Listeria monocytogenes Outbreaks Related to Commercially Produced Caramel Apples: Developments in Sanitation, Product Formulation, and Packaging: A Review.

ABSTRACT: Prior to a deadly 2014 listeriosis outbreak, caramel apples were not thought to be vehicles for the foodborne pathogen Listeria monocytogenes. The purpose of this review article is to summarize what has been learned from research prompted by this outbreak. This overview includes descriptions of the two L. monocytogenes infection outbreaks related to prepackaged caramel apples and a brief discussion of apple sanitation, the production processes used to make caramel apples, and research on ways to prevent future outbreaks associated with caramel apples. A qualitative analysis of the literature and interviews with current caramel apple manufacturers were conducted. Sanitation, packaging, and storage procedures used by manufacturers in the past may not effectively inactivate L. monocytogenes from contaminated product. Novel apple sanitation methods and product formulations to control L. monocytogenes on caramel apples have been developed and, in some cases, implemented in commercial production.