Outbreak of E. coli Infections Linked to Romaine Lettuce

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Posted December 4, 2019 at 3:00 PM ET

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administrationexternal icon (FDA) are investigating a multistate outbreak of E. coli O157:H7 infections linked to romaine lettuce harvested from the Salinas, California, growing region. Visit the Frequently Asked Questions webpage for more information.

Recall and Advice to Consumers, Restaurants, and Retailers
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At A Glance
Photo of romaine lettuce in a wood bowl.

Photo of Salinas Valley label.

Example of a harvest region label.

CDC advises that consumers not eat and retailers not sell any romaine lettuce grown in the Salinas, California, growing region. This includes all use-by dates and brands of romaine lettuce from this region.

Have questions? Visit the Frequently Asked Questions web page.

  • Most romaine lettuce products are labeled with a harvest location showing where they were grown.
  • This advice includes all types of romaine lettuce grown in Salinas, California, such as whole heads of romaine, organic romaine, hearts of romaine, romaine in salad wraps, and packages of precut lettuce and salad mixes which contain romaine, including baby romaine, spring mix, and Caesar salad.
    • Hydroponically- and greenhouse-grown romaine, which may be labeled as “indoor grown,” from any region does not appear to be related to the current outbreak.
  • If you have romaine lettuce or packaged foods containing romaine at home:
    • Look for a label showing where the romaine lettuce was grown. It may be printed on the package or on a sticker.
    • If the label says “grown in Salinas” (whether alone or with the name of another location), don’t eat it. Throw it away.
    • If it isn’t labeled with a growing region, don’t eat it. Throw it away.
    • If you don’t know if the lettuce is romaine or whether a salad mix or wrap contains romaine, don’t eat it. Throw it away.
    • Wash and sanitize drawers or shelves in refrigerators where romaine lettuce was stored. Follow these five steps to clean your refrigerator.
  • If you are buying romaine lettuce at a store:
    • Look for a label showing where the romaine lettuce was grown. It may be printed on the package or on a sticker.
    • If the label says “grown in Salinas” (whether alone or with the name of another location), don’t buy it.
    • If it isn’t labeled with a growing region, don’t buy it.
  • Restaurants and retailers should check the label on bags or boxes of romaine lettuce, or ask their suppliers about the source of their romaine lettuce.
    • Look for a label showing where the romaine lettuce was grown. It may be printed on the package or on a sticker.
    • If the label says “grown in Salinas” (whether alone or with the name of another location), don’t sell or serve it.
    • If it isn’t labeled with a growing region, don’t sell or serve it.
  • Suppliers, distributors, and others in the supply chain should not ship or sell romaine harvested in Salinas, California.

Take action if you have symptoms of an E. coli infection.

  • Talk to your healthcare provider.
  • Write down what you ate in the week before you started to get sick.
  • Report your illness to your local health department.
  • Assist public health investigators by answering questions about your illness.
  • Wash your hands thoroughly after changing diapers, using the toilet, and before and after preparing food to lower the chance of infecting others.
Latest Outbreak Information
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  • A total of 102 people infected with the outbreak strain of E. coli O157:H7 have been reported from 23 states.
    • A total of 58 hospitalizations have been reported. Ten people have developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.
  • Epidemiologic, laboratory, and traceback evidence collected to date indicate that romaine lettuce from the Salinas, California, growing region may be contaminated with E. coli O157:H7 and is making people sick.
  • The investigation is ongoing to determine the source of contamination and if additional products are linked to illness.
  • CDC will provide more information as it becomes available.
  • Have questions? Visit the Frequently Asked Questions webpage.
Symptoms of E. coli Infection
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  • People usually get sick from Shiga toxin-producing E. coli (STEC) 2 to 8 days (average of 3 to 4 days) after swallowing the germ.
  • Some people with E. coli infections may get a type of kidney failure called hemolytic uremic syndrome (HUS).
  • E. coli infection is usually diagnosed by testing a stool sample.
  • Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out. Some studies have shown that administering antibiotics to patients with E. coli infections might increase their risk of developing HUS, and a benefit of treatment has not been clearly demonstrated.
  • For more information, see Symptoms of E. coli Infection.
Investigation Details

December 4, 2019

Since the previous update on November 26, an additional 35 ill people have been reported. As of December 2, 2019, a total of 102 people infected with the outbreak strain of E. coli O157:H7 have been reported from 23 states. A list of the states and the number of cases in each can be found on the Map of Reported Cases page.

Illnesses started on dates ranging from September 24, 2019, to November 18, 2019. Ill people range in age from less than 1 to 89 years, with a median age of 25. Sixty-five percent of ill people are female. Of 98 ill people with information available, 58 hospitalizations have been reported, including 10 people who developed hemolytic uremic syndrome (HUS), a type of kidney failure. No deaths have been reported.

Investigation of the Outbreak

Epidemiologic, laboratory, and traceback evidence indicate that romaine lettuce from the Salinas, California, growing region is the likely source of this outbreak.

FDA and states continue to trace 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 continues to advise that consumers not eat and retailers not sell any romaine lettuce grown in Salinas, California. The investigation is ongoing to determine the source of contamination and if 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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