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E. COLI EHEC - USA (27): O157, ROMAINE LETTUCE

E. COLI EHEC - USA (27): 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>

In this update:

[1] 40 people in 16 states ill
[2] CDC

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[1] 40 people in 16 states ill
Date: Fri 22 Nov 2019
Source: CNN [edited] <https://www.cnn.com/2019/11/22/health/e-coli-outbreak-romaine-lettuce/index.html>


A total of 40 people in 16 states have fallen ill due to an _E. coli_ outbreak in romaine lettuce, according to a report from the CDC and US FDA.

The agencies warn consumers, retailers and restaurants not to purchase or sell romaine lettuce harvested in Salinas, California, about 59 miles south of San Jose. The warning includes all types of romaine lettuce, according to a CDC tweet. So far, 28 people were hospitalized, though no deaths were reported, according to the FDA. Wisconsin has had 10 cases, the most reported from the 16 states, the CDC said.

"If romaine lettuce does not have labeling information for its growing area or the source cannot be confirmed, consumers should not eat or use the romaine," said Frank Yiannas, FDA's deputy commissioner for food policy and response. "Restaurants and retailers should not serve or sell romaine lettuce if they cannot confirm it is from outside Salinas."

This outbreak was caused by the same _E. coli_ strain that caused outbreaks in 2017 and 2018, according to Yiannas and the CDC.

"Heading into the Thanksgiving holiday, it is critically important to avoid buying or eating romaine lettuce from the Salinas growing area so you can protect yourself and your family," said Robert Tauxe, CDC's director of the division of foodborne, waterborne and environmental diseases.

This strain is known as the Shiga toxin-producing _E. coli_, which can cause 3-4 days of sickness after swallowing the germ, the CDC says. Most people who swallow this strain experience possible bloody diarrhea, severe stomach cramps and vomiting, the CDC says.

Recovery usually takes about a week, but the CDC says the strain can lead to longer and more severe illness.

[Byline: Amir Vera]

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

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[2] CDC
Date: Fri 22 Nov 2019
Source: CDC [edited] <https://www.cdc.gov/ecoli/2019/o157h7-11-19/index.html>


Since the initial investigation notice, 23 additional ill people have been reported. As of 21 Nov 2019, a total of 40 people infected with the outbreak strain of _E. coli_ O157:H7 have been reported from 16 states.

State / Ill People
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Arizona / 2
California / 4
Colorado / 1
Idaho / 3
Illinois / 1
Maryland / 3
Michigan / 1
Minnesota / 1
Montana / 1
New Jersey/ 1
New Mexico / 2
Ohio / 5
Pennsylvania / 3
Virginia / 1
Washington / 1
Wisconsin / 10
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Total / 40

Illnesses started on dates ranging from 24 Sep 2019, to 10 Nov 2019. Ill people range in age from 3 to 89 years, with a median age of 22. Six* percent of ill people are female. Of 39 ill people with information available, 28 hospitalizations have been reported, including 5 people who developed hemolytic uremic syndrome (HUS), a type of kidney failure. No deaths have been reported.

Epidemiologic, laboratory, and traceback evidence indicate that romaine lettuce from the Salinas, California growing region 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. Eight (80%) of 10 people interviewed reported eating romaine lettuce. This percentage is significantly higher than results from a survey of healthy people in which 47% reported eating romaine lettuce in the week before they were interviewed. Ill people in Maryland reported eating Ready Pac Foods Bistro Chicken Caesar Salad. To date, ill people in other states have not reported eating this particular salad, which contained romaine lettuce from the Salinas, California growing region.

As reported on 20 Nov 2019, the Maryland Department of Health external icon identified _E. coli_ O157 in romaine lettuce from an unopened package of Ready Pac Foods Bistro Chicken Caesar Salad collected from a sick person's home in Maryland. Whole genome sequencing has been completed and shows that the _E. coli_ strain in the romaine lettuce is closely related genetically to the _E. coli_ found in sick people in this outbreak. This provides additional evidence that people in this outbreak got sick from eating romaine lettuce.

FDA and states are tracing the source of the romaine lettuce eaten by ill people. Preliminary information indicates that some of the ill people ate lettuce grown in Salinas, California. No common grower, supplier, distributor, or brand of romaine lettuce has been identified.

CDC is advising that consumers not eat, and retailers not sell, any romaine lettuce harvested from Salinas, California until more information is available. The investigation is ongoing to determine the source of contamination and whether additional products are linked to illness.

This outbreak is caused by the same strain of _E. coli_ O157:H7 that caused outbreaks linked to leafy greens in 2017 and to romaine lettuce in 2018.

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

[On 14 Nov 2019, ProMED 1st posted on 3 cases of O157 infection occurring in the Eau Claire, WI area. It has been stated that at least 20 cases have been reported throughout Wisconsin. We await additional updates on the total in Wisconsin and nationwide. - Mod.LL

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

[See Also:
E. coli EHEC - USA (26), possible salad source http://promedmail.org/post/20191121.6789750
E. coli EHEC - USA (25): (OR) ground beef, recall http://promedmail.org/post/20191120.6785356
E. coli EHEC - USA (24): (MD) O157, prepackaged salad http://promedmail.org/post/20191118.6785355
E. coli EHEC - USA (23): (WI) http://promedmail.org/post/20191117.6783064
E. coli EHEC - USA (22): (WI) O157, possible salad source, RFI http://promedmail.org/post/20191114.6778989
E. coli EHEC - USA (21): (KY) siblings http://promedmail.org/post/20191031.6756403
E. coli EHEC - USA (20): (MN) O157, state fair, livestock exposure http://promedmail.org/post/20190919.6682768
E. coli EHEC - USA (19): (Philadelphia) http://promedmail.org/post/20190905.6659371
E. coli EHEC - USA (18): (MN) lake swimming http://promedmail.org/post/20190822.6635293
E. coli EHEC - USA (17): (MN) lake swimming http://promedmail.org/post/20190815.6622983
E. coli EHEC - USA (16): (SD) http://promedmail.org/post/20190731.6598318
E. coli EHEC - USA (15): (ME) O26, ex Iceland (SL) http://promedmail.org/post/20190722.6581313
E. coli EHEC - USA, Canada: O103, O121, ground bison, alert, recall http://promedmail.org/post/20190717.6572099
E. coli EHEC - USA (14): (CO) O157, restaurant http://promedmail.org/post/20190713.6566584
E. coli EHEC - USA (13): (CA) county fair, fatal http://promedmail.org/post/20190705.6554115
E. coli EHEC - USA (12): (CA) county fair, fatal http://promedmail.org/post/20190701.6545757
E. coli EHEC - USA (11): (MO) http://promedmail.org/post/20190623.6534267
E. coli EHEC - USA (10): O26, flour, alert, recall http://promedmail.org/post/20190615.6522440
E. coli EHEC - USA (09): (IL) http://promedmail.org/post/20190611.6513053
E. coli EHEC - USA (08): flour, alert, recall http://promedmail.org/post/20190527.6488348
E. coli EHEC - USA (07): O103, ground beef, CDC, recall http://promedmail.org/post/20190514.6468615
E. coli EHEC - USA (06): O103, ground beef, CDC, recall http://promedmail.org/post/20190424.6436748
E. coli EHEC - USA (05): O103, ground beef, CDC http://promedmail.org/post/20190413.6420590
E. coli EHEC - USA (04): O103, CDC http://promedmail.org/post/20190410.6414420
E. coli EHEC - USA (03): O103, CDC http://promedmail.org/post/20190405.6406761
E. coli EHEC - USA (02): O103, multistate spread http://promedmail.org/post/20190404.6404859
E. coli EHEC - USA: (KY) O103 http://promedmail.org/post/20190329.6393053

2018
---
E. coli EHEC - USA, Canada: O157, romaine lettuce http://promedmail.org/post/20181122.6159743
E. coli EHEC - USA (28): O157, romaine lettuce http://promedmail.org/post/20181120.6156581
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: O157, leafy greens http://promedmail.org/post/20180110.5550773]

Published 04-10-2017 in Focus on , last update 28-11-2019

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