Amid a deadly listeria outbreak across California and nine other states, public health authorities are warning consumers against eating prepackaged caramel apples.
Listeria has been implicated in three deaths, including one in California, and more than two dozen hospitalizations. Investigators' suspicions are focusing on prepackaged caramel apples contaminated with Listeria monocytogenes, a particularly virulent pathogen, state officials said Thursday.
Listeria outbreaks tend to be more deadly than those associated with other food-borne pathogens, such as salmonella and Escherichia coli. A 2011 listeria outbreak linked to Colorado cantaloupes caused 33 deaths.
Five deaths have been reported in the current outbreak, according to the U.S. Centers for Disease Control and Prevention. The agency said three of the deaths were directly linked to listeria. The cause of another death is unclear, and the fifth is believed to be unrelated.
Among the deaths is an 81-year-old California woman who bought caramel apples from a Safeway store in Felton, according to a lawsuit filed by her family. Shirlee Jean Frey died Dec. 2.
Health officials removed the remaining apples from her home, and Safeway pulled the caramel apples from its shelves.
Symptoms of listeriosis include high fever, headaches, neck stiffness, nausea and diarrhea. The risk of severe illness and death are greatest for infants, the elderly and people with weakened immune systems. In pregnant women, listeria can lead to miscarriage, stillbirth, premature delivery, and newborns can be infected.
Of those sickened in the current outbreak, nine patients were pregnant women or newborns. Others range in age from 7 to 92.
Frey is the only case reported in California. Missouri and New Mexico are the states with the most cases, five each.
Twenty of the 23 people interviewed by health investigators after they became ill said they had eaten commercially produced, prepackaged caramel apples, according to the CDC. Neither plain apples nor caramel candy by itself has been linked to the outbreak.
The CDC recommended consumers avoid all prepackaged caramel apples until investigators determine what brands are involved.
In a warning issued Thursday, California Department of Public Health Director Ron Chapman singled out Happy Valley Co., which has manufacturing plants in Orosi, Calif., and Union, Mo.
The warning followed Happy Valley's voluntary recall of its caramel apples with "best if used by dates" between Aug. 25 and Nov. 23, 2014. The apples come in several varieties and are sold at retail, club and discount stories.
A voluntary recall by one of Happy Valley's apple suppliers appears to have triggered the cascade of action this week.
The state health department urged consumers who feel ill after eating a caramel apple to call their doctor. If consumers see recalled caramel apples for sale, they are urged to notify the state health department at (800) 495-3232.