The agency said 28 people from 10 states have been sickened with Listeria monocytogenes.
Of these, 26 have been hospitalized, five deaths have been reported and Listeriosis contributed to at least four.
Prepacked caramel coated apples
CDC said the information it has indicates that commercially produced, prepackaged caramel apples contaminated with Listeria may be causing the outbreak.
No illnesses had been linked to apples that are not caramel-coated and not prepackaged or to caramel candy.
However, it recommended that consumers do not eat any commercially produced, prepackaged caramel apples, including plain caramel apples, those containing nuts, sprinkles, chocolate, or other toppings, until more specific guidance can be provided.
Although caramel apples are often a fall seasonal product, contaminated commercially produced, prepackaged caramel apples may still be for sale at grocery stores and other retailers nationwide or may be in consumers’ homes.
CDC, the Food and Drug Administration (FDA) and others are working to determine specific brands or types of caramel apples that may be linked to illnesses and to identify the source of contamination.
The Minnesota Department of Health reported four illnesses, who purchased caramel apples from Cub Foods, Kwik Trip, and Mike’s Discount Foods, which carried Carnival brand and Kitchen Cravings brand caramel apples.
These two brands are no longer available at retail locations.
Details of outbreak
Nine illnesses were pregnancy-related and three invasive illnesses (meningitis) were among otherwise healthy children aged 5–15 years.
To date, 15 (83%) of the 18 ill people interviewed reported eating commercially produced, prepackaged caramel apples before becoming ill.
Illness onset dates range from October 17 to November 27 and, excluding illness related to pregnancy, ages ranged from 7 to 92 years, with a median age of 64 years, and 32% were female.
Two outbreak clusters were identified by the pulsed-field gel electrophoresis (PFGE) and Listeriaisolates within each cluster were found to be highly related by the Whole Genome Sequencing (WGS) technique but distinct.
CDC is investigating the two clusters together because one person was infected with both Listeriastrains simultaneously and also because illnesses in the two clusters have occurred during a similar time period and in similar regions of the country.