The Tennessee Department of Health is leading a national outbreak investigation of E. coli O157:H7 that appears to be associated with consumption of Totino's and Jeno's brand frozen pizzas containing pepperoni topping.

A total of 21 laboratory-confirmed cases of E. coli O157:H7 have been identified and are potentially linked with this outbreak, with illness onsets ranging from mid-July through early October.

Of the eight cases reported in Tennessee, five people were hospitalized. However, all eight patients have now recovered.

Cases of illness have been reported in a total of 10 states.

"The Department of Health continues to conducts groundbreaking work that is recognized nationally," said Health Commissioner Susan R. Cooper, MSN, RN. "From emergency preparedness to disease outbreaks, the employees of the State Health Department work diligently and prepare tirelessly to be able to respond quickly to any public health emergency that threatens the wellbeing of Tennessee's residents."

As a result of the possible contamination, General Mills, the parent company of Totino's and Jeno's brand products, has issued a voluntary recall of 414,000 cases of pizza products. The company is working closely with federal officials and state health departments to identify any potential problem. Totino's and Jeno's pizzas are sold in the freezer section at grocery stores and other outlets throughout Tennessee and nationwide. The Department advises consumers not to eat any Totino's or Jeno's brand frozen pizzas containing pepperoni topping.

"An ongoing investigation by Tennessee and other state and federal public health officials has shown a strong association between several cases of recent illness and consumption of Totino's and Jeno's pizzas that contain pepperoni," said Tennessee Deputy State Epidemiologist Tim F. Jones, M.D. "The Department is working closely with the U.S. Department of Agriculture and the Centers for Disease Control and Prevention to identify additional information about the extent of the outbreak."

Consumers with questions about the recall should contact the company at 1-800-949-9055. Representatives also can provide information about receiving a full refund for Totino's or Jeno's pizza products. More information can also be obtained on the General Mills Web site at http://www.generalmills.com/corporate/media_center/index.aspx.

"Consumers who have any of these Totino's pizzas in their freezers should not eat them," said Jones. "Anyone who has eaten the product but did not become ill need not take any special action. People who have severe diarrhea should seek medical care, and let their doctors know if they have consumed frozen pizza within the week before they became sick."

Escherichia coli O157:H7 is a common cause of foodborne illness. An estimated 73,000 cases of infection and 61 deaths occur in the United States each year. People generally become ill from E. coli O157:H7 two to eight days after being exposed to the bacteria, with an average onset of illness of three to four days after exposure. E. coli O157:H7 infection often causes severe bloody diarrhea and abdominal cramps. Most people recover completely within five to 10 days, but some people, particularly young children and the elderly, are at increased risk for serious illness. Antibiotic therapy is not necessary for most patients, and may increase the risk of complications.

Cattle are the principal source of E. coli O157 infection; they carry E. coli O157 in their intestines. Though most illness caused by E. coli O157 has been associated with eating undercooked, contaminated ground beef, people have also become ill from eating contaminated bean sprouts, fresh leafy vegetables such as lettuce and spinach, and other foods. E. coli in food can be killed by thorough cooking, but the bacteria can survive undercooking or uneven cooking, as may happen in some microwave ovens. Consumers are reminded to thoroughly cook all products that are not ready-to-eat, such as frozen pizzas, according to package instructions.

For more information on the product recall, visit the Department of Health Web site at http://health.state.tn.us/ or the U.S. Department of Agriculture Web site at http://www.fsis.usda.gov/News_&_Events/Recall_049_2007_Release/index.asp. To learn more about E. coli infection and how to prevent it, visit http://health.state.tn.us/FactSheets/ecoli.htm.

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