As of May 1, 2023, a total of 13 people have been infected in a multistate outbreak of Salmonella illnesses linked to flour.
On April 28, 2023, General Mills voluntarily issued a nationwide recall of 2-pound, 5-pound, and 10-pound bags of Gold Medal Bleached and Unbleached All-Purpose Flour. Specific expiration dates and UPC codes for involved products are listed on CDC and FDA outbreak pages.
Clinical Guidance
- Presentation: Most people infected with Salmonella experience diarrhea, fever, and stomach cramps. Symptoms typically start 6 hours to 6 days after swallowing the bacteria. Most people recover without treatment after 4 to 7 days.
- Who is at highest risk/complications: The incidence of non-typhoidal Salmonella (NTS) infection is highest in children younger than 4 years of age. In the United States, rates of invasive infections and mortality are higher in infants, elderly people, and people with hemoglobinopathies (including sickle cell disease) and immunocompromising conditions (eg, malignant neoplasms, HIV infection).
- Patients should be seen by their pediatrician if they present with the following symptoms of Salmonella infection:
- Diarrhea and a fever higher than 102°F
- Diarrhea for more than 3 days that is not improving
- Bloody diarrhea
- Not tolerating oral liquids
- Signs of dehydration, such as:
- Decreased urine output
- Dry mucous membranes
- Orthostatic hypotension
- Diagnosis: Isolation of Salmonella organisms from cultures of stool, blood, urine, bile (including duodenal fluid containing bile), and material from foci of infection is diagnostic. Salmonella gastroenteritis is diagnosed by stool culture or molecular testing (including PCR); stool testing should be obtained in all children with bloody diarrhea or unexplained persistent or severe diarrhea. See Red Book Salmonella diagnostic tests.
- Risk Mitigation:
- Do not use any recalled flour. If you stored recalled flour in another container, throw the flour away and wash the container thoroughly with warm water and soap before using again.
- Always bake or cook food made with any brand of raw flour, like cookie dough or cake batter, before eating it. Do not bake or cook recalled flour.
- Follow the recipe or package instructions for cooking or baking flour that hasn’t been recalled. Use the temperature and cooking time given in the recipe or instructions.
- Buy heat-treated flour to use in recipes for homemade playdough.
- Wash any bowls, utensils, and surfaces that touched raw flour with warm water and soap.
- Wash your hands with warm water and soap before and after using raw flour.
- Keep raw flour, dough, and batter separate from foods that won’t be cooked.
- Treatment: Antimicrobial therapy usually is not indicated for patients with either asymptomatic infection or uncomplicated gastroenteritis caused by NTS, because therapy does not shorten the duration of diarrheal disease, can prolong duration of fecal shedding, and increases symptomatic relapse rate. Antimicrobial therapy is recommended for gastroenteritis caused by NTS serovars in people at increased risk for invasive disease, including infants younger than 3 months and people with chronic gastrointestinal tract disease, malignant neoplasms, hemoglobinopathies, HIV infection, or other immunosuppressive illnesses or therapies. It should also be considered for those experiencing severe symptoms such as severe diarrhea or prolonged or high fever. If antimicrobial therapy is initiated in patients in the United States with presumed or proven NTS gastroenteritis, a blood and a stool culture should be obtained prior to antibiotic administration and an initial dose of ceftriaxone should be given. The patient who does not appear ill or have evidence of disseminated infection can be discharged with oral azithromycin pending blood culture results. Once susceptibilities are available, ampicillin or trimethoprim-sulfamethoxazole may be considered for susceptible strains. A fluoroquinolone is an alternative option. For those who appear ill or have evidence of disseminated infection, hospitalization is required.
Prevention:
Hand washing with soap and water. Hand sanitizers if not available
Should not go to daycare/school/sports while having diarrhea