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Multistate Outbreak of E. coli O157:H7 Infections Linked to Romaine Lettuce

Posted April 20, 2018 4:00 PM EST

What's New?

  • Based on new information, CDC is expanding its warning to consumers to cover all types of romaine lettuce from the Yuma, Arizona growing region. This warning now includes whole heads and hearts of romaine lettuce, in addition to chopped romaine and salads and salad mixes containing romaine.
  • Do not buy or eat romaine lettuce at a grocery store or restaurant unless you can confirm it is not from the Yuma, Arizona, growing region.
  • Unless the source of the product is known, consumers anywhere in the United States who have any store-bought romaine lettuce at home should not eat it and should throw it away, even if some of it was eaten and no one has gotten sick. Product labels often do not identify growing regions; so, throw out any romaine lettuce if you’re uncertain about where it was grown. This includes whole heads and hearts of romaine, chopped romaine, and salads and salad mixes containing romaine lettuce. If you do not know if the lettuce is romaine, do not eat it and throw it away.
  • Restaurants and retailers should not serve or sell any romaine lettuce from the Yuma, Arizona growing region.
  • The expanded warning is based on information from newly reported illnesses in Alaska. Ill people in Alaska reported eating lettuce from whole heads of romaine lettuce from the Yuma, Arizona growing region.

Highlights

  • Information collected to date indicates that romaine lettuce from the Yuma, Arizona growing region could be contaminated with E. coli O157:H7 and could make people sick.
    • At this time, no common grower, supplier, distributor, or brand has been identified.
  • Advice to Consumers:
    • Do not buy or eat romaine lettuce at a grocery store or restaurant unless you can confirm it is not from the Yuma, Arizona, growing region.
    • Unless the source of the product is known, consumers anywhere in the United States who have any store-bought romaine lettuce at home should not eat it and should throw it away, even if some of it was eaten and no one has gotten sick. Product labels often do not identify growing regions; so, throw out any romaine lettuce if you’re uncertain about where it was grown. This includes whole heads and hearts of romaine, chopped romaine, and salads and salad mixes containing romaine lettuce. If you do not know if the lettuce is romaine, do not eat it and throw it away.
  • Advice to Restaurants and Retailers:
    • Restaurants and retailers should not serve or sell any romaine lettuce from the Yuma, Arizona growing region. This includes whole heads and hearts of romaine, chopped romaine, and salads and salad mixes containing romaine lettuce.
    • Restaurants and retailers should ask their suppliers about the source of their romaine lettuce.
  • CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Shiga toxin-producing Escherichia coli O157:H7 (E. coli O157:H7) infections.
  • 53 people infected with the outbreak strain of E. coli O157:H7 have been reported from 16 states.
    • 31 people have been hospitalized, including five people who have developed a type of kidney failure called hemolytic uremic syndrome.
    • No deaths have been reported.
  • This investigation is ongoing, and CDC will provide updates when more information is available.

April 20, 2018

Investigation Update

State and local health officials in Alaska interviewed ill people at a correctional facility in that state to ask about the foods they ate and other exposures before they became ill. Ill people reported eating romaine lettuce. Traceback investigations show that the lettuce ill people ate came from whole heads of romaine lettuce from the Yuma, Arizona growing region.

The new information from the investigation in Alaska along with other information collected to date indicates that romaine lettuce from the Yuma, Arizona growing region could be contaminated with E. coli O157:H7 and could make people sick. Read CDC’s advice to consumers, restaurants, and retailers.

This investigation is ongoing, and CDC will provide more information as it becomes available. The new Alaska cases will be included in the next case count update; they are not reflected on the epi curve and map for this posting.

Previous Outbreak Announcements

April 18, 2018

Case Count Update

Since the last update on April 13, 2018, 18 more people were added to this outbreak.

As of April 18, 2018, 53 people infected with the outbreak strain of E. coli O157:H7 have been reported from 16 states. A list of the states and the number of cases in each can be found on the Case Count Map page. Illnesses started on dates ranging from March 13, 2018 to April 6, 2018. Ill people range in age from 10 to 85 years, with a median age of 34. Seventy percent of ill people are female. Thirty-one ill people have been hospitalized, including five people who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

Illnesses that occurred after March 29, 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 two to three weeks.

Investigation Update

State and local health officials continue to interview ill people to ask about the foods they ate and other exposures before they became ill. Forty-one (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 [787 KB] 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. Read CDC’s advice to consumers, restaurants, and retailers.

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

April 13, 2018

Case Count Update

Since the last update on April 10, 2018, 18 more people from 9 states were added to this outbreak.

As of April 12, 2018, 35 people infected with the outbreak strain of E. coli O157:H7 have been reported from 11 states. A list of the states and the number of cases in each can be found on the Case Count Map page. Illnesses started on dates ranging from March 22, 2018 to March 31, 2018. Ill people range in age from 12 to 84 years, with a median age of 29. Sixty-nine percent of ill people are female. Twenty-two ill people have been hospitalized, including three people who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

Illnesses that occurred after March 27, 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 two to three weeks.

The current outbreak is not related to a recent multistate outbreak of E. coli O157:H7 infections linked to leafy greens. People in the previous outbreak were infected with a different DNA fingerprint of E. coli O157:H7 bacteria.

Investigation Update

Epidemiologic evidence collected to date indicates that chopped romaine lettuce is the likely source of this outbreak. Twenty-six (93%) of 28 people interviewed reported consuming romaine lettuce in the week before their illness started. This percentage is significantly higher than results from a survey [787 KB] 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.

Traceback investigations are ongoing to determine the source of chopped romaine lettuce supplied to restaurant locations where ill people ate. At this time, no common grower, supplier, distributor, or brand has been identified. However, preliminary information indicates that the chopped romaine lettuce was from the Yuma, Arizona growing region.

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. Read CDC’s advice to consumers, restaurants, and retailers.

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

Initial Announcement

April 10, 2018

CDC, several states, the U.S. Food and Drug Administration, and the U.S. Department of Agriculture’s Food Safety and Inspection Service are investigating a multistate outbreak of Shiga toxin-producing E. coli O157:H7 infections. This investigation includes E. coli O157:H7 infections recently reported by the New Jersey Department of Health.

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 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.

Illnesses reported by investigators in New Jersey also included ill people who had a diagnostic test showing they were infected with E. coli bacteria. Laboratory testing is ongoing to link their illnesses to the outbreak using DNA fingerprinting. Some people may not be included in CDC’s case count because no bacterial isolates are available for the DNA fingerprinting needed to link them to the outbreak.

As of April 9, 2018, 17 people infected with the outbreak strain of E. coli O157:H7 have been reported from 7 states. A list of the states and the number of cases in each can be found on the Case Count Map page. Illnesses started on dates ranging from March 22, 2018 to March 31, 2018. Ill people range in age from 12 to 84 years, with a median age of 41. Among ill people, 65% are female. Six ill people have been hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

The investigation is still ongoing and a specific food item, grocery store, or restaurant chain has not been identified as the source of infections. State and local public health officials are interviewing ill people to determine what they ate and other exposures in the week before their illness started.

CDC will provide more information as it becomes available.

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