I have been asked that questions several dozen times in the last 48 hours as this outbreak has mushroomed to nearly 70 in some 28 states with at least 25 hospitalized and 7 with HUS.  So, how did this nasty bug get into such an "All-American" product?  Here is the list of ingredients:

E. coli O157:H7 bacteria are believed to mostly live in the intestines of cattle but have also been found in the intestines of chickens, deer, sheep, goats, and pigs. E. coli O157:H7 does not make the animals that carry it ill; the animals are merely the reservoir for the bacteria.  It is hard to figure how one of these animals slipped into the Danville, Virginia plant and leave enough feces to sicken people in two dozen states.

Certainly milk has been linked to E. coli outbreaks.  But is seems unlikely that Nestles was using raw milk in it’s cookie dough.  Eggs, well, you might expect Salmonella, but not E. coli O157:H7.  Same with chocolate – there have been Salmonella cases in the past with some of the major players in the industry.  Perhaps an ill worker who did not wash his or her hands?  Seems unlikely given the size of the outbreak. 

Bio-terrorism?  Hopefully not.  What about vermin (rats, mice, birds, etc) either contaminating raw ingredients in the Danville facility or the facilities of other ingredient manufacturer?  Although there is no evidence that any of the plants had these problems, my hunch would be to look hard here, but always be aware that somewhere in the background likely lurks a cow.

By way of background, the Centers for Disease Control and Prevention (CDC) estimated in 1999 that 73,000 cases of E. coli O157:H7 occur each year in the United States. Approximately 2,000 people are hospitalized, and 60 people die as a direct result of E. coli O157:H7 infections and complications. The majority of infections are thought to be foodborne-related, although E. coli O157:H7 accounts for less than 1% of all foodborne illness.

However, E. coli O157:H7 does cause illness in humans – at times severe. An E. coli O157:H7 infection is characterized by the sudden onset of abdominal pain and severe cramps, followed within 24 hours by diarrhea. As the disease progresses, the diarrhea becomes watery and then may become grossly bloody – bloody to naked eye. Vomiting can also occur, but there is usually no fever. The incubation period for the disease (the period from ingestion of the bacteria to the start of symptoms) is typically 3 to 9 days, although shorter and longer periods are not that unusual. An incubation period of less than 24 hours would be unusual, however. In most infected individuals, the intestinal illness lasts about a week and resolves without any long-term problems.

Hemolytic Uremic Syndrome (HUS) is a severe, life-threatening complication of an E. coli O157:H7 bacterial infection. Although most people recover from an E. coli O157:H7 infection, about 5-10% of infected individuals goes on to develop HUS. E. coli O157:H7 is responsible for over 90% of the cases of HUS that develop in North America. Some organs appear more susceptible than others to the damage caused by these toxins, possibly due to the presence of increased numbers of toxin-receptors. These organs include the kidney, pancreas, and brain.

  • D. L. Whitehead

    Made on equipment that also processes peanuts/nuts…

  • Michele

    Theoretical possibility that eggs were the vehicle (if not pasteurized)?
    Variable colonization of chickens perorally inoculated with Escherichia coli O157:H7 and subsequent contamination of eggs
    Challenging 1-day-old White Leghorn chicks perorally with 2.6 x 10(1) to 2.6 x 10(5) Escherichia coli O157:H7 bacteria per chick resulted in cecal colonization at all levels.
    Eggs from five hens that were fecal shedders of E. coli O157:H7 until the termination of the study (10 to 11 months) were assayed for E. coli O157:H7. The organism was isolated from the shells of 14 of 101 (13.9%) eggs but not from the yolks and whites. Considering that chicks can be readily colonized by small populations of E. coli O157:H7 and continue to be long-term shedders, it is possible that chickens and hen eggs can serve as vehicles of this human pathogen.

  • From an Email from Robert:
    You should drop the word “cow” from your title. You have currently no
    evidence to implicate cattle. It is much more likely to be birds (my
    guess) or rodents. E. coli O157:H7 does not arise solely from cattle,
    although from a bulk point of view, it is the most common source.
    As far as quantity of foeces, my guess it is an amount measured in
    handfuls, not milligrams. Thus my guess that birds are involved.
    However, grain would attract rodents. I would be able to estimate
    better if I knew the mass of the product lots directly implicated in
    the outbreak. But if a “taste” (10 g?) were sufficient to deliver a
    100+ CFU dose, then contamination is at the 10 CFU/g level or higher,
    typical of an E. coli O157:H7 outbreak.
    At the current time, when I am mostly ignorant of any details
    concerning the outbreak, I would conjecture that some bulk
    ingredient, such as flour or its grain, was exposed to long-term
    harborages of birds or rodents who routinely defecated into the lot.
    This would represent a long-term bad behavior on the part of some
    supplier (such as a flour producer or grain elevator) who had drifted
    into apathy concerning food wholesomeness. But this time the
    birds/rodents were E. coli O157:H7 carriers, and the hygiene so bad
    that a large-scale outbreak was generated. (Very similar to the
    peanut butter outbreaks.)
    Is this the fault of the consumer who failed to distrust all foods?
    Or the unconscionable behavior of a supplier who lost all moral
    principles concerning food safety? Who should know better? The
    consumer or the supplier? A la NRA: “Food doesn’t kill people, people do.”
    Outbreaks happen for causes, and the causes are typically crimes or
    moral lapses on the part of producers.
    Robert A. LaBudde, PhD, PAS, Dpl. ACAFS e-mail: ral@lcfltd.com
    Least Cost Formulations, Ltd. URL: http://lcfltd.com/
    824 Timberlake Drive Tel: 757-467-0954
    Virginia Beach, VA 23464-3239 Fax: 757-467-2947
    “Vere scire est per causas scire”

  • Sharon Knoll

    Bill Marler is a well-known attorney focused on food issues – in light of our movie I thought you would be interested in this article.

  • roy costa

    We cannot rule out contaminated well water. We should be asking if any of the manufacturing facilities were on a well. There is some evidence for birds as vectors (seagulls come to mind). Rodents could be transient vectors but I do not think we have much of a precedent for any true reservoir in rodents. We cannot also rule out a back up of sewage or a cross connection in some facility piping. Trucks hauling cattle and then hauling grain is another possibility
    O157:H7 is getting wide dissemination in human populations, animals and water. But right now I am thinking water or sewage.

  • DC Madman

    I knew there was a reason to not eat raw cookie dough.

  • Dean Hughson

    No one uses unpasteurized eggs in commercial food operations so rule that out immediately.

  • Janice Boase

    It will be interesting to find out how the contamination actually occurred.
    Certainly Nestle contracts with a variety of manufacturers for its ingredients and that those manufacturers are required to follow HAACP. While it is possible that anyone of the ingredient manufacturers could have had a lapse in sanitation and Nestle as well, it could have nothing to do with them at all. Ingredient(s) have become contaminated during transport. There have been instances where tanker trucks have not been properly sanitized between uses. If say raw milk was transported and then pastuerized eggs or milk, this would be how the (&*(*&()* gets into the cookie dough.
    It’s always something.

  • Catherine

    It might still be the eggs. Eggs come in shells, and shells, sorry to say, will have chicken doings on them, in Nature. It only takes one instance of improper pasteurisation to cause a problem.
    to quote Calvin, of Calvin and Hobbes:
    Another nostalgic part of childhood goes ptttthhhbbtttt.
    Unfortunately in today’s food supply there are a lot of vectors as to how something could become a problem….

  • marymack

    The problem is our Food Industry
    Small farms who sell locally do not have these problems
    Corporate Agriculture is the culprit
    Are YOU ready to take on BIG AGRA?
    Go to the source.
    CODEX Alimentarius is coming so grow your own food like your grandparents did or eat the garbage that is sold in most “super” markets.

  • A friend sent me this:
    I wonder if it might have been contaminated flour?

  • Anthro

    Whatever the culprit turns out to be, the message is: DON’T EAT RAW COOKIE DOUGH! I don’t do cookies anymore and if I did, I would make my own dough, not buy expensive pre-mixed stuff with lots more ingredients than my own recipe has. I always used to eat the dough, and will remember not to in future, should I have a lapse in my healthy-eating plan!
    Also, don’t we have to accept that nothing is perfect and that a small number of people WILL get sick from time to time? That does not imply that we should let our guard down or not try to do everything possible to prevent contamination, but if people would make more of their own food (it doesn’t take long to mix up a batch of cookies, for heaven’s sake) we would have fewer problems related to transportation and storage at least. If it’s the flour in this case, then we must just stop eating the raw dough.

  • Marymary

    The flour (as noted above) by a few people, eggs (could have been contaminated after pasteurization somehow), the chocolate or possibly dairy ingredients come to mind. Water supply could have also been the culprit, as someone mentioned above. It seems very unlikely, but perhaps an ill employee was involved. I know that at the retail food level, employees diagnosed with shiga-toxin E. coli infections (as well as other specific illnesses, including Hepatitis A) were not supposed to be at work. If they weren’t diagnosed, but had certain symptoms, their job duties were supposed to be extremely limited. Perhaps there was a breakdown in the employee health policy.
    Are only semi-sweet chocolate chip cookies implicated in the illnesses? Could other flavors such as peanut butter, oatmeal, sugar, double chocolate, white chocolate, etc. be involved? Those varieties could point to other suspect ingredients.
    Sorry to go on and on. Very interesting comments and this should be an interesting case. I hope that no one else becomes ill.

  • As long as we mass produce animals (and yes, I mean “produce”), we will continue to see these problems. This is a basic of history – if you corral mass numbers of living things together, living in squaller, there will be disease. I’m guessing the viruses and bacteria just got sick of hanging out in the barn. At least they had the option leaving. Big Agri needs to go.

  • Michele Keyes

    I wonder if Nestle’s added some beef suet into the cookie dough mix?