“The thought that a caramel apple could sicken and kill people is a little disconcerting,” Bill Marler said. “It’s been hard for the family; it’s been a shock to them.”

As of December 22, 2014, a total of 29 people infected with the outbreak strains of Listeria monocytogenes have been reported from 10 states: Arizona (4), California (1), Minnesota (4), Missouri (5), New Mexico (5), North Carolina (1), Texas (4), Utah (1), Washington (1), and Wisconsin (3). Illness onset dates range from October 17, 2014, to November 27, 2014. Nine illnesses have been associated with a pregnancy (occurred in a pregnant woman or her newborn infant). No miscarriages or fetal losses have been reported. Among people whose illnesses were not associated with a pregnancy, ages ranged from 7 to 92 years, with a median age of 66 years, and 41% were female. Three invasive illnesses (meningitis) occurred among otherwise healthy children aged 5–15 years. All 29 ill people have been hospitalized and, five deaths have been reported. Listeriosis contributed to three of these deaths and it is unclear whether it contributed to a fourth. The fifth death was unrelated to listeriosis.

At this point in the investigation, CDC’s Advice to Consumers remains the same. Out of an abundance of caution, CDC recommends that U.S. consumers not eat any commercially produced, prepackaged caramel apples, including plain caramel apples as well as those containing nuts, sprinkles, chocolate, or other toppings, until more specific guidance can be provided. These products could have a shelf life of more than one month. CDC, the involved states, and FDA continue to work closely on this rapidly evolving investigation, and new information will be provided as it becomes available.