Multiple Outbreaks of Gastrointestinal Illness Among School Children Associated with Consumption of Flour Tortillas—Massachusetts, 2003-2004

In October 2003, staff from the regional office of the Chicago District Office of FDA, the Illinois Department of Public Health, the Chicago Department of Public Health, and CDC inspected the facilities of manufacturer A. FDA noted several deficiencies at the plant, including improper storage, use, and labeling of chemicals; food ingredients and additives in unlabeled containers; food contact surfaces not protected from environmental contamination; and a lack of backflow protection from a piping system that discharged waste water. Bromides were not identified in urine specimens from students involved in these outbreaks, although the results might have been affected by delayed collection of specimens or poor correlation between urine bromides and ingested bromate dose.4 Manufacturer A was alerted by FDA that calcium propionate and potassium bromate were present in the tortillas at higher than typical use levels and was advised to reduce the amounts used in the manufacture of these products. Local and state health officials are also encouraged to contact the Rapid Onset of Gastroenteritis with Unknown Etiology (ROGUE) workgroup at CDC (National Center for Infectious Diseases, Foodborne and Diarrheal Diseases Branch, and the National Center for Environmental Health, Division of Environmental Hazards and Health Effects) to obtain epidemiologic assistance and specialized laboratory analysis (telephone 770-488-3410 or 404-639-2206).