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E. COLI EHEC - USA (28): O157, ROMAINE LETTUCE

E. COLI EHEC - USA (28): 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: Tue 20 Nov 2018
Source: CDC [edited] <https://www.cdc.gov/ecoli/2018/o157h7-11-18/index.html>


Outbreak of _E. coli_ Infections Linked to Romaine Lettuce
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CDC, public health and regulatory officials in several states, Canada, and the FDA are investigating a multistate outbreak of Shiga toxin-producing _Escherichia coli_ O157:H7 (_E. coli_ O157:H7) infections.

Public health investigators are using the PulseNet system to identify illnesses that may be 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 _E. coli_ bacteria from ill people in this outbreak showed that the strains were closely related genetically. This means that the ill people were more likely to share a common source of infection.

As of 20 Nov 2018, 32 people infected with the outbreak strain of _E. coli_ O157:H7 have been reported from 11 states.

State: [reported cases]
------------------
California: 10
Connecticut: 1
Illinois: 2
Massachusetts: 2
Maryland: 1
Michigan: 7
New Hampshire: 2
New Jersey: 3
New York: 2
Ohio: 1
Wisconsin: 1
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Total: 32

Illnesses started on dates ranging from 8 Oct 2018 to 31 Oct 2018. Ill people range in age from 7 to 84 years, with a median age of 24. 66 percent of ill people are female. Of 26 people with information available, 13 (50 percent) were hospitalized, including 1 person who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

Illnesses that occurred after 30 Oct 2018, might not yet be reported due to the time it takes between when a person becomes ill with _E. coli_ infection and when the illness is reported. This takes an average of 2 to 3 weeks.

Investigation of the Outbreak
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Epidemiologic evidence indicates that romaine lettuce is a likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. 11 (79 percent) of 14 people interviewed reported eating romaine lettuce. This percentage is significantly higher than results from a survey of healthy people in which 47 percent reported eating romaine lettuce in the week before they were interviewed. Ill people reported eating different types of romaine lettuce in several restaurants and at home.

Whole genome sequencing (WGS) results showed that the _E. coli_ O157:H7 strain isolated from ill people in this outbreak is closely related genetically to the _E. coli_ strain isolated from ill people in a 2017 outbreak linked to leafy greens in the United States and to romaine lettuce in Canada. The current outbreak is not related to a recent multistate outbreak of _E. coli_ O157:H7 infections linked to romaine lettuce. People in the spring outbreak were infected with _E. coli_ O157:H7 bacteria with a different DNA fingerprint.

FDA and states are working to trace back romaine lettuce that ill people ate in the current outbreak. At this time, no common grower, supplier, distributor, or brand of romaine lettuce has been identified. CDC is advising that consumers not eat any romaine lettuce, and restaurants and retailers not sell any, until we learn more about this outbreak and the source of the contaminated lettuce.

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

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Communicated by: ProMED-mail Rapporteur Mary Marshall

[ProMED thanks Glenn Snow for submitting the post as well. - Mod. LL

HealthMap/ProMED map available at: United States: <http://healthmap.org/promed/p/106>]

[See Also:
E. coli EHEC - USA (27): (UT) http://promedmail.org/post/20181028.6113669
E. coli EHEC - USA (26): O26, ground beef, alert, recall http://promedmail.org/post/20180920.6041171
E. coli EHEC - USA (25): (WA) raw milk http://promedmail.org/post/20180909.6016693
E. coli EHEC - USA (24): (FL) O26, grocery chain ground beef, alert, recall http://promedmail.org/post/20180831.5998786
E. coli EHEC - USA (23): (OK) possible recreational water exposure http://promedmail.org/post/20180801.5941698
E. coli EHEC - USA (22): (WA) restaurants http://promedmail.org/post/20180708.5893948
E. coli EHEC - USA (21): (TN) O157, 2 clusters, 2 sources http://promedmail.org/post/20180706.5891482
E. coli EHEC - USA (20): O157, romaine lettuce, water source http://promedmail.org/post/20180702.5882323
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

Published 29-09-2017 in Focus on , last update 26-11-2018

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