Overview
This CDC MMWR report documents the national investigation of lead and chromium poisoning linked to cinnamon-containing applesauce pouches marketed primarily to young children. In October 2023, routine pediatric blood lead surveillance in North Carolina identified four cases of lead poisoning linked to WanaBana brand applesauce; FDA subsequently detected lead concentrations of 1.9–3.0 ppm in product pouches, representing 200–300 times FDA’s recommended action level for fruit purees intended for babies and young children. The distributor voluntarily recalled 2,998,088 pouches sold under three brand names (WanaBana, Schnucks, Weis). A national call for cases yielded 566 total cases across 44 U.S. states, the District of Columbia, and Puerto Rico, with the median maximum venous blood lead level (BLL) of 7.2 µg/dL (range 3.5–39.3 µg/dL; IQR 5.2–11.3). On January 5, 2024, FDA determined the contaminating agent in the cinnamon was lead chromate (a yellow pigment), explaining the co-occurrence of both lead and chromium.
Key numbers
n = 566 cases (130 confirmed, 401 probable, 35 suspected). Children aged <6 years: 542 (96%) of all cases; aged <2 years: 311 (55%). Median maximum venous BLL: 7.2 µg/dL; range 3.5–39.3 µg/dL; IQR 5.2–11.3 µg/dL; mean 9.2 µg/dL (SD 5.85). Approximately 32% of values were ≥10 µg/dL. Symptomatic cases: 81 (approximately 20%), of which 55 gastrointestinal and 35 developmental or behavioral. No hospitalizations. Pb in product: 1.9–3.0 ppm in cinnamon (roughly 200–300× FDA action level for fruit purees for infants). Source of contamination: lead chromate in cinnamon from foreign manufacturer. Product first sold November 2022; recall initiated October 29, 2023.
Methods (brief)
National surveillance case series. Case definition: BLL ≥3.5 µg/dL within 3 months of consuming a recalled product. Three classification tiers: suspected (capillary or unspecified blood test), probable (venous BLL without completed environmental assessment), confirmed (venous BLL with environmental assessment excluding other lead sources). Data submitted biweekly to CDC via secure website. Analysis: SAS 9.4.
Implications
Certification: This outbreak directly supports the wiki’s evidence base on spice-contaminated food as a route of heavy metal exposure for infants and young children. Lead chromate adulteration of cinnamon (from foreign supply chains) is a supply-chain surveillance issue relevant to HMT&C certification programs covering spiced or spice-containing products. Courses: A canonical regulatory event for courses on food supply chain metal contamination, recall response, and pediatric lead exposure via food. App: The ingredient-level signal (cinnamon as a Pb/Cr contamination risk from adulteration) is app-relevant for any product containing cinnamon marketed to young children.
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Update history
The five most recent substantive edits to this page, classified major (evidence or structure moved), correction (a published value or statement was wrong and has been fixed), or minor (narrative rewritten without changing the underlying evidence). Each description is derived from what the edit did to this page; the linked commit is the authoritative record, routine regeneration passes are excluded, and the full version history lives in git. When DOI minting comes online (see schema docs), each entry below will also link to a version-pinned DataCite DOI.
| Commit | Date | Change | Description |
|---|---|---|---|
| a8052bb | 2026-08-09 | major | 6 sections added; narrative text revised |