Is eating raw eggs harmful, especially for individuals with weakened immune systems or chronic illnesses?

Is Eating Raw Eggs Harmful?

Yes, eating raw eggs is harmful and should be avoided, particularly for immunocompromised individuals, as raw eggs pose a significant risk of Salmonella infection that can cause severe gastroenteritis and potentially life-threatening bacteremia in vulnerable populations. 1

Risk for Immunocompromised Populations

HIV-Infected Individuals

• HIV-infected persons should absolutely not eat raw or undercooked eggs, including foods that might contain raw eggs such as hollandaise sauce, Caesar salad dressings, homemade mayonnaise, uncooked cookie and cake batter, and eggnog 1
• This recommendation is particularly critical for those with CD4+ counts <200 cells/µL, who face substantially higher risk of severe infection and bacteremia 1
• Salmonella gastroenteritis in HIV-infected patients frequently progresses to bacteremia, requiring blood cultures from any patient presenting with diarrhea and fever 1

Hematopoietic Stem Cell Transplant Recipients

• HSCT patients must avoid raw or undercooked eggs and any foods containing them (hollandaise sauce, Caesar dressings, homemade mayonnaise, homemade eggnog) due to the risk of Salmonella enteritidis infection 1
• This precaution applies throughout the post-transplant period when patients remain severely immunosuppressed 1

Pregnant Women

• Pregnant women with confirmed Salmonella gastroenteritis require antibiotic treatment to prevent extraintestinal spread, which can lead to placental/amniotic fluid infection and pregnancy loss 2
• Between 17% and 33% of all invasive Listeria disease cases occur among pregnant women, unborn fetuses, or newborn infants—a 13-17 fold increase compared with the general population 3

Microbiological Evidence of Risk

The evidence demonstrates that contaminated eggs are actively circulating in the food supply:

• Surveillance data from Northern Ireland found Salmonella in 0.43% of egg packs tested, with 0.05% contamination of egg contents where bacteria can proliferate to infectious levels if inadequately cooked 4
• Most contaminated eggs had apparently clean and uncracked shells, making visual inspection an unreliable safety measure 4
• Outbreak investigations have repeatedly confirmed raw egg consumption as the source of severe Salmonella Typhimurium infections, with one outbreak showing a crude odds ratio of 130.50 for illness associated with eating tiramisu containing raw eggs 5

Clinical Severity in Vulnerable Populations

• Body builders consuming substantial quantities of raw eggs presented with severe febrile illness and diarrhea, presumably reflecting large bacterial inocula 6
• The CDC/NIH/IDSA guidelines emphasize that antimicrobial resistance can develop during therapy in HIV-infected persons with gram-negative enteritides, often associated with clinical deterioration or relapse 1

Safe Food Handling Practices

To minimize risk, the following practices are essential:

• Poultry and meat must reach internal temperatures of 180°F (82°C) for poultry and 165°F (74°C) for red meats when using a thermometer 1
• Avoid cross-contamination: uncooked meats and their juices must not contact other foods 1
• Hands, cutting boards, counters, knives, and utensils must be washed thoroughly after contact with uncooked foods 1
• Caterers should use pasteurized liquid egg to eliminate risk 4

Common Pitfalls

• Visual inspection of eggs is inadequate: contaminated eggs typically appear clean with uncracked shells 4
• Color change of cooked meat (absence of pink) does not always correlate with safe internal temperature—use a thermometer 1
• Over 10,000 boxes containing one or more contaminated eggs may be sold annually even in developed countries with food safety programs 4
• The practice of consuming raw eggs continues despite repeated public health warnings, particularly among certain populations like body builders 6