Lead and Chromium Poisoning Outbreak Linked to Cinnamon Applesauce Pouches – Case Definition

Introduction

People might have higher blood lead levels (BLLs) after consumption of recalled cinnamon-containing apple purée and applesauce products. While some individuals can be asymptomatic, others can experience symptoms like anemia, abdominal pain, weakness, and severe neurological sequelae (e.g., seizures, encephalopathy, and coma). Low levels of lead have been associated with learning, behavioral, and cognitive deficits in children. A blood lead test is the most accurate way to determine BLLs, which can guide medical management.

The U.S. Food and Drug Administration (FDA) has identified and recalled some cinnamon-containing apple purée and applesauce products contaminated with lead, including WanaBana brand apple cinnamon fruit purée pouches, Schnucks brand cinnamon applesauce pouches, and Weis brand cinnamon applesauce pouches. Please refer to the FDA website for more information: FDA – Investigation of Lead Levels: Applesauce Pouches (November 2023). CDC will update the case definition if additional products are identified as the investigation progresses.

Recommended Case Definitions

Confirmed case:

• Blood lead levels of 3.5 μg/dL or higher confirmed through venous testing in a person within 3 months after consuming a recalled WanaBana, Schnucks, or Weis brand fruit purée product after November 2022 and

1. 1. a follow-up environmental assessment to determine potential sources of lead exposure was completed (consult with state lead poisoning prevention program as needed)
      AND
   2.  the environmental assessment results indicated no other significant sources of lead exposure

Probable case:

• Blood lead levels of 3.5 μg/dL or higher confirmed through venous testing in a person within 3 months after consuming a recalled WanaBana, Schnucks, or Weis brand fruit purée product after November 2022 and

1. 1. a follow-up environmental assessment was not completed
      OR
   2. a follow-up environmental assessment was completed, but the environmental assessment results indicated other potential sources of lead exposure

Suspect case:

• Blood lead levels of 3.5 μg/dL or higher detected through capillary or unspecified testing, not yet confirmed via venous blood testing, in a person within 3 months after consuming a recalled WanaBana, Schnucks, or Weis brand fruit purée product after November 2022

Non-case:

• A person who meets one of the following criteria:
  1. The person did not consume a recalled WanaBana, Schnucks, or Weis brand fruit purée product after November 2022 (irrespective of BLL results).
     OR
  2. The person consumed a recalled WanaBana, Schnucks, or Weis brand fruit purée product after November 2022 but the confirmatory test result was less than 3.5 μg/dL.