Raw Egg Safety for Immunocompromised Individuals
Immunocompromised individuals—including HIV-infected persons, pregnant women, young children, and the elderly—should absolutely avoid consuming raw eggs and any foods containing raw eggs due to the serious risk of life-threatening bacterial infections, particularly Salmonella enteritidis. 1
High-Risk Populations Who Must Avoid Raw Eggs
Multiple authoritative guidelines from the U.S. Public Health Service and Infectious Diseases Society of America consistently identify specific vulnerable groups:
- HIV-infected persons, particularly those with CD4+ counts <200 cells/µL, face unusually high risk for severe bacterial enteric infections 1
- Pregnant women are at 10-17 times higher risk for invasive listeriosis and can experience fetal miscarriage from foodborne infections 1, 2
- Young children and infants are at higher risk for severe illness from Salmonella 1, 3
- Elderly individuals have increased susceptibility to serious complications from foodborne pathogens 1
- Patients on immunosuppressive therapy, including cancer chemotherapy, corticosteroids, or with chronic liver disease 3, 2
Specific Foods to Avoid
The CDC and IDSA guidelines explicitly warn against raw egg-containing products 1:
- Hollandaise sauce (certain preparations) 1, 4
- Caesar salad dressing and other salad dressings 1, 4
- Mayonnaise (particularly homemade preparations) 1, 4
- Uncooked cookie and cake batter 1
- Egg nog 1
- Raw or undercooked eggs in any form 1
The Salmonella Risk
Research demonstrates that raw egg consumption leads to severe Salmonella enteritidis infections, with bodybuilders who consumed substantial quantities of raw eggs presenting with severe febrile illness and diarrhea, presumably reflecting large bacterial inocula 5. Restaurant data shows that 54% of establishments pool raw eggs for extended periods (4-6 hours), creating additional contamination risk 6.
Safe Egg Preparation Standards
All eggs must be cooked until no pink remains, with internal temperatures exceeding 165°F (73.8°C) for complete safety 1:
- Use a food thermometer to confirm adequate cooking temperature 2
- Poultry and meat containing eggs should reach 180°F (82°C) internally 1
- Reheating leftover egg-containing foods until steaming hot is essential 1, 3, 4
Cross-Contamination Prevention
Strict food handling practices are mandatory 1:
- Never allow uncooked eggs or their residue to contact other foods 1, 4
- Wash hands, cutting boards, counters, knives, and utensils thoroughly after contact with raw eggs 1
- Maintain scrupulous handwashing after handling any raw foods and before eating 1, 2
Common Pitfall to Avoid
The most dangerous misconception is that "healthy eating patterns" or nutritional benefits of raw eggs outweigh infection risks. While recent research shows raw versus cooked eggs produce similar muscle protein synthesis in healthy young men 7, and dietary cholesterol concerns have been revised 8, 9, these findings apply only to healthy individuals, not immunocompromised populations. The guidelines are unequivocal: immunocompromised persons must avoid raw eggs entirely, as the risk of life-threatening infection far exceeds any theoretical nutritional advantage 1.