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.