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Questions and Answers about E. coli O157:H7 Outbreak from Fresh Spinach

October 12, 2006

Why is the number of cases increasing when the contaminated fresh spinach has been recalled and is being removed from the shelves?

The increasing number of E. coli O157:H7cases is partly due to the amount of time it takes to confirm that new cases are part of an outbreak. The time from the beginning of a patient’s illness to the confirmation that he or she was part of an outbreak is typically about 2 to 3 weeks. For a more detailed explanation of illness reporting, please see the Timeline for Reporting of Cases.

How long does it take for symptoms to show up after E. coli O157:H7 infection?

On average, symptoms from E. coli O157:H7 infection develop within 3 to 4 days of eating contaminated food, with a range of 1 to 10 days. Symptoms usually include severe bloody diarrhea and abdominal cramps; sometimes the infection causes non-bloody diarrhea or no symptoms. Usually little or no fever is present, and the illness resolves in 5 to 10 days. In some people, the infection can also cause a complication called hemolytic uremic syndrome (HUS), in which the red blood cells are destroyed and the kidneys fail.

How many and which states are affected?

As of 1 PM (ET) October 12, 2006, Thursday, 199 persons infected with the outbreak strain of E. coli O157:H7 have been reported to CDC from 26 states. For current information and daily updates, please visit the E. coli O157:H7 Outbreak website.

Which brands of spinach were contaminated?

Products implicated in the outbreak include fresh spinach and spinach-containing products from brands processed by Natural Selection Foods with a "use by date" of October 1, 2006 or earlier. Consumers should not eat, retailers should not sell, and restaurants should not serve spinach implicated in the E. coli O157:H7 outbreak. The September 29 Food and Drug Administration (FDA) press release lists the brand names that have been the subject of recalls. If you cannot tell if a brand of fresh spinach was implicated in the outbreak, and the package has a "use by date" of October 1, 2006 or earlier, you should not purchase or eat it. Frozen and canned spinach is not implicated in this outbreak.

Should I return purchased fresh spinach to the store where I bought it?

CDC recommends that you throw away any fresh spinach processed by Natural Selection Foods with a "use by date" of October 1, 2006 or earlier. The spinach can be thrown away in your regular trash.

How is E. coli O157:H7 illness treated?

Most people recover without specific treatment within 5 to 10 days. Antibiotics should not be used to treat this infection, and it is thought that treatment with some antibiotics could lead to kidney complications. Antidiarrheal agents, such as loperamide (Imodium®), should also be avoided.

In some people, E. coli O157:H7 infection can cause a complication called hemolytic uremic syndrome (HUS), a life-threatening condition that is usually treated in an intensive care unit. Blood transfusions and kidney dialysis are often required. With intensive care, the death rate for hemolytic uremic syndrome is 3% to 5%.

Can E. coli O157:H7 be passed to a baby?

Bacteria in diarrheal stools of infected persons can be passed from one person to another if the patient and family members do not properly wash their hands with soap and water before eating and using the bathroom and otherwise maintain good hygiene. This is particularly likely among toddlers who are not toilet trained. Family members and playmates of these children may be at high risk of becoming infected. Young children typically shed the organism in their feces for a week or two after their illness resolves. Older children rarely carry the organism without symptoms. To prevent transmission to a baby, infected individuals should avoid direct contact with infants and toddlers.

Have there been any other outbreaks of E. coli O157:H7 in the United States?

Outbreaks of E. coli O157:H7 infection occur regularly and have been both large and small in localized areas and across several states. Transmission of E. coli was first associated with contaminated ground beef but has also been spread through unpasteurized fruit juices, lettuce, and contaminated drinking water, as well as through contact with infected animals (such as in petting zoos) and person-to-person, especially among children in day care centers. The way E. coli O157:H7 is transmitted changes over time, which is why the CDC works closely with state health departments to monitor and investigate cases and outbreaks of E. coli O157:H7.

Are other leafy greens and vegetables safe to eat?

No other type of leafy green (e.g., lettuce, collard greens, kale) is implicated in this outbreak.

Consumers should always practice safe food handling and preparation measures. At home, keep raw meat, poultry, and seafood separate from produce and ready-to-eat foods. Wash hands, utensils, and surfaces with hot, soapy water before and after handling food. At the grocery store, separate raw meat, poultry, seafood, and eggs from other foods in your shopping cart and grocery bags.

Do restaurants buy the same spinach that is available at the grocery store?

Restaurants and grocery stores often buy spinach from the same major food distributors in the U.S. Therefore, the spinach that you purchase from a grocery store may have been processed by the same company as the spinach that you eat in a restaurant.

CDC and FDA are working to ensure that the restaurant industry is fully aware of the E. coli O157:H7 outbreak related to spinach and are taking the appropriate measures to prevent exposure of their customers to E. coli O157:H7.

Restaurants should not purchase spinach implicated in the current E. coli O157:H7 outbreak. If you cannot verify that a brand of spinach was not processed by Natural Selection Foods, and it has a "use by date" of October 1, 2006 or earlier, you should not buy or eat the fresh spinach.  For more information on restaurant guidelines, contact your local health department.

How should I clean my kitchen surfaces to kill E. coli O157:H7 bacteria?

Wash countertops with a solution of 5 milliliters (1 teaspoon) of chlorine bleach in about 1 liter (1 quart) of water or with a commercial kitchen cleaning agent diluted according to product directions.

If handling fresh spinach, avoid cross-contamination with other foods and/or food contact surfaces. Wash hands thoroughly with hot, soapy water. Wash utensils and surfaces with bleach, cleaning agents, and/or hot, soapy water before and after handling spinach.

Dish cloths and sponges can harbor bacteria and may promote their growth. Wash these items weekly in hot water in the washing machine.

Periodically sanitize kitchen sink drains by pouring a solution of 1 teaspoon of bleach to 1 quart of water or a commercial kitchen cleaning agent down the sink drain. Food particles often get trapped in drains and disposals and, along with moistness, can create an ideal environment for bacteria growth.

If I threw out spinach with my trash, do I need to clean/empty my refrigerator?

Keeping a refrigerator clean at all times helps keep food safe. Any spills—especially those involving fresh spinach—should be wiped up immediately and surfaces should be cleaned thoroughly with a solution of 5 milliliters (1 teaspoon) of chlorine bleach in about 1 liter (1 quart) of water, with a commercial kitchen cleaning agent or with hot, soapy water, and then rinsed. Once a week, make it a habit to throw out perishable foods that are past their expiration date. For more information, see the U.S. Department of Agriculture fact sheet Refrigeration and Food Safety.

Should I be concerned about the meals served at my child’s school?

Schools should not purchase spinach implicated in the current E. coli O157:H7 outbreak. If you cannot verify that the spinach was not processed by Natural Selection Foods, you should advise your child to not buy or eat the fresh spinach. For more information on school cafeteria guidelines, contact your local health department.


For information about E. coli O157:H7 symptoms, treatment, and prevention, see General Questions and Answers About E. coli.

Page last modified October 12, 2006
Content source: National Center for Infectious Diseases

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