An outbreak of E. coli this past spring that sickened at least 12 people — and hospitalized seven of them — was caused by ground beef burgers cooked rare and medium-rare at restaurants, according to health department documents obtained by Food Safety News through records requests made over several months. This is the first time the exact cause of the outbreak, which occurred in April and May 2014, has been disclosed to the public. Public health experts speaking with Food Safety News say the outbreak is a stark reminder that undercooked ground beef poses a serious health risk and that consumers should be aware of the risk when ordering their burgers rare or medium-rare. The outbreak was first publicly reported by federal health authorities on May 19, 2014, with an announcement that ground beef produced by Detroit-based Wolverine Packing Company had sickened at least 12 people in 4 states. At the same time, the company and the U.S. Department of Agriculture (USDA) announced a recall of 1.8 million pounds of ground beef produced by Wolverine between March 31 and April 18, 2014. In notices to the public, health agencies warned consumers against eating undercooked ground beef since cooking burgers to only rare or medium-rare does not kill potentially harmful bacteria such as E. coli that might be present in the center. The recommended temperature for beef burgers is 160 degrees F, according to the outbreak announcement from the U.S. Centers for Disease Control and Prevention (CDC). What the public health warnings did not spell out, however, was that the illnesses were all connected to undercooked burgers served at restaurants, including an Ohio “gastropub” chain specializing in medium-rare burgers. That chain is Bar 145. The name is a reference to what the company’s website calls the perfect temperature for medium-rare burgers, 145 degrees F. Health department documents show that four of the five people sickened in the outbreak in Ohio ate medium-rare burgers at Bar 145 locations — three at the Toledo restaurant and one in the city of Kent. They came down with E. coli infections within days, and the illnesses prompted a restaurant inspection that found the beef came from Wolverine. Each of the 12 people with confirmed cases told health officials that they ate burgers at restaurants within the outbreak window, with eight of them specifically noting that they ate rare or medium-rare burgers. For every laboratory-confirmed case of E. coli infection, CDC estimates another 26 cases go unreported. Documents also show that the cases are all connected by an uncommon variety of E. coli O157:H7, one seen only once before in PulseNet, the national epidemiological database. That evidence adds up to a “really clear-cut” outbreak caused by the burgers, said Carlota Medus, principal epidemiologist with the Minnesota Department of Health. “It’s extremely unlikely that these illnesses could have been caused by a different source, based on the evidence,” she said. Two cases involved people who ate “very rare” burgers at Stella’s Lounge in Grand Rapids, MI. That beef also came from Wolverine. Other patients ordered burgers from a brew pub in St. Louis, MO, a burger bar in Farmington, MI, and a steakhouse in Kent, OH, not connected to Bar 145. Each of the restaurants received Wolverine beef, although documents do not specify how those burgers were cooked. According to Dave Theno, the many risks associated with serving rare ground beef mean that restaurants need to take a number of additional safety precautions — and these restaurants weren’t doing them all. Theno is a food-safety consultant and former vice president of technical services at Jack in the Box, where he was hired to rebuild the fast-food chain’s quality-assurance procedures following the 1993 E. coli outbreak from undercooked burgers that sickened hundreds of people and killed four children. “Obviously, serving rare ground beef is just super ill-advised,” he said. Understanding the risk While there’s nothing stopping consumers from ordering a rare burger, they should make sure they’re well-informed about the risks beforehand, said Benjamin Chapman, associate professor of food safety at North Carolina State University. Chapman is currently leading a nationwide study to assess how well restaurants inform their customers about the risks of undercooked burgers. Restaurants that serve undercooked meat or seafood are required by the federal food code to provide a warning on their menus and have the server verbally inform customers when they want something considered risky. While the study is still underway, Chapman said that he believes adults should be able to order a burger cooked however they want as long as they’re well-informed about the pathogenic risk. The jury is still out on whether or not they are. “The thing that I’m most interested in is whether the advisory is useful,” he said. “Does someone who goes into a restaurant and orders an undercooked meat product — are they given enough information to make a good decision based on their risk tolerance?” That question gets more tricky when the customer is a child or an elderly person. Both demographic groups are more susceptible to illness and permanent injury due to their relatively weaker immune systems. “The menu warning is a very weak control because you don’t really have any control,” said Roy Costa, owner of Environ Health Associates, a food-safety consulting firm for restaurants. Restaurants can’t guarantee an adequate level of food safety when leaving it up to servers to inform customers and make decisions on who should or shouldn’t eat a medium-rare burger, Costa said. Legal until someone gets sick The laws regarding serving undercooked ground beef put restaurants in a peculiar situation. While serving rare burgers is perfectly legal, it’s illegal to serve a burger that’s contaminated with E. coli. It’s considered an adulterated, defective product. But there’s no way for a restaurant to know that their beef is free of E. coli unless they take a number of major precautions. To start, restaurants need strict supplier control, Costa said. They should only buy beef from suppliers who perform microbial testing and provide certificates of analysis. On top of that, Costa recommends that the restaurants perform random testing of beef in addition to the supplier’s testing to make sure the supplier is doing things right. When asked if he knew of any restaurants performing both those steps, Costa said he did not. He knows of one gastropub that does require certificates of analysis from its suppliers for its medium-rare burgers, but they don’t perform their own additional testing, despite his recommendation. “You just need to have a strong operation overall. No cross-contamination,” Costa said. “You have to show you can meet the food code from A to Z, with really good supplier control and a very active person at the counter who’s empowered to decide who can and can’t eat these burgers. That’s the best you can do.” “That, and carry a $10-million insurance policy,” he added. Another option, Theno said, is to use cold-pasteurized beef. Through processes such as irradiation and electron-beam pasteurization, beef suppliers and restaurants can eliminate any bacteria and parasites from raw beef. They’re then free to cook the beef however they like without the threat of sickening customers, he said. While some restaurants and grocery stores now offer cold-pasteurized beef, the practice is still far from mainstream. “If you want to serve undercooked products like this, you’ve got to use cold-pasteurization,” Theno said. Who’s responsible? But what about the segment of the population who are fully aware of the risk and still want to enjoy a medium-rare, irradiation-free burger? If they get sick despite knowing the risk, are they responsible for their illness, or is the restaurant still on the line? Legally speaking, the restaurant is ultimately responsible. The disclaimers on the menu won’t absolve anyone in court, Theno said. “If someone wants to buy ground beef, take it home and cook it rare, that’s a personal choice,” he said. “But as soon as someone walks in my restaurant, I take responsibility for their health.” Even if restaurants cook food to order, they’re legally not allowed to sell products considered defective, which would include a contaminated burger, Costa added. Word travels fast through the food-safety world, and Theno said that when he heard about Bar 145 and their connection to the outbreak, he tried to get in touch with the owners to give them some advice, but he couldn’t get a return call. Food Safety News also contacted Bar 145’s Toledo location and spoke with a manager, but the owners did not return a call looking for comment. Ultimately, Costa said, consumers are the ones who risk illness and injury from a contaminated burger, and everyone should do the best they can to educate themselves on the risks and make informed choices. “You have to make a decision as a consumer if you’re going to expose yourself to a potentially life-threatening infection,” he said. “My advice is to do what you want, but understand what the risk is. Make an intelligent decision.” Theno, on the other hand, placed the final responsibility on restaurant owners. “Short of pasteurization, there’s no way to guarantee that there aren’t harmful microbes in ground beef,” he said. “Restaurant owners have a responsibility to protect public health and ensure no one gets sick from your products. They’ll tell you they have it under control, but they don’t.”

  • John Munsell

    Very interesting article. Admittedly, if the ground beef hasn’t been subjected to a kill step such as irradiation (many consumers refuse irradiated meat) or electron beam pasteurization, the ground beef is guaranteed risky. The article above quotes Benjamin Chapman as saying adults should be able to order burger cooked however they want as long as they’re well-informed about the pathogenic risk. Merely being well-informed will not magically prevent the customer from developing an e.coli infection, serious illness, even death. And, obtaining Certificates of Analysis from the meat packer is NOT a guarantee of safe meat! Testing for E.coli likewise is no guarantee, since the incidence of E.coli is so low, testing for it is somewhat like searching for a needle in a haystack. USDA’s Office of Inspector General criticized the highly-ballyhooed current N60 testing protocol, saying it is just as likely to not detect low levels of E.coli as it is to detect it. I don’t know who is more stupid: (1) restaurants which do not require full cooking of ground beef, or (2) consumers who order burgers which are not fully cooked. Eventually we must face reality: covering our derrieres with an abundance of paperwork will NOT guarantee safe food when raw meat is involved. Even if a restaurant provides every customer with a document which discloses the risk involved with consuming ground beef not fully cooked, and requires the consumer to sign a disclaimer holding the restaurant not accountable for resulting illnesses, raw meat will still sicken people in spite of all the paperwork documentation. Ironic: USDA has successfully convinced Americans that if the packing plant, processing plant and restaurant daily compile mountains of HACCP documents which purport that meat is safe (a claim justified by all the HACCP protocol implementedl), all those documents are worthless when raw meat is involved. True HACCP was designed for ready-to-eat products which have been subjected to a kill step. Wolverine Packing Company never claimed that its raw meat is guaranteed to be free of pathogens: Mission Impossible in raw meat. If the restaurant is foolish enough to not fully cook ground beef, and the consumer foolish enough to eat it, those two entities are solely accountable for their ill-advised actions and resulting illnesses. The only other alternative is illegalize the sale of raw meat. Restaurants must implement Good Manufacturing Practices, and consumers must implement Good Consumer Practices. If an alcoholic dies from cirrhosis of the liver, should he sue the distillery? Or a cigarette smoker sue the tobacco company? If I die from obesity-related issues, should I sue Hershey because I ate a dozen of their candy bars daily? All RAW food is risky, including sprouts, apples, fruit, veggies…….and lastly….fresh ground beef. John Munsell

    • Joe Blow

      It all comes back to lawsuits regardless of HACCP, GMP’s, waivers, etc. While a HACCP plan can never guarantee 100% food safety all of the time with all products, it does well in addressing hazards (at least theoretically). As with anything in life there are no 100% guarantees…we can only hope to get as close to 100% as possible.

  • johnmarkcarter

    I reckon eating under-cooked ground beef is like riding a motorcycle with no helmet. A person who chooses to engage in such risky behavior shouldn’t be allowed to blame anyone else when bad things happen. But our legal system allows victims to sue, even if they have signed a waiver.

    • Joe Blow

      In both instances the public ultimately shares and assumes the risk with people who participate in risky behavior as it affects insurance rates and the ability to sue.

  • I eat rare burgers; however, I buy a piece of quality round or sirloin and grind it myself in a food processor. I would never eat rare burgers at a restaurant. I eat a steak rare, but that’s a cut piece of meat, not ground. I don’t know where the ground beef comes from or the process used to grind it. The problem usually comes in with the grinder does not follow best practices in sanitation. Cows are herbivores and should carry few bacteria compared to pork or poultry.

    • John Munsell

      I disagree with your statement “The problem usually comes in with the grinder does not follow best practices in sanitation”. End quote. If true, this means that unsanitary conditions at the grinding plant allegedly INTRODUCE the pathogen. Please note that E.coli & Salmonella are “Enteric” bacteria, which by definition means they emanate from intestines, and by logical extension, from manure which is found on hides. The vast majority of further processing grinding plants and retail meat markets do not have any intestines or manure-covered hides on their premises. Rather, the invisible pathogens lurk on the meat which the grinding facilities purchase from source originating slaughter plants. Garbage in, garbage out. You may have noticed that only in recent years has USDA gotten involved in Tracebacks to the Source, historically content to assess all liability against the victimized downstream destination which unwittingly purchased previously-contaminated meat. As such, we shouldn’t have been surprised with the ongoing outbreaks and recurring recalls, because USDA’s blinders were designed to focus exclusively on the destination, while insulating the SOURCE of contamination from accountability. Public revelation of this scandal eventually forced the agency to increase its surveillance of the large source slaughter plants, where thousands of hides and countless colons are disgorged daily. John Munsell

    • Joe Blow

      You are playing Russian roulette. How lucky do you feel?

      • MungFace

        you play russian roulette every time you walk out the door. you play it every time you sleep. there are more home invasion murders every year than deaths by rare burger. what an idiotic comment.

  • Barb3000

    I wonder if restaurants could protect themselves by putting large signs on the walls stating that they only serve well cooked beef with the reasons listed below? I can’t see that being illegal because some consumers really don’t know about the dangers of undercooked beef or any meat.

    • tallen2007

      Or sign a release of liability form for eating anything not cooked…. lol

  • Joe Blow

    Sadly, we will likely never see it catch on. The closest thing which may catch is high-pressure processing which is showing a lot of promise and as the technology grows and equipment prices comes down we should see this become more mainstream.

  • MungFace

    wow 12 people in 300 million. that’s a real epidemic. i guess we should all start panicking and eating terrible burgers.

    • Jennifer Johns

      Because you obviously don’t know the definition of the word outbreak here it is.
      In epidemiology, an outbreak is an occurrence of disease greater than expected at a particular time and place. It may affect a small and localized group or impact upon thousands of people across an entire continent.

  • MaryFinelli

    Pasteurization is no guarantee, either. The only way to be protected from getting sick by eating meat is to not eat it. That will protect you from both the acute and chronic disease that eating it presents.

  • Aaron Applebee

    That’s so disgusting.