The 1993 Jack in the Box E. coli outbreak occurred when 732 people were infected with the Escherichia coli O157:H7 bacterium originating from undercooked beef patties in hamburgers. The outbreak involved 73 Jack in the Box restaurants in California, Idaho, Washington, and Nevada, and has been described as "far and away the most infamous food poison outbreak in contemporary history." The majority of the victims were under 10 years old. Four children died and 178 other victims were left with permanent injury including kidney and brain damage.
The wide media coverage and scale of the outbreak were responsible for "bringing the exotic-sounding bacterium out of the lab and into the public consciousness" but it was not the first E. coli O157:H7 outbreak resulting from undercooked patties. The bacterium had previously been identified in an outbreak of food poisoning in 1982 (traced to undercooked burgers sold by McDonald's restaurants in Oregon and Michigan), and before the Jack in the Box incident there had been 22 documented outbreaks in the United States resulting in 35 deaths.
171 people required hospitalization. The majority of the victims who presented symptoms and were clinically diagnosed (but not hospitalized) were children under 10 years old.
45 of the infected children required hospitalization — 38 suffered serious kidney problems and 21 required dialysis.
Four children died:
6-year-old Lauren Beth Rudolph of southern California, who died on December 28, 1992, due to complications of an E. coli O157:H7 infection later tied to the same outbreak.
2-year-old Michael Nole of Tacoma, WA, who died on January 22, 1993.
2-year-old Celina Shribbs of Mountlake Terrace, WA, who died on January 28, 1993. She became ill due to a secondary contact transmission from another child sick with E. coli.
17-month-old Riley Detwiler of Bellingham, WA, who died on February 20, 1993, following secondary contact (person-to-person) transmission from another child sick with E. coli. The 18-month-old boy who infected Riley had spent two days in the daycare center before a clinical laboratory could return the positive test results for E. coli. The first boy's mother suspected her son had E. coli but did not tell the daycare staff for fear that he would be sent home. When the test results came in positive for E. coli, county health officials could not reach the child’s parents in the middle of the workday. Both of the first boy's parents worked at Jack in the Box, where they regularly fed their son hamburgers. Riley, on the other hand, had never eaten a hamburger.
Sen. Richard Durbin [D-IL], addressing a congressional hearing on food safety in 2006, described the outbreak as "a pivotal moment in the history of the beef industry." James Reagan, vice president of Research and Knowledge Management at the National Cattlemen's Beef Association (NCBA), said that the outbreak was "significant to the industry" and "the initiative that moved us further down the road [of food safety] and still drives us today." David Acheson, a former U.S. Food and Drug Administration Associate Commissioner for Foods, recently told Retro Report that "Jack in the Box was a wakeup call to many, including the regulators. You go in for a hamburger with the kids and you could die. It changed consumers' perceptions and it absolutely changed the behaviors of the industry."
As a direct result of the outbreak:
E. coli O157:H7 was upgraded to become a reportable disease at all state health departments.
The Food and Drug Administration (FDA) increased the recommended internal temperature for cooked hamburgers from 140 °F (60 °C) to 155 °F (68 °C).
The USDA's Food Safety and Inspection Service (FSIS) introduced safe food-handling labels for packaged raw meat and poultry retailed in supermarkets, alongside an education campaign alerting consumers to the risks associated with undercooked hamburgers. The labels and the education campaign came with criticism and objection from the industry.
The FSIS introduced testing for E. coli O157:H7 in ground meat.
The United States Department of Agriculture (USDA) reclassified E. coli O157:H7 as an adulterant in ground beef.
The USDA introduced the Pathogen Reduction and Hazard Analysis and Critical Control Point (PR/HACCP) program.
The NCBA created a task force to fund research into the reduction of E. coli O157:H7 in cattle and slaughterhouses.
Jack in the Box completely overhauled and restructured their corporate operations around food safety priorities, setting new standards across the fast food industry.
Parents of victims formed STOP Foodborne Illness (formerly Safe Tables Our Priority, or S.T.O.P.), a national non-profit organization dedicated “to prevent Americans from becoming ill and dying from foodborne illness” by advocating for sound public policy, building public awareness, and assisting those impacted by foodborne illness.
Parents of the victims played key roles in spreading awareness and advocating for change — speaking directly to President Bill Clinton, meeting with Vice President Al Gore, testifying before the Clinton Healthcare Task Force, working with the Secretary of Agriculture, and discussing food safety issues with lawmakers in Washington, D.C.
Some parents, including Dr. Darin Detwiler (who lost his son, Riley, to E. coli and hemolytic-uremic syndrome during the outbreak) later served as a regulatory policy advisor to the USDA for meat and poultry inspection. Dr. Detwiler is now a professor of Food Policy and the Director of Regulatory Affairs of Food and Food Industry at Northeastern University.
