{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T03:48:44Z","timestamp":1793072924903,"version":"4.5.0"},"reference-count":32,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2017,1,9]],"date-time":"2017-01-09T00:00:00Z","timestamp":1483920000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["www.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:title>SUMMARY<\/jats:title><jats:p>Whole apples have not been previously implicated in outbreaks of foodborne bacterial illness. We investigated a nationwide listeriosis outbreak associated with caramel apples. We defined an outbreak-associated case as an infection with one or both of two outbreak strains of <jats:italic>Listeria monocytogenes<\/jats:italic> highly related by whole-genome multilocus sequence typing (wgMLST) from 1 October 2014 to 1 February 2015. Single-interviewer open-ended interviews identified the source. Outbreak-associated cases were compared with non-outbreak-associated cases and traceback and environmental investigations were performed. We identified 35 outbreak-associated cases in 12 states; 34 (97%) were hospitalized and seven (20%) died. Outbreak-associated ill persons were more likely to have eaten commercially produced, prepackaged caramel apples (odds ratio 326\u00b77, 95% confidence interval 32\u00b72\u20133314). Environmental samples from the grower's packing facility and distribution-chain whole apples yielded isolates highly related to outbreak isolates by wgMLST. This outbreak highlights the importance of minimizing produce contamination with <jats:italic>L. monocytogenes<\/jats:italic>. Investigators should perform single-interviewer open-ended interviews when a food is not readily identified.<\/jats:p>","DOI":"10.1017\/s0950268816003083","type":"journal-article","created":{"date-parts":[[2017,1,9]],"date-time":"2017-01-09T02:32:28Z","timestamp":1483929148000},"page":"848-856","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":191,"title":["Multistate outbreak of <i>Listeria monocytogenes<\/i> infections linked to whole apples used in commercially produced, prepackaged caramel apples: United States, 2014\u20132015"],"prefix":"10.1017","volume":"145","author":[{"given":"K. M.","family":"ANGELO","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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Accessed 29 September 2015."},{"key":"S0950268816003083_ref1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1701.P11101"},{"key":"S0950268816003083_ref25","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw242"},{"key":"S0950268816003083_ref19","doi-asserted-by":"crossref","DOI":"10.2807\/ese.18.04.20380-en","article-title":"Overview of molecular typing methods for outbreak detection and epidemiological surveillance","volume":"18","author":"Sabat","year":"2013","journal-title":"Eurosurveillance"},{"key":"S0950268816003083_ref32","unstructured":"Food and Drug Administration. FSMA final rule on produce safety. Silver Spring, Maryland (http:\/\/www.fda.gov\/Food\/GuidanceRegulation\/FSMA\/ucm334114.htm). 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Wholesome Soy Products, Inc. Atlanta: Sprouts and investigation of human listeriosis cases (Final update), 27 January 2015 (http:\/\/www.cdc.gov\/listeria\/outbreaks\/bean-sprouts-11-14\/index.html). 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