The CDC reports that thirty-eight people infected with the outbreak strain of STEC O121 have been reported from 20 states – Alabama 1, Arkansas 1, Arizona 2, California 1, Colorado 4, Iowa 1, Illinois 4, Massachusetts 2, Maryland 1, Michigan 4, Minnesota 3, Missouri 1, Montana 1, New York 1, Oklahoma 2, Pennsylvania 2, Texas 2, Virginia 2, Washington 2 and Wisconsin 1.  Illnesses started on dates ranging from December 21, 2015 to May 3, 2016. Ill people range in age from 1 year to 95, with a median age of 18. Seventy-eight percent of ill people are female. Ten ill people have been hospitalized.

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WGS showed that isolates from ill people are closely related genetically. This close genetic relationship means that people in this outbreak are more likely to share a common source of infection.

Collaborative investigative efforts of state, local, and federal health and regulatory officials indicate that flour produced at General Mills’ Kansas City, Missouri facility is a likely source of this outbreak. This investigation is ongoing.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Sixteen (76%) of 21 people reported that they or someone in their household used flour in the week before they became ill. Nine (41%) of 22 people reported eating or tasting raw homemade dough or batter. Twelve (55%) of 22 people reported using Gold Medal brand flour. Three ill people reported eating or playing with raw dough at restaurants.

These investigations indicated that the flour used by ill people or used in restaurant locations was produced in the same week in November 2015 at the General Mills facility in Kansas City, Missouri. General Mills produces Gold Medal brand flour. On May 31, 2016, General Mills recalled several sizes and varieties of Gold Medal Flour, Gold Medal Wondra Flour, and Signature Kitchens Flour due to possible E. coli contamination. The recalled flours were produced in the Kansas City facility during a time frame identified by traceback and sold nationwide. CDC recommends that consumers, restaurants, and retailers do not use, serve, or sell the recalled flours.