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An outbreak of E. coli O157

linked to McDonald’s Quarter Pounder burgers has resulted in 49 illnesses and one death across 10 states, according to the U.S. Centers for Disease Control and Prevention (CDC). The CDC issued a statement on Tuesday confirming that most of the cases have been reported in Colorado and Nebraska.

Among the 28 individuals whose medical information is available, 10 have been hospitalized, and one person developed hemolytic uremic syndrome (HUS), a life-threatening complication that can lead to kidney failure. The fatality occurred in an older adult from Colorado, the CDC added.

The outbreak has prompted a rapid investigation by public health officials. While E. coli outbreaks often have multiple potential sources, the majority of sick individuals reported consuming McDonald’s Quarter Pounder hamburgers, and investigators are working to pinpoint the contaminated food ingredient. According to early findings, slivered onions used in the burgers, sourced from a single supplier, may be the source of the contamination.

In response to the outbreak, McDonald’s has instructed all affected restaurants to remove slivered onions from their inventory and halted their distribution in regions that could be impacted. The fast-food chain has also temporarily suspended the sale of Quarter Pounder burgers in several states, including Colorado, Kansas, Utah, Wyoming, Idaho, Iowa, Missouri, Montana, Nebraska, Nevada, New Mexico, and Oklahoma.

“The true number of sick people in this outbreak is likely much higher than the number reported,” said the CDC, cautioning that many individuals with E. coli infections recover without seeking medical attention, leading to underreporting. Additionally, the CDC noted that “recent illnesses may not yet be reported as it usually takes 3 to 4 weeks to determine if a sick person is part of an outbreak.”

As news of the outbreak broke, McDonald’s saw its shares plummet by over 9 percent in after-hours trading on Tuesday. The fast-food giant has faced previous scrutiny over food safety issues, but this recent outbreak is one of the most significant in recent years.

The CDC advises consumers who have recently eaten at McDonald’s and are experiencing symptoms such as severe stomach cramps, diarrhea (often bloody), and vomiting to seek medical attention, as E. coli infections can be severe, particularly in young children and older adults.

The fast-moving investigation is ongoing, with health officials urging consumers to remain vigilant as they work to determine the full scope of the outbreak.

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