Monday, January 15, 2018

CDC and FDA Hold Off from Implicating Romaine Lettuce in E. coli Outbreak

FDA and CDC did not pull the trigger on making a public notice to avoid romaine lettuce for involvement in an E. coli outbreak.   The Canadians were first to issue a public notice implicating Romaine lettuce on Dec 14th.  At this point, however, there were no additional cases of E. coli infection reported with the last case on December 12th being reported (and recognizing there is a delay from infection and reporting).

In the end, that call was right.  Even if it is found that romaine lettuce was the source, that contaminated product would had already been through the system (considering the short shelf-life of product).  A public notice would have been missed the target and resulted in needless waste.

However, what we did see was a lot of confusion on the part of various entities issuing reactionary notices.  FDA and CDC would have done better to put their findings out there earlier.  Outbreak investigations are not perfect, and while it would have been easier on their part to trash the leafy green industry, relaying the findings would have gone a long way to quieting the alarmists.

https://www.fda.gov/Food/RecallsOutbreaksEmergencies/SafetyAlertsAdvisories/ucm591989.htm
FDA Information about E. coli O157:H7 Outbreak Likely Linked to Leafy Greens
January 10, 2018

The U.S. Food and Drug Administration is working with the Centers for Disease Control and Prevention (CDC), and state and local authorities in an investigation of an outbreak of Shiga toxin-producing Escherichia coli (E. coli) O157:H7 illnesses. The FDA has also been in contact with Canadian food safety authorities on this outbreak, since cases were first identified in Canada. disclaimer icon

Whole genome sequencing showed that the U.S. and Canadian E. coli O157:H7 strains are closely related, suggesting a common source of illness. Canadian health officials identified romaine lettuce as the likely source of their outbreak. CDC has been working to determine the source of the outbreak in the U.S., and today announced it believes that this outbreak is likely linked to leafy greens. Health officials have not identified a specific type of leafy greens that sick people ate in common.

The known illnesses in the U.S. had illness onsets in late November and early December. This suggests that suspect leafy greens linked to this outbreak are likely no longer in the food supply.

The FDA’s outbreak investigation team is working with CDC and state and local officials to determine what ill people ate, where they bought it, and the distribution chain -- all with the goal of reaching where these foods were produced, to see if there’s any common food or point where the food might have become contaminated. At this point, we have not identified a common or single point of origin for the food that made people ill. We want to make sure the information we provide is accurate and when we have information that consumers can use – such as any foods to avoid – we will share it immediately.

https://www.cdc.gov/media/releases/2018/s0110-update-ecoli.html
Update: Multistate Outbreak of E. coli O157:H7 Infections
Media Statement

For Immediate Release: Wednesday, January 10, 2018
Contact: Media Relations, (404) 639-3286

On January 10, 2018, the Public Health Agency of Canada reported that an outbreak of Shiga toxin-producing E. coli O157:H7 infections (STEC O157:H7) they had identified was linked to romaine lettuce appears to be over.

In the United States, CDC, several states, and the U.S. Food and Drug Administration continue to investigate a multistate outbreak of 24 STEC O157:H7 infections in 15 states. Since CDC’s initial media statement on December 28, seven more illnesses have been added to this investigation. The last reported illness started on December 12, 2017.

The likely source of the outbreak in the United States appears to be leafy greens, but officials have not specifically identified a type of leafy greens eaten by people who became ill. Leafy greens typically have a short shelf life, and since the last illness started a month ago, it is likely that contaminated leafy greens linked to this outbreak are no longer available for sale. Canada identified romaine lettuce as the source of illnesses there, but the source of the romaine lettuce or where it became contaminated is unknown.

Whole genome sequencing (WGS) showed that the STEC O157:H7 strain from ill people in the United States is closely related genetically to the STEC O157:H7 strain from ill people in Canada. WGS data alone are not sufficient to prove a link; health officials rely on other sources of data, such as interviews from ill people, to support the WGS link. This investigation is ongoing. Because CDC has not identified a specific type of leafy greens linked to the U.S. infections, and because of the short shelf life of leafy greens, CDC is not recommending that U.S. residents avoid any particular food at this time.

Outbreak Summary
In the United States, a total of 24 STEC O157:H7 infections have been reported from California (4), Connecticut (2), Illinois (1), Indiana (2), Maryland (3), Michigan (1), Nebraska (1), New Hampshire (2), New Jersey (1), New York (1), Ohio (1), Pennsylvania (2), Vermont (1), Virginia (1), and Washington (1). Illnesses started on dates from November 15 through December 12, 2017. Among the 18 ill people for whom CDC has information, nine were hospitalized, including one person in California who died. Two people developed hemolytic uremic syndrome, a type of kidney failure.

The Public Health Agency of Canada identified romaine lettuce as the source of the outbreak in Canada. In the United States, the likely source of the outbreak appears to be leafy greens, but health officials have not identified a specific type of leafy greens that sick people ate in common.

State and local public health officials continue to interview sick people in the United States to determine what they ate in the week before their illness started. Of 13 people interviewed, all 13 reported eating leafy greens. Five (56%) of nine ill people specifically reported eating romaine lettuce. This percentage was not significantly higher than results from a survey of healthy people in which 46% reported eating romaine lettuce in the week before they were interviewed. Based on this information, U.S. health officials concluded that ill people in this outbreak were not more likely than healthy people to have eaten romaine lettuce. Ill people also reported eating different types and brands of romaine lettuce. Currently, no common supplier, distributor, or retailer of leafy greens has been identified as a possible source of the outbreak. CDC continues to work with regulatory partners in several states, at the U.S. Food and Drug Administration, and the Canadian Food Inspection Agency to identify the source.

Although the most recent illness started on December 12, there is a delay between when someone gets sick and when the illness is reported to CDC. For STEC O157:H7 infections, this period can be two to three weeks. Holidays can increase this delay. Because of these reporting delays, more time is needed before CDC can say the outbreak in the United Stated is over. This investigation is ongoing.

Advice to Consumers

CDC is not recommending that U.S. residents avoid any particular food given the short shelf life of leafy greens and because a specific type of leafy greens has not been identified.

Symptoms of E. coli Infections

Most people develop diarrhea (often bloody) and stomach cramps. People usually get sick from E. coli O157:H7 three to four days after eating food contaminated with the germ. If you are concerned that you have an E. coli infection, talk to your healthcare provider.

General Recommendations for Preventing E. coli Infections

You can protect yourself by washing your hands thoroughly before and after preparing or eating food. You can also wash counters, cutting boards, and utensils after they touch raw meat to avoid contaminating other foods. It’s also important to avoid preparing food when you are sick, particularly if you are sick with diarrhea.

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