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E. COLI EHEC - USA (05): O157, ROMAINE LETTUCE

E. COLI EHEC - USA (05): O157, ROMAINE LETTUCE

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A ProMED-mail post <http://www.promedmail.org> ProMED-mail is a program of the International Society for Infectious Diseases <http://www.isid.org>

Date: Wed 18 Apr 2018
Source: CDC [edited] <https://www.cdc.gov/ecoli/2018/o157h7-04-18/index.html>

Case Count Update: Since the last update on 13 Apr 2018, 18 more people were added to this outbreak.

As of 18 Apr 2018, 53 people infected with the outbreak strain of _E. coli_ O157:H7 have been reported from 16 states. Illnesses started on dates ranging from 13 Mar 2018 to 6 Apr 2018. Ill people range in age from 10 to 85 years, with a median age of 34. 70 percent of ill people are female. 31 ill people have been hospitalized, including 5 people who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

State / Ill People
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Alaska / 1
Arizona / 3
California / 1
Connecticut / 2
Idaho / 10
Illinois / 1
Louisiana / 1
Michigan / 2
Missouri / 1
Montana / 6
New Jersey / 7
New York / 2
Ohio / 2
Pennsylvania / 12
Virginia / 1
Washington / 1
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Total / 53

Illnesses that occurred after 29 Mar 2018, might not yet be reported due to the time it takes between when a person becomes ill with _E. coli_ and when the illness is reported. This takes an average of 2 to 3 weeks.

Investigation Update
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State and local health officials continue to interview ill people to ask about the foods they ate and other exposures before they became ill. 41 (95%) of 43 people interviewed reported eating romaine lettuce in the week before their illness started. This percentage is significantly higher than results from a survey of healthy people in which 46% reported eating romaine lettuce in the week before they were interviewed. Most people reported eating a salad at a restaurant, and romaine lettuce was the only common ingredient identified among the salads eaten. The restaurants reported using bagged, chopped romaine lettuce to make salads. At this time, ill people are not reporting whole heads or hearts of romaine.

Information collected to date indicates that chopped romaine lettuce from the Yuma, Arizona growing region could be contaminated with _E. coli_ O157:H7 and could make people sick.

This investigation is ongoing, and CDC will provide more information as it becomes available.

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Communicated by: ProMED-mail <promed@promedmail.org>

[This is a continued expansion of the outbreak which was originally reported from New Jersey, and the vehicle is noted to be romaine lettuce.

ProMED has previously posted on outbreaks of enteric pathogens, including both O157 and non-O157 EHEC, salmonellosis and yersinosis associated with lettuce. The contamination of the produce can occur at any step in the food chain from growth in a field to harvesting to contamination in a restaurant or home kitchen. While aggressive washing of the produce can remove outside contamination, pathogens can internalize as well, as highlighted in this paper:

Wright KM, Crozier L, Marshall J, Merget B, Holmes A, Holden NJ: Differences in internalization and growth of _Escherichia coli_ O157:H7 within the apoplast of edible plants, spinach and lettuce, compared with the model species _Nicotiana benthamiana_. Microb Biotechnol. 2017;10: 555-569.

Abstract
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Internalization of food-borne bacteria into edible parts of fresh produce plants represents a serious health risk. Therefore, internalization of verocytotoxigenic _E. coli_ O157:H7 isolate Sakai was assessed in 2 species associated with outbreaks, spinach (_Spinacia oleracea_) and lettuce (_Lactuca sativa_) and compared to the model species _Nicotiana benthamiana_. Internalization occurred in the leaves and roots of spinach and lettuce throughout a 10-day time-course. The plant species, tissue type and inoculum dose all impacted the outcome. A combination of low inoculum dose (approx. 100 CFU) together with light microscopy imaging highlighted marked differences in the fate of endophytic _E. coli_ O157:H7 Sakai. In the fresh produce species, bacterial growth was restricted but viable cells persisted over 20 days, whereas there was a greater than 400-fold increase in growth in _N. benthamiana_. Colony formation occurred adjacent to epidermal cells and mesophyll cells or close to vascular bundles of _N. benthamiana_ and contained components of a biofilm matrix, including curli expression and elicitation, extracellular DNA and a limited presence of cellulose. Together the data show that internalization is a relevant issue in crop production and that crop species and tissue need to be considered as food safety risk parameters.

HealthMap ProMED-mail of the United States: <http://healthmap.org/promed/p/106>. - Mod.LL]

[See Also:

E. coli EHEC - USA (04): O157, romaine lettuce http://promedmail.org/post/20180413.5745944
E. coli EHEC - USA (03): O157, expansion of NJ outbreak http://promedmail.org/post/20180411.5738813
E. coli EHEC - USA (02): (NJ) poss. restaurant chain link, RFI http://promedmail.org/post/20180405.5728398
E. coli EHEC - USA: O157, leafy greens http://promedmail.org/post/20180110.5550773

2017
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E. coli EHEC - USA (39): relatedness to Canada isolates http://promedmail.org/post/20171229.5527271
E. coli EHEC - Canada (14): O157, lettuce, fatal http://promedmail.org/post/20171222.5518867
E. coli EHEC - Canada (13): O157, lettuce, fatal http://promedmail.org/post/20171215.5506384
E. coli EHEC - Canada (12) : O157, lettuce http://promedmail.org/post/20171212.5497097
E. coli EHEC - USA (38): (CA) http://promedmail.org/post/20171212.5498214
E. coli EHEC - USA (37): raw dough, FDA alert http://promedmail.org/post/20171202.5479176
E. coli EHEC - USA (36): (CA) military outbreak, O157 http://promedmail.org/post/20171111.5436982
E. coli EHEC - USA (35): (CA) military outbreak, O157 http://promedmail.org/post/20171104.5424631
E. coli EHEC - USA (34): (CA) military outbreak, O157 http://promedmail.org/post/20171103.5422415
E. coli EHEC - USA (33): (CA) military outbreak, O157 http://promedmail.org/post/20171102.5421203
E. coli EHEC - USA (32): (CA) military outbreak, revised case numbers http://promedmail.org/post/20171102.5420166
E. coli EHEC - USA (31): (CA) military outbreak http://promedmail.org/post/20171101.5417972
E. coli EHEC - USA (30): (CA) military outbreak, RFI http://promedmail.org/post/20171031.5416569
E. coli EHEC - USA (29): (MI) farm animal exposures, RFI http://promedmail.org/post/20171030.5410350
E. coli EHEC - USA (28): (VT) O157, ground beef, alert, recall http://promedmail.org/post/20171014.5381117
E. coli EHEC - USA (27): (WI) O157, RFI http://promedmail.org/post/20170921.5330484
E. coli EHEC - USA (26): (MI) O157, antimicrobial resistance http://promedmail.org/post/20170824.5272308
E. coli EHEC - USA (25): (CA) O157, recreational water http://promedmail.org/post/20170818.5258783
E. coli EHEC - USA (24): (CO) county fair, RFI http://promedmail.org/post/20170811.5243577
E. coli EHEC - USA (23): (CA) recreational water http://promedmail.org/post/20170810.5240983
E. coli EHEC - USA (22): (CA) recreational water http://promedmail.org/post/20170804.5227891
E. coli EHEC - USA (21): (CA) recreational water http://promedmail.org/post/20170802.5220799
E. coli EHEC - USA (20): (CA) recreational water, RFI http://promedmail.org/post/20170731.5217061
E. coli EHEC - USA (19): (UT, AZ) O157, fatalities, susp. livestock exposure http://promedmail.org/post/20170730.5215421
E. coli EHEC - USA (18): (UT, AZ) O157, fatalities http://promedmail.org/post/20170727.5206988
E. coli EHEC - USA (17): (OH) summer camp, RFI http://promedmail.org/post/20170724.5198725
E. coli EHEC - USA (16) : (MN) fatality http://promedmail.org/post/20170721.5195217
E. coli EHEC - USA (15): (UT) O157, fatalities http://promedmail.org/post/20170711.5167176
E. coli EHEC - USA (14): (UT) O157, fatalities http://promedmail.org/post/20170705.5152059
E. coli, EHEC - USA (13): (UT) fatalities, susp EHEC, RFI http://promedmail.org/post/20170703.5147181
E. coli EHEC - USA (12): (TX) http://promedmail.org/post/20170621.5121066
E. coli EHEC - USA (11): O157, deer droppings, water exposure, 2016 http://promedmail.org/post/20170511.5028649
E. coli EHEC - USA (10): O157, soynut butter http://promedmail.org/post/20170505.5014128
E. coli EHEC - USA (09): (AR) fatality, unrelated cases http://promedmail.org/post/20170422.4988037
E. coli EHEC - USA (08): (AR) fatality, RFI http://promedmail.org/post/20170421.4984124
E. coli EHEC - USA (07): (MA) O157, restaurant chain, RFI http://promedmail.org/post/20170414.4970974
E. coli EHEC - USA (06): O157, soynut butter http://promedmail.org/post/20170405.4949992
E. coli EHEC - USA (05): O157, soynut butter, CDC update http://promedmail.org/post/20170401.4941247
E. coli EHEC - USA (04): (OR) O157, soynut butter, preschool http://promedmail.org/post/20170315.4902827
E. coli EHEC - USA (03): O157, soynut butter, more cases, recall http://promedmail.org/post/20170308.4887992
E. coli EHEC - USA (02): O157, soynut butter http://promedmail.org/post/20170307.4883675
E. coli EHEC - USA http://promedmail.org/post/20170302.4875298]

Published 27-09-2017 in Focus on , last update 19-04-2018

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