Use of traceback methods to confirm the source of a multistate Escherichia coli O157:H7 outbreak due to in-shell hazelnuts.

Traceback methods by state regulatory agencies were used to complement traditional epidemiological cluster investigation methods and confirmed hazelnuts (also referred to as filberts) as the vehicle in a multistate outbreak of Escherichia coli O157:H7 infections. Bulk in-shell hazelnut and mixed-nut purchase locations were identified during the initial epidemiological interviews. Based on purchase dates and case onset dates, regulators in Minnesota, Michigan, and Wisconsin traced product back through the supply chain. Six (86%) retail locations received the suspect hazelnut or mixed-nut shipments from a Minnesota distributor, with one retailer (14%) receiving products from a Wisconsin distributor. Both distributors received 100% of their bulk in-shell hazelnuts and mixed nuts from a distributor in California. The California distributor received 99% of their hazelnuts from a packing company in Oregon. The California distributor received the hazelnuts in 50-lb (22.7-kg) bags and either resold them without o...