By following this link you'll go directly to the site map at the end of each page
(EN)
   Person in charge: Stefano Morabito
You're in:
Focus on

Third Update!!! E. COLI EHEC - USA (20): O157, ROMAINE LETTUCE, WATER SOURCE

E. COLI EHEC - USA (20): O157, ROMAINE LETTUCE, WATER SOURCE

************************************************************
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: Thu 28 Jun 2018
Source: CDC, _E. coli_ Homepage, 2018 Outbreaks [edited] <https://www.cdc.gov/ecoli/2018/o157h7-04-18/index.html>


Multistate outbreak of _E. coli_ O157:H7 infections linked to romaine lettuce (final update)
----------------------------------------------------------------------
CDC, public health and regulatory officials in several states, and the FDA investigated a multistate outbreak of _E. coli_ O157:H7 infections.

Public health investigators used the PulseNet system to identify illnesses that were part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is performed on _E. coli_ bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE. WGS performed on bacteria isolated from ill people in this outbreak showed that they were closely related genetically. This means that the ill people were more likely to share a common source of infection.

As of 27 Jun 2018, 210 people infected with the outbreak strain of _E. coli_ O157:H7 were reported from 36 states. Illnesses started on dates ranging from 13 Mar 2018 to 6 Jun 2018. Ill people ranged in age from 1 to 88 years, with a median age of 28. 67 percent of ill people were female. Of 201 people with information available, 96 (48 percent) were hospitalized, including 27 people who developed hemolytic uremic syndrome, a type of kidney failure. 5 deaths were reported from Arkansas, California, Minnesota (2), and New York.

State / Ill people

Alabama / 3
Alaska / 8
Arkansas / 1
Arizona / 9
California / 49
Colorado / 3
Connecticut / 2
Florida / 3
Georgia / 5
Idaho / 12
Illinois / 2
Iowa / 1
Kentucky / 1
Louisiana / 1
Massachusetts / 4
Michigan / 5
Minnesota / 12
Mississippi / 1
Missouri / 1
Montana / 9
Nebraska / 1
New Jersey / 8
New York / 11
North Carolina / 1
North Dakota / 3
Ohio / 7
Oklahoma / 1
Oregon / 1
Pennsylvania / 24
South Dakota / 1
Tennessee / 3
Texas / 4
Utah / 1
Virginia / 1
Washington / 8
Wisconsin / 3
-------------
Total / 210

WGS analysis of isolates from 184 ill people identified antimicrobial resistance to chloramphenicol, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Standard resistance testing of 8 clinical isolates by CDC's National Antimicrobial Resistance Monitoring System (NARMS) laboratory confirmed these findings. Isolates from four of those ill people also contained genes for resistance to ampicillin and ceftriaxone. These findings do not affect treatment guidance since antimicrobials are not recommended for patients with _E. coli_ O157 infections.

Investigation of the outbreak
--------------------
Epidemiologic, laboratory, and traceback evidence indicated that romaine lettuce from the Yuma growing region was the likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures they had before they became ill. Of the 166 people interviewed, 145 (87 percent) reported eating romaine lettuce in the week before their illness started. This percentage was significantly higher than results from a survey of healthy people in which 46 percent reported eating romaine lettuce in the week before they were interviewed. Some people who became sick in this outbreak did not report eating romaine lettuce, but had close contact with someone else who got sick from eating romaine lettuce.

The FDA and state and local regulatory officials traced the romaine lettuce to many farms in the Yuma growing region. The FDA, along with CDC and state partners, started an environmental assessment in the Yuma growing region and collected samples of water, soil, and manure. CDC laboratory testing identified the outbreak strain of _E. coli_ O157:H7 in water samples taken from a canal in the Yuma growing region. WGS showed that the _E. coli_ O157:H7 found in the canal water is closely related genetically to the _E. coli_ O157:H7 from ill people. Laboratory testing for other environmental samples is continuing. FDA is continuing to investigate to learn more about how the _E. coli_ bacteria could have entered the water and ways this water could have contaminated romaine lettuce in the region.

According to the FDA, the last shipments of romaine lettuce from the Yuma growing region were harvested on 16 Apr 2018, and the harvest season there has ended. Contaminated lettuce that made people sick in this outbreak should no longer be available.

As of 28 Jun 2018, this outbreak appears to be over.

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

[This large American outbreak seems now over and is suspected to have been associated with contaminated water. - Mod.LL

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

[See Also:

E. coli EHEC - USA (19): (UT, AZ) O157, 2017 http://promedmail.org/post/20180616.5858104
E. coli EHEC - USA (18): (TN) raw milk, more cases http://promedmail.org/post/20180614.5856110
E. coli EHEC - USA (17): (OR) O111, daycare center http://promedmail.org/post/20180613.5854733
E. coli EHEC - USA (16): (TN) raw milk http://promedmail.org/post/20180607.5844304
E. coli EHEC - USA (15): O157, romaine lettuce, more cases, fatal http://promedmail.org/post/20180604.5837662
E. coli EHEC - USA (14): (WA) sandwich shops http://promedmail.org/post/20180527.5820803
E. coli EHEC - USA (13): O157, romaine lettuce, increasing cases, fatality http://promedmail.org/post/20180517.5799620
E. coli EHEC - USA (12): O157, romaine lettuce, increasing cases, fatality http://promedmail.org/post/20180510.5791677
E. coli EHEC - USA (11): (OK) day care center http://promedmail.org/post/20180502.5780250
E. coli EHEC - USA (10): O157, romaine lettuce, fatality http://promedmail.org/post/20180502.5780249
E. coli EHEC - USA (09): O157, romaine lettuce http://promedmail.org/post/20180427.5771229
E. coli EHEC - USA (08): (CA) military outbreak, undercooked beef, 2017 http://promedmail.org/post/20180425.5769489
E. coli EHEC - USA (07): O157, romaine lettuce http://promedmail.org/post/20180425.5769488
E. coli EHEC - USA (06): O157, romaine lettuce http://promedmail.org/post/20180421.5761217
E. coli EHEC - USA (05): O157, romaine lettuce http://promedmail.org/post/20180418.5756056
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
---
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 03-07-2018

Share: 

Legal information


© - Istituto Superiore di Sanità Viale Regina Elena 299 - 00161 - Roma (I)
Partita I.V.A. 03657731000 - C.F. 80211730587 - Legal information

ISS Home

Informiamo i visitatori, in virtù della individuazione delle modalità semplificate per l'informativa e l'acquisizione del consenso per l'uso dei cookie - 8 maggio 2014 (Pubblicato sulla Gazzetta Ufficiale n. 126 del 3 giugno 2014), che questo sito utilizza direttamente solo cookie tecnici.[Ho letto]