UPDATED CONTENT — General Mills provided additional information at the request of Food Safety News, including the volume of the flour recall expansion. Today’s addition of 15 million pounds brings the total to 45 million pounds, which is “a small percentage of the flour we produce,” according to company officials. Additional updated content throughout.

The Kansas City, MO, plant that produced 45 million pounds of recalled General Mills flour continues to operate as the recall expands and more people fall victim to a 21-state E. coli outbreak linked to flour made there.

General Mills Inc. expanded the recall Monday after federal officials told company officials that four more people have been confirmed with E. coli infections matching strains of the pathogen proven by lab tests to be in the company’s flour.

Thirteen of the 46 confirmed outbreak victims have been hospitalized and one has developed a type of kidney failure known as hemolytic uremic syndrome (HUS), which is often fatal. The first confirmed case began Dec, 21, 2015, with the most recent victim becoming ill June 25.

The recall includes three main brands of flour, Gold Medal, Signature Kitchens and Wondra. Several sizes and varieties of these three brands are under recall. The complete list is available online.

The first recall on May 31 was for 10 million pounds of flour. A July 1 expansion added 20 million pounds.

General Mills provided the Food and Drug Administration with some recalled flour recovered from its customers. The FDA reported Monday it had used whole genome sequencing and found the recovered flour was contaminated with a second E. coli outbreak strain that public health officials have confirmed in victims — E. coli O26.

That finding is what spurred General Mills to add more lots of flour from the Kansas City plant to the recall on Monday, making the dates of production involved in the recall Nov. 4, 2015, through Feb. 10 this year.

Status of the KC plant and advice to consumers
General Mills continues to operate the production plant in Kansas City, MO, a company spokesperson said Monday evening. She said to date, the company hadn’t found any E. coli in the facility.

“We don’t believe the facility to be the source, but out of an abundance of caution, elevated cleaning protocols have been followed,” the spokeswoman said.

“Regarding current capacity, it varies day-to-day, as with any plant. …  Only a small sub-set of flour produced at the Kansas City plant has been traced back to individuals who have become ill.”

General Mills’ Chief Operating Officer Jeff Harmening said in Monday’s news release that “the most important thing (consumers) can do to keep safe is to not eat uncooked flour.”

The release also warned “flour is made from wheat that is grown outdoors where bacteria are often present and the normal flour milling process does not remove these bacteria. In order for severe E. coli illness to occur from flour, all three of the following things have to happen.”