In 2018 Canadian public health and agriculture officials investigated an outbreak of E. coli O121 infections linked to consumption of raw milk Gouda like cheese made in British Columbia. Cases were identified through laboratory testing results and epidemiologic surveillance data.

Four out of the seven cases consumed the same raw milk Gouda-like cheese between August and October 2018. Illnesses started on August 19 to November 9. No one was hospitalized and no one died. The implicated cheese was aged longer than the required minimum of 60 days, and no production deficiencies were noted. One sample of the implicated cheese tested positive for E. coli O121. The seven clinical isolates and one cheese isolate matched by wgMLST within 6.5 alleles.