Outbreak Investigation of E. coli O103: Clover Sprouts


FDA, along with CDC and state and local partners, are investigating an outbreak of 14 illnesses caused by E. coli O103 in Iowa, Illinois, Missouri, Texas and Utah. CDC is reporting that the epidemiologic evidence indicates that clover sprouts from Jimmy John’s restaurants are a likely source of this outbreak.  

The CDC is recommending that consumers who have recently eaten clover sprouts on a sandwich from Jimmy John’s restaurants and who are experiencing symptoms of E. coli infection, such as severe stomach cramps, diarrhea, fever, nausea, and/or vomiting, should contact their doctor and report their illness to their local health department. If consumers have a leftover sandwich with clover sprouts from Jimmy John’s, do not eat it and throw it away.

Generally, it is recommended that children, the elderly, pregnant women, and persons with weakened immune systems should avoid eating raw sprouts of any kind.

Jimmy John’s LLC reported that all of its restaurants stopped serving clover sprouts on February 24, 2020. At this time, clover sprouts should not be available at Jimmy John’s.

FDA has activated a team to coordinate this outbreak investigation. This team is currently collecting records and initiating a traceback investigation to determine the source of the clover sprouts. Authorities are investigating whether implicated sprouts have been distributed elsewhere and will continue monitoring for additional illnesses.


On February 21, 2020, the FDA issued a warning letter to Jimmy John’s Franchise LLC for engaging in a pattern of receiving and offering for sale adulterated fresh produce, specifically clover sprouts and cucumbers. On February 24, 2020, Jimmy John’s reported to FDA that they had removed sprouts from their restaurants.

The warning letter lays out evidence from five outbreaks, including recent outbreaks in the state of Iowa during November and December 2019, of human infections with Escherichia coli O103, a Shiga toxin producing Escherichia coli (STEC) linked to sprouts.

These 14 illnesses are new and are not associated with the outbreaks mentioned in the Jimmy Johns warning letter. FDA will continue its investigation and provide updates as more information becomes available.

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Case Counts

Total Illnesses: 14
Hospitalizations: 0
Deaths: 0
Last illness onset: February 11, 2020
States with Cases: IA (3), IL (6), MO (1), TX (1), UT (3)

What is E. coli?

E. coli are mostly harmless bacteria that live in the intestines of people and animals and contribute to intestinal health. However, eating or drinking food or water contaminated with certain types of E. coli can cause mild to severe gastrointestinal illness. Some types of pathogenic (illness-causing) E. coli, such as Shiga toxin-producing E. coli (STEC), can be life-threatening.

People infected with pathogenic E. coli can start to notice symptoms anywhere from a few days after consuming contaminated food or as much as nine days later. Generally, the symptoms include severe stomach cramps, diarrhea, fever, nausea, and/or vomiting.

The severity or presence of certain symptoms may depend on the type of pathogenic E. coli causing the infection. Some infections can cause severe bloody diarrhea and lead to life-threatening conditions, such as a type of kidney failure called hemolytic uremic syndrome (HUS), or the development of high blood pressure, chronic kidney disease, and neurologic problems. Other infections may have no symptoms or may resolve without medical treatment within five to seven days.

Due to the range in severity of illness, people should consult their health care provider if they suspect that they have developed symptoms that resemble a(n) E. coli infection., including HUS, but even healthy older children and young adults can become seriously ill.

People of any age can become infected with pathogenic E. coli. Children under the age of 5 years, adults older than 65, and people with weakened immune systems are more likely to develop severe illness as a result of an E. coli infection. However, even healthy older children and young adults can become seriously ill.

General Food Safety Tips for Retailers

Restaurants and retailers should always practice safe food handling and preparation measures. It is recommended that employees wash hands, utensils, and surfaces with hot, soapy water before and after handling food.

  • Regular frequent cleaning and sanitizing of food contact surfaces and utensils used in food preparation may help to minimize the likelihood of cross-contamination.
  • Wash and sanitize display cases and refrigerators regularly.
  • Wash and sanitize cutting boards, surfaces, and utensils used to prepare, serve, or store food.
  • Wash hands with hot water and soap following the cleaning and sanitation process. 

General Food Safety Tips for Consumers

People should consult their healthcare provider if they suspect that they have developed symptoms that resemble a E. coli infection.

Consumers should follow these steps for preventing foodborne illness:

  • Wash the inside walls and shelves of the refrigerator, cutting boards and countertops, and utensils that may have contacted contaminated foods; then sanitize them with a solution of one tablespoon of chlorine bleach to one gallon of hot water; dry with a clean cloth or paper towel that has not been previously used.
  • Wash and sanitize surfaces used to serve or store potentially contaminated products.
  • Wash hands with warm water and soap following the cleaning and sanitation process.

Consumers can also submit a voluntarily report, a complaint, or adverse event (illness or serious allergic reaction) related to a food product.

Children, the elderly, pregnant women, and persons with weakened immune systems should avoid eating raw sprouts of any kind.