the plant’s February 2026 reopening, reporters were still writing that DOJ “is investigating whether criminal charges are warranted” — present tense — and that the IG “is reviewing” the agency’s handling. Present tense, twenty months on.

What we do not have is a single public document closing the loop. No indictment. No criminal information. No plea. No deferred-prosecution agreement. No consent decree. No public declination explaining why no charge was brought. And no public report from the Inspector General on whether the inspectors who walked past mold, insects, and dripping condensation for years did their jobs. On the central questions, the file is blank.

I want to head off the easy excuse. Someone will say these things take time. They do — and I have made that argument myself. Food-safety criminal cases routinely run two to four years from outbreak to charge. The Peanut Corporation of America prosecution that put Stewart Parnell away for twenty-eight years took years to build. Chipotle’s $25 million deferred-prosecution deal in 2020 followed outbreaks that began long before. So, I am not banging the table because charges haven’t appeared on a schedule I prefer. I am asking a narrower and fairer question: is anyone still working this, and will the public ever be told how it ends?

Because here is what should make every regulator uncomfortable. While we wait, the same company’s other plants keep generating the same kind of paperwork. Records released to the AP around the reopening documented dozens of noncompliance reports at a second Boar’s Head facility in 2025 — dripping condensation, meat residue, and a failure to follow the company’s own written Listeria controls. One inspector noted that a single violation was the fifth of its kind in a month. That is not ancient history dredged up by a plaintiff’s lawyer. That is last year. If the threat of accountability has already faded, the conduct it was supposed to deter apparently has not.

I am asking, on the record, two simple questions.

To the Department of Justice: What happened to the Boar’s Head investigation? If you charged it, say so. If you closed it, say so and tell the families why ten deaths did not clear your bar. The responsible-corporate-officer doctrine and the Federal Meat Inspection Act exist precisely for executives who preside over uncorrected, dangerous conditions. Either those tools applied here or they did not. The public deserves an answer, not a shrug.

To the USDA Inspector General (assuming there is one): What happened to your review of FSIS? You opened it to learn how inspectors and the cooperative state-inspection arrangement let Jarratt operate for years. That answer belongs to the public, because the public is the next set of people who will eat what these plants ship.

Ten people are dead. Sixty were hospitalized across nineteen states. A plant that should never have been allowed to deteriorate the way it did is back in business. The least we are owed — the families, the survivors, and everyone who buys lunch meat trusting that someone is watching — is to be told whether anyone in Washington ever finished the job.

I will keep my calendar open. I would rather fill in an answer than another month of silence.

Legal Basis for a Criminal Investigation Under the Federal Meat Inspection Act

1. The prohibited conduct

The Federal Meat Inspection Act (“FMIA”), 21 U.S.C. § 601 et seq., makes it unlawful to sell, transport, offer for sale or transportation, or receive for transportation in commerce any meat or meat food product that is adulterated or misbranded. 21 U.S.C. § 610 (prohibited acts), including § 610(c). A federal criminal investigation of a meat processor proceeds from the premise that adulterated product entered commerce in violation of § 610.

2. What makes the product “adulterated”

“Adulterated” is defined at 21 U.S.C. § 601(m). Two clauses are directly relevant to a Listeria outbreak: § 601(m)(1) covers a product bearing or containing any poisonous or deleterious substance that may render it injurious to health, and § 601(m)(4) covers a product prepared, packed, or held under insanitary conditions whereby it may have become contaminated with filth or rendered injurious to health. FSIS treats Listeria monocytogenes in ready-to-eat product as an adulterant on a zero-tolerance basis, so confirmed contamination of RTE deli meat establishes adulteration under § 601(m)(1), and a documented record of insanitary plant conditions independently supports adulteration under § 601(m)(4).

3. The criminal penalty structure

Criminal penalties are set by 21 U.S.C. § 676(a), which creates two tiers:

  • Misdemeanor (baseline). Any violation of the FMIA for which no other penalty is provided is punishable by up to one year of imprisonment and a fine. This tier requires no proof of intent or knowledge — it is a strict-liability “public-welfare” offense.
  • Felony (elevated). The offense becomes a felony, punishable by up to three years of imprisonment and a larger fine, if the violation involves intent to defraud or any distribution or attempted distribution of an article that is adulterated (other than the narrow pesticide/additive carve-out at § 601(m)(8), which does not apply to Listeria). Because Listeria-contaminated RTE meat is adulterated under § 601(m)(1), distributing it can supply the felony predicate even without proof of intent to defraud.

Separately, § 676(b) lets the Secretary decline to refer minor violations for prosecution where a written warning will adequately serve the public interest — a discretion provision, not a shield for a repeated, uncorrected pattern of the kind documented at Jarratt.

4. Reaching corporate officers: the responsible-corporate-officer doctrine

Because the FMIA misdemeanor is a strict-liability public-welfare offense, individual executives can be charged under the responsible-corporate-officer doctrine of United States v. Dotterweich, 320 U.S. 277 (1943), and United States v. Park, 421 U.S. 658 (1975). Under Park, an officer who stood in a position of authority and responsibility over the conditions that produced the violation — and who had the power to prevent or correct them — may be convicted of the misdemeanor without any showing that the officer personally participated in or knew of the violation. A documented, repeated, uncorrected pattern of insanitary conditions is the classic factual setting in which these tools are deployed.

5. Who investigates and who charges

  • FSIS. USDA’s Food Safety and Inspection Service investigates suspected FMIA violations through its Office of Investigation, Enforcement, and Audit and refers matters warranting prosecution to the Department of Justice. FSIS’s invocation of the law-enforcement FOIA exemption (Exemption 7, 5 U.S.C. § 552(b)(7)) over the Boar’s Head records is the public marker that such an investigation existed.
  • DOJ. Criminal FMIA matters are prosecuted by the Department of Justice — typically the Consumer Protection Branch (which handles FMIA and Food, Drug, and Cosmetic Act food prosecutions) working with the U.S. Attorney’s Office for the relevant district, here the Eastern District of Virginia. Any charging instrument would appear as an indictment or criminal information on that court’s docket.
  • Grand-jury secrecy. An ongoing federal criminal investigation is shielded by Fed. R. Crim. P. 6(e), which is why continued silence is consistent with either a pending matter or a closed one; the public record cannot distinguish between them.

6. The distinct basis for the FSIS internal investigation

The USDA Inspector General’s review is grounded in different authority — the Inspector General Act of 1978, now recodified at 5 U.S.C. § 401 et seq. (formerly 5 U.S.C. App.) — which empowers the IG to audit and investigate the programs and operations of USDA, including whether FSIS and the cooperative (Talmadge-Aiken) state-inspection arrangement responded appropriately to the documented conditions at Jarratt. This is oversight of the agency itself, separate from any FMIA prosecution of the company, and its findings are ordinarily released to the public in an IG report.

Whole genome sequencing results show that the beef kofta samples collected by FSIS and produced at Olympia Food Industries (Est. 18743) matched the outbreak strain of E. coli O157:H7. FSIS continues to coordinate with the California Department of Public Health and local health departments in California on the outbreak investigation.

The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) is issuing a public health alert due to concerns that beef kofta products served at The Kebab Shop restaurant locations may be contaminated with Shiga toxin-producing E. coli (STEC) O157:H7. A recall was not requested because the products are no longer available for purchase.

The beef kofta was produced as a raw ground beef product by Olympia Food Industries, Inc. dba Olympia Foods (Est. 18743) in Franklin Park, Illinois, on January 6, 2026, and supplied to The Kebab Shop restaurant locations in California, Texas, and Florida.
The problem was discovered as part of an ongoing illness outbreak investigation. FSIS, the California Department of Public Health (CDPH), and local health departments in California are investigating a localized outbreak of E. coli O157:H7 that includes 9 sick people in California. As of May 24, 2026, illness onset dates have been reported ranging from March 27, 2026, to April 30, 2026. Because the identified illnesses are limited to California, CDPH is leading this investigation with FSIS. FSIS continues to keep its federal partners informed as the investigation progresses. FSIS collected raw ground beef kofta product samples that tested positive for E. coli O157:H7. Further testing is ongoing to determine if the product samples are related to the specific outbreak strain.

FSIS is issuing this public health alert to ensure that consumers in California, Texas, and Florida are aware of the outbreak. The Kebab Shop stopped selling beef kofta at all of its restaurant locations on May 18, 2026.

E. coli O157:H7 is a potentially deadly bacterium that can cause dehydration, bloody diarrhea and abdominal cramps 2 to 8 days (3 to 4 days, on average) after exposure to the organism. While most people recover within a week, some develop a type of kidney failure called hemolytic uremic syndrome (HUS). 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. Consumers who ate beef kofta from any location of The Kebab Shop and develop symptoms of STEC infection within 10 days of exposure should contact their health care provider. Consumers should discard any leftover beef kofta from The Kebab Shop.

William “Bill” Marler has been a food safety lawyer and advocate since the 1993 Jack-in-the-Box E. coli Outbreak which was chronicled in the book, “Poisoned” and in the recent Emmy Award winning Netflix documentary by the same name. Bill work has been profiled in the New Yorker, “A Bug in the System;” the Seattle Times, “30 years after the deadly E. coli outbreak, A Seattle attorney still fights for food safety;” the Washington Post, “He helped make burgers safer, Now he is fighting food poisoning again;” and several others. 

Dozens of times a year Bill speaks to industry and government throughout the United States, Canada, Europe, Africa, China and Australia on why it is important to prevent foodborne illnesses.  He is also a frequent commentator on food litigation and food safety on Marler Blog. Bill is also the publisher of Food Safety News.

E. coli:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of E. coli outbreaks and hemolytic uremic syndrome (HUS). The E. coli lawyers of Marler Clark have represented thousands of victims of E. coli and other foodborne illness infections and have recovered over $900 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our E. coli lawyers have litigated E. coli and HUS cases stemming from outbreaks traced to ground beef, raw milk, lettuce, spinach, sprouts, and other food products.  The law firm has brought E. coli lawsuits against such companies as Jack in the Box, Dole, ConAgra, Cargill, and Jimmy John’s.  We have proudly represented such victims as Brianne Kiner, Stephanie Smith and Linda Rivera.

If you or a family member became ill with an E. coli infection or HUS after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark E. coli attorneys for a free case evaluation.

Additional Resources:

I have spent more than thirty years representing the people who get left holding the bill for someone else’s contaminated food. I have read more outbreak reports than I can count. And in all those years, I have learned to pay close attention not just to what a government agency tells the public, but to what it decides to hide.

So, when the FDA finally released its Executive Incident Summary on the ByHeart infant botulism outbreak, the first thing I looked for was the name of the company that supplied the powdered milk. It wasn’t there. In the single most important sentence of the document, the one tracing the contaminated ingredient back through the supply chain, the agency had blacked out two things: the name of the supplier and the place it operates. The sentence now reads that eight whole milk lot powders were traced to 33 fluid milk lots from a company FDA won’t name, located somewhere FDA won’t say.

Let me say plainly why that was the wrong call. And let me start with the part that should trouble any lawyer who has ever filed a public records request.

The wrong exemption for the wrong reason

When a federal agency withholds information, it has to cite a legal basis. FDA stamped these redactions with exemption (b)(5). That is the deliberative-process privilege. It exists to protect the give-and-take of internal agency decision-making, draft opinions, recommendations, the pre-decisional back-and-forth that helps officials reach a conclusion. It is not a tool for hiding facts.

The name of a milk supplier and the state it sits in are not anyone’s deliberations. They are findings. They are the factual result of a traceback investigation, the kind of bedrock fact a public health record exists to convey. Even the exemption that might at least be argued here, (b)(4), which covers confidential commercial information, would be a stretch given what’s already public. But (b)(5) isn’t even the right neighborhood. Using the deliberative-process privilege to black out a company’s name reads less like a careful legal judgment and more like reaching for whatever stamp was closest to hand. When the government has to misapply a privilege to keep a fact from the public, that is usually a sign the fact should have been public all along.

A redaction that protects no one

This outbreak sickened 48 infants across 17 states. Every single one of them was hospitalized. The youngest victims of any foodborne outbreak are the ones who can do nothing to protect themselves, and botulism in a baby is about as frightening a diagnosis as a parent can hear: a toxin that attacks the nervous system and causes paralysis, treatable only with a specialized antitoxin made from pooled human plasma. 

These families did everything right. They bought a premium formula marketed as the next-best thing to breast milk. What they got was a product whose contamination, by FDA’s own case definition, reaches all the way back to March 23, 2022, the very day ByHeart began manufacturing. The agency drew the outbreak’s starting line at the company’s first day in business and then declined to name the supplier that fed into it.

Here is the part that should bother every one of us. The name isn’t actually a secret. Dairy Farmers of America has already confirmed, publicly and on the record, that its plant in Fallon, Nevada dried the milk, that Organic West was the source of the milk in the sample the FDA collected, and that Organic West sold the resulting powder to ByHeart. Trade publications have walked the entire chain in detail: roughly 55 organic farms shipping to Organic West, the milk dried into organic whole milk powder at the DFA facility, and that powder going into ByHeart’s formula before testing found botulinum toxin in sealed cans and in the ingredient itself.

So, the FDA redacted a name that the implicated processor has already volunteered to the world. That is not protecting an investigation. That is not guarding a trade secret. And here is the detail that turns an odd decision into an indefensible one: FDA named these very companies in its own public outbreak advisory. The agency’s February 26 advisory states in plain text that the milk powder isolates were collected at Dairy Farmers of America, the processor for ByHeart’s supplier, Organic West Milk. The agency put the names in one official document and then blacked them out of another, citing a privilege, while the underlying fact sat published on its own website. You cannot credibly claim a name must be withheld to protect anything when you have already printed it yourself.

It matters all the more because the abstract concedes the investigation came up empty on the central question. In FDA’s own words, the findings could not identify the source or root cause of the contamination. When an agency cannot tell the public why a product poisoned 48 babies, the least it owes them is a complete account of what it did learn, including where the ingredient came from. Redacting the one concrete link in the chain, after admitting you never found the cause, leaves the public with less than the facts already on the record.

Transparency is not a courtesy, It is the job.

People sometimes forget what these reports are for. An outbreak summary is not a press release for the companies involved. It is a public health document. Its purpose is to tell parents, pediatricians, regulators, and yes, other formula makers, what went wrong so that it does not happen again.

When you redact the supplier, you take that knowledge away from exactly the people who need it. Other manufacturers buying organic whole milk powder have a direct interest in knowing whose product was implicated and how. Public health officials in 17 states have an interest in a complete record. And the families whose babies spent weeks in hospital beds have a right to know the full path the contamination traveled to reach their kitchen counters. Withholding the name does not make anyone safer. It only makes accountability harder.

I have said for years that the FDA and the CDC too often decide that the public can handle less information than it can. We saw it with the romaine outbreaks. We are seeing it again here. The instinct toward secrecy is presented as caution. In practice it is the opposite of caution, because nothing invites a repeat outbreak faster than a record the next manufacturer cannot learn from.

Secrecy lets the finger-pointing win

There is a practical consequence to all this beyond principle. When the government keeps the supply chain in the dark, it hands the companies involved the power to write the story themselves.

That is already happening. The Dairy Farmers of America has put out a statement saying its powder met all required tests and reminding everyone that manufacturers of end-use consumer products have a responsibility to properly process ingredients to ensure product safety. Translation: not our problem, it was ByHeart’s job to control for this. ByHeart, for its part, declined to identify the source of the milk powder samples its own testing flagged. Each link in the chain is busy positioning blame at the next link, and the FDA’s redaction simply gives them more room to do it in the shadows.

Meanwhile we know what the FDA found inside ByHeart’s own operation. As far back as December 2023, the agency raised warnings, after inspectors documented a leaking roof, mold in a water tank, and 2,500 dead flies in a food production area at the company’s plant. Inspectors also found the facility violating its own rules for maintaining the temperatures needed to kill bacteria before packaging. That is the record. The public deserves to weigh it alongside a full and unredacted account of where the contaminated ingredient came from, not a version with the inconvenient names removed.

What the agency should do now

The fix is simple. Reissue the abstract without the redactions, or at minimum drop the (b)(5) stamp that never fit a factual finding to begin with. Name the supplier and its location the way the agency already named them in its own advisory. Stop treating a public health record as a document to be negotiated with the companies it describes.

I am not asking the FDA to assign legal blame. That is what courts are for, and the civil justice system will sort out responsibility among the farms, the processor, and the manufacturer with the benefit of full discovery. What I am asking is far more basic: that the agency charged with protecting our food supply tell us the truth, completely, when babies have been hospitalized in 17 states and the agency itself admits it never found the cause.

Forty-eight families learned the hard way that the system failed them. The least the FDA can do is give them, and the rest of us, an honest accounting. A black box where a name should be, propped up by a privilege that doesn’t fit, is not an honest accounting. It is the agency deciding, one more time, that we are better off not knowing.

Most people who survive Shiga toxin–producing Escherichia coli hemolytic uremic syndrome (STEC-HUS) recover, yet a meaningful minority are left with lasting neurological problems, and in adults some of that injury declares itself only well after the acute illness has resolved.

The baseline recovery figures are broadly consistent. Spinale and colleagues’ review concluded that roughly 70% of patients recover fully, with the kidneys bearing the bulk of long-term damage and a smaller subset experiencing extrarenal sequelae, including brain injury.[1] Long-term pediatric data align closely: in the Austrian/German cohort followed by Rosales et al. for ten years, 66% of 138 STEC-HUS patients had fully recovered, while 34% retained some residual abnormality — most often reduced glomerular filtration, proteinuria, or hypertension, with persistent neurological symptoms in about 3%.[2] So while frank neurological sequelae affect only a small percentage at a decade out, they are a real and durable component of the residual-disease burden.

The scale of that risk is clearest in population-level work. Merrick et al.’s matched cohort from Wales (1990–2020) tracked neurological endpoints such as epilepsy and cognitive impairment alongside renal, cardiac, and other outcomes, and found that long-term complications were nearly twice as likely after STEC O157 infection and up to eight times as likely after STEC-HUS compared with unexposed controls — a gradient that led the authors to recommend monitoring for at least five years.[3] This reframes neurological sequelae not as rare curiosities but as part of an elevated, measurable long-term risk profile that warrants structured follow-up.

The adult experience adds a distinctive and clinically important wrinkle. Schuppner and colleagues followed 44 adults from the 2011 O104:H4 outbreak at 2, 7, and 19 months using neurological, neuropsychological, MRI, and EEG assessment. At 19 months only about 39% performed normally, and — most strikingly — roughly a quarter of patients showed a secondary decline in cognitive function that was unrelated to the severity of their acute illness.[4] This delayed deterioration means that an apparently good early recovery does not guarantee a durable one, and that acute-phase severity is an unreliable predictor of cognitive outcome.

The pattern of injury helps explain why recovery is so often partial rather than absent. STEC-HUS brain injury is fundamentally microvascular and Shiga-toxin/Gb3-mediated rather than the result of large-vessel occlusion, producing the characteristic symmetric and frequently reversible oedema in the basal ganglia, thalami, and brainstem rather than territorial infarction. Because the insult is diffuse and often partly reversible, many patients improve substantially, but the same microangiopathic mechanism can leave residual cognitive and seizure-related deficits. Tonkovic et al.’s comprehensive review situates these long-term, age-specific outcomes within that mechanistic framework,[5] and the broader concern is underscored by the observation that HUS mortality of around 5% rises toward 40% once the CNS is involved — marking neurological participation as the principal driver of poor outcomes.[6]

Taken together, the evidence supports a few practical conclusions: full neurological recovery is the most common outcome but is not universal; children and adults differ, with adults notably at risk of a delayed cognitive decline; and the elevated long-term risk justifies sustained, multidisciplinary follow-up rather than discharge once renal function stabilizes.

References

Pathophysiology and mechanism (microangiopathy)

1.  [Author byline to verify]. Deleterious consequences of Shiga toxin in the CNS. Microbiol Mol Biol Rev. 2026;90(1):e00301-25. doi:10.1128/mmbr.00301-25

Current mechanism review (clinical + experimental). STEC encephalopathy is described as a main predictor of death; Shiga toxin in circulation rapidly induces endothelial damage via the Gb3 receptor, with consistently reported brain inflammation.

2.  Goldstein J, Nuñez-Goluboay K, Pinto A. Therapeutic strategies to protect the central nervous system against Shiga toxin from enterohemorrhagic Escherichia coli. Curr Neuropharmacol. 2021;19(1):24-44.doi:10.2174/1570159X18666200220143001

Reviews CNS injury and neuroprotective strategies; notes HUS mortality ~5%, rising to ~40% with CNS involvement, plus the contribution of lipopolysaccharide-driven inflammation.

3.  Tonkovic U, Bogicevic M, Manzar A, Andrejic N, Sic A, Atanaskovic M, et al. Neurological manifestations of hemolytic uremic syndrome: a comprehensive review. Brain Sci. 2025;15(7):717. doi:10.3390/brainsci15070717

Primary recommended overview. Dedicated section on Shiga toxin–mediated endothelial injury and microangiopathy (Gb3/CD77 binding, microvesicle transport); spans pathophysiology, clinical spectrum, imaging, and age-specific outcomes for typical (STEC) and atypical HUS, covering both acute presentation and long-term risk.

4.  Kim M, Lee KS, Park JY, Kim CU, Jeong YJ, Lee MS. Shiga toxin induces apoptosis via ROS–caspase activation in human cerebral endothelial cell line hCMEC/D3 and astrocyte co-culture. J Microbiol Biotechnol. 2026;36:e2512.12006. doi:10.4014/jmb.2512.12006

In vitro model of cerebral microvascular endothelial (blood-brain barrier) injury: Stx1a/Stx2a induce MAPK/ER-stress and caspase-mediated apoptosis with tight-junction loss and increased paracellular permeability. Directly relevant to the cerebral microangiopathy mechanism.

Acute-phase illness: clinical presentation and neuroimaging

5.  Fodor TA, Schmook MT, Brücke C. Pearls & Oy-sters: neurologic involvement in Shiga toxin–associated hemolytic uremic syndrome. Neurology. 2024;103(9):e209881. doi:10.1212/WNL.0000000000209881

Concise clinical teaching article: the thrombotic microangiopathy mainly affects the small vessels of the kidneys and brain; acute signs include decreased consciousness, altered mental status, seizures, hyperreflexia.

6.  Nakamura T, Fujikawa H, Uenishi N. Brain magnetic resonance imaging findings of Shiga toxin-producing Escherichia coli hemolytic uremic syndrome-associated encephalopathy. JMA J. 2025;8(1):298-299.doi:10.31662/jmaj.2024-0201

Confirmed O157:H7 case; bilateral symmetric pontine and thalamic FLAIR changes; incidence of neurological involvement cited at 17–34%, with a near-symmetric distribution (basal ganglia, centrum semiovale, thalami, brainstem).

7.  Wengenroth M, Hoeltje J, Repenthin J, Meyer TN, Bonk F, Becker H, et al. Central nervous system involvement in adults with epidemic hemolytic uremic syndrome. AJNR Am J Neuroradiol. 2013;34(5):1016-1021. doi:10.3174/ajnr.A3336

MRI series of 11 adults from the 2011 Hamburg EHEC (O104:H4) outbreak; symmetric brainstem vasogenic edema, with no territorial ischemia, hemorrhage, or blood-brain barrier disruption (consistent with a microangiopathic process).

8.  [Author byline to verify]. Shiga toxin-producing Escherichia coli infection-related acute encephalopathy. Neurol Sci. 2025. doi:10.1007/s10072-025-08034-9

Adult (34-year-old) case of STEC-related acute encephalopathy without concurrent kidney involvement; seizures, cortical blindness, left hemiparesis.

9.  Ylinen E, Salmenlinna S, Halkilahti J, Jahnukainen T, Korhonen L, Virkkala T, et al. Hemolytic uremic syndrome caused by Shiga toxin–producing Escherichia coli in children: incidence, risk factors, and clinical outcome. Pediatr Nephrol. 2020;35(9):1749-1759. doi:10.1007/s00467-020-04560-0

Finnish nationwide pediatric cohort; O157 most common serogroup (66%); acute-phase outcomes and risk factors (age <3 y, stx2/stx2a), bridging to long-term prognosis.

Long-term complications and neurological sequelae

10.  Schuppner R, Maehlmann J, Dirks M, Worthmann H, Tryc AB, Sandorski K, et al. Neurological sequelae in adults after E coli O104:H4 infection-induced hemolytic-uremic syndrome. Medicine (Baltimore). 2016;95(6):e2337. doi:10.1097/MD.0000000000002337

Longitudinal follow-up of 44 adults from the 2011 outbreak at 2, 7, and 19 months (neurologic, neuropsychological, MRI, EEG). At 19 months only ~39% performed normally; a secondary decline of cognitive function occurred in ~1/4 of patients, unrelated to acute-phase severity.

11.  Rosales A, Kuppelwieser S, Giner T, Hofer J, Riedl Khursigara M, Orth-Höller D, et al. Outcome 10 years after Shiga toxin-producing E. coli (STEC)-associated hemolytic uremic syndrome: importance of long-term follow-up. Pediatr Nephrol. 2024;39(9):2739-2750. doi:10.1007/s00467-024-06355-z

Austrian/German pediatric cohort, 138 STEC-HUS patients at 10 years: 66% fully recovered; 34% had decreased GFR, proteinuria, hypertension, or neurological symptoms (3%).

12.  Merrick R, Song J, Fina L, Sawyer C, Jenkins C, King G, et al. Long-term health outcomes of Shiga toxin-producing Escherichia coli O157 (STEC O157) infection and STEC-associated haemolytic uraemic syndrome (STEC-HUS), Wales, 1990–2020. Pediatr Nephrol. 2025;40(7):2363-2374. doi:10.1007/s00467-024-06640-x

Population-based matched cohort (4:1) vs. unexposed comparators; outcomes (kidney, neurological [epilepsy, cognitive impairment], cardiac, GI, respiratory, endocrine) via Cox regression. Long-term complications nearly twice as likely after STEC O157 and up to eight times after STEC-HUS; recommends ≥5-year monitoring.

13.  Spinale JM, Ruebner RL, Copelovitch L, Kaplan BS. Long-term outcomes of Shiga toxin hemolytic uremic syndrome. Pediatr Nephrol. 2013;28(11):2097-2105. doi:10.1007/s00467-012-2383-6

Review of long-term sequelae: ~70% recover fully; kidneys bear most long-term damage, with a smaller number of extrarenal sequelae including brain injury.

Treatment of CNS involvement (acute management bearing on long-term outcome)

14.  Wildes DM, Harvey S, Costigan CS, Sweeney C, Twomey É, Awan A, et al. Eculizumab in STEC-HUS: a paradigm shift in the management of pediatric patients with neurological involvement. Pediatr Nephrol. 2024;39(3):935-940. doi:10.1007/s00467-023-06102-w

Retrospective series (n = 4 children) with CNS involvement (ataxia, altered mental status, visual symptoms, seizures, days 2–7) treated with eculizumab plus supportive care; rapid symptom resolution and complete kidney/neurological recovery at 12 months.

15.  Spagnol R, Alfisi A, Moi M, Bonvecchio I, Bertazza Partigiani N, Vidal E. Eculizumab in severe pediatric STEC-HUS and its impact on neurological prognosis—a systematic review and meta-analysis. Eur J Pediatr. 2025;184(6):360. doi:10.1007/s00431-025-06160-2

Systematic review/meta-analysis; notes neurological complications in 17–34% of affected children, arising from thrombotic events in the cerebral microvasculature, and evaluates eculizumab’s effect on neurological prognosis.

16.  Rosazza C, Cappellari AM, Gandini C, Scola E, Ardissino G. Steroid pulse therapy for severe central nervous system involvement in Shiga toxin-producing Escherichia coli-related hemolytic uremic syndrome. Case Rep Pediatr. 2021;2021:5587050. doi:10.1155/2021/5587050

Pediatric case (7-year-old) where severe CNS involvement (subacute encephalitis → coma) emerged as the TMA was resolving — attributed to reperfusion injury — and resolved without sequelae after high-dose IV steroids.

[1]Spinale JM, Ruebner RL, Copelovitch L, Kaplan BS. Long-term outcomes of Shiga toxin hemolytic uremic syndrome. Pediatr Nephrol. 2013;28(11):2097-2105. doi:10.1007/s00467-012-2383-6

[2]Rosales A, Kuppelwieser S, Giner T, et al. Outcome 10 years after Shiga toxin-producing E. coli (STEC)-associated hemolytic uremic syndrome: importance of long-term follow-up. Pediatr Nephrol. 2024;39(9):2739-2750. doi:10.1007/s00467-024-06355-z

[3]Merrick R, Song J, Fina L, et al. Long-term health outcomes of Shiga toxin-producing Escherichia coli O157 (STEC O157) infection and STEC-associated haemolytic uraemic syndrome (STEC-HUS), Wales, 1990–2020. Pediatr Nephrol. 2025;40(7):2363-2374. doi:10.1007/s00467-024-06640-x

[4]Schuppner R, Maehlmann J, Dirks M, et al. Neurological sequelae in adults after E. coli O104:H4 infection-induced hemolytic-uremic syndrome. Medicine (Baltimore). 2016;95(6):e2337. doi:10.1097/MD.0000000000002337

[5]Tonkovic U, Bogicevic M, Manzar A, et al. Neurological manifestations of hemolytic uremic syndrome: a comprehensive review. Brain Sci. 2025;15(7):717. doi:10.3390/brainsci15070717

[6]Goldstein J, Nuñez-Goluboay K, Pinto A. Therapeutic strategies to protect the central nervous system against Shiga toxin from enterohemorrhagic Escherichia coli. Curr Neuropharmacol. 2021;19(1):24-44. doi:10.2174/1570159X18666200220143001