Friday, May 11, 2018

Case Count of E. coli Infection Continues to Increase in Outbreak Associated with Romaine Lettuce

There are now 149 reported cases of E. coili infection associated with romaine.  Cases were reported from 29 different states.  There have been 64 hospitalizations and one death.

The romaine lettuce is no longer being harvested from the suspected areas of Yuma AZ.  While one farm has been linked to a set of illnesses in Alaska and this through consumption of whole heads, product from this farm does not seem to be linked to the vast majority of cases which were linked to chopped romaine.

https://www.cdc.gov/ecoli/2018/o157h7-04-18/index.html
Multistate Outbreak of E. coli O157:H7 Infections Linked to Romaine Lettuce
Posted May 9, 2018 1:45 PM ESTAt A Glance
  • Case Count: 149 
  • States: 29 
  • Deaths: 1
  • Hospitalizations: 64
  • Recall: No
What's New?
  • Twenty-eight more ill people from 12 states were added to this investigation since the last update on May 2, 2018.
  • Four more states have reported ill people: Florida, Minnesota, North Dakota, and Texas
  • The most recent illness started on April 25, 2018. Illnesses that occurred in the last two to three weeks might not yet be reported because of the time between when a person becomes ill with E. coli and when the illness is reported to CDC.
Highlights
  • Information collected to date indicates that romaine lettuce from the Yuma growing region could be contaminated with E. coli O157:H7 and could make people sick. ◦For the latest information on the investigation into where romaine lettuce was sourced, visit the U.S. Food and Drug Administration (FDA) website.
  • Advice to Consumers: 
    • Do not eat or buy romaine lettuce unless you can confirm it is not from the Yuma growing region. Romaine lettuce has a shelf life of several weeks, and contaminated lettuce could still be in homes, stores, and restaurants.
    • Product labels often do not identify growing regions; so, do not eat or buy romaine lettuce if you do not know where it was grown.
    • This advice includes whole heads and hearts of romaine, chopped romaine, baby romaine, organic romaine, and salads and salad mixes containing romaine lettuce. If you do not know if the lettuce in a salad mix is romaine, do not eat it.
  • Advice to Restaurants and Retailers: 
    • Do not serve or sell any romaine lettuce from the Yuma growing region. This includes whole heads and hearts of romaine, chopped romaine, baby romaine, organic romaine, and salads and salad mixes containing romaine lettuce.
    • Restaurants and retailers should ask their suppliers about the source of their romaine lettuce.
  • Advice to Clinicians:
    • Antibiotics are not recommended for patients with suspected E. coli O157 infections until diagnostic testing can be performed and E. coli O157 infection is ruled out.
    • CDC, public health and regulatory officials in several states, and the FDA are investigating a multistate outbreak of Shiga toxin-producing Escherichia coli O157:H7 (E. coli O157:H7) infections.
    • 149 people infected with the outbreak strain of E. coli O157:H7 have been reported from 29 states. 64 people have been hospitalized, including 17 people who have developed a type of kidney failure called hemolytic uremic syndrome.
    • One death was reported from California.
  • This investigation is ongoing, and CDC will provide updates when more information is available.
https://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm604254.htm
FDA Investigating Multistate Outbreak of E. coli O157:H7 Infections Likely Linked to Romaine Lettuce from Yuma Growing Region
May 9, 2018
The U.S. Food and Drug Administration, along with the Centers for Disease Control and Prevention (CDC) and state and local partners, are investigating a multistate outbreak of E. coli O157:H7 illnesses linked to romaine lettuce from the Yuma growing region.

Update
The FDA has received confirmation from the Arizona Leafy Greens Marketing Agreement administered by the Arizona Department of Agriculture that romaine lettuce is no longer being produced and distributed from the Yuma growing region, reducing the potential for exposure to contaminated product. However, due to the 21-day shelf life, we cannot be certain that romaine lettuce from this region is no longer in the supply chain.

The FDA is continuing to investigate illnesses related to romaine lettuce from the Yuma growing region. We are working to identify multiple distribution channels that can explain the entirety of the nation-wide outbreak and are tracing back from multiple groupings of ill people located in diverse geographic areas.

The FDA has identified one farm as the source of the whole-head romaine lettuce that sickened several people at a correctional facility in Alaska. However, the agency has not determined where in the supply chain the contamination occurred. The agency is examining all possibilities, including that contamination may have occurred at any point along the growing, harvesting, packaging, and distribution chain before reaching the Alaska correctional facility where it was served.

All of the lettuce in question from this farm was harvested during March 5-16 and is past its 21-day shelf life. Because the growing season in the Yuma region is at its end, the farm is not growing any lettuce at this time.

Most of the illnesses in this outbreak are not linked to romaine lettuce from this farm, and are associated with chopped romaine lettuce. The agency is investigating dozens of other fields as potential sources of the chopped romaine lettuce and will share information as it becomes available.

To date, the FDA also has no evidence that other types of lettuce, or romaine lettuce grown outside of the Yuma growing region, are involved in this outbreak.

Fast Facts
The FDA is investigating a multistate outbreak of E. coli O157:H7 illnesses likely linked to romaine lettuce sourced from the winter growing areas in and around the Yuma region.
The CDC reports that 149 people in 29 states have become ill. These people reported becoming ill in the time period of March 13, 2018 to April 25, 2018. There have been 64 hospitalizations and one death.
The FDA has identified Harrison Farms of Yuma, Arizona, as the grower and sole source of the whole-head romaine lettuce that sickened several people in an Alaska correctional facility, but has not determined where in the supply chain the contamination occurred. The agency is examining all possibilities, including that contamination may have occurred at any point along the growing, harvesting, packaging, and distribution chain before reaching the Alaska correctional facility where it was served.
All of the whole head lettuce in question from Harrison Farms was harvested during March 5-16 and is past its 21-day shelf life. Because the growing season in the Yuma region is at its end, the farm is not growing any lettuce at this time.
The remainder of illnesses in this outbreak are not linked to whole head romaine lettuce from Harrison Farms. 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. Traceback does not indicate that Harrison Farms is the source of the chopped romaine that sickened these people. The FDA is continuing to investigate the source of the chopped romaine lettuce that caused these illnesses and has identified dozens of other fields as possible sources.
The FDA recommends that consumers ask grocers, restaurants, and other food service establishments where their romaine lettuce originated, and avoid any romaine lettuce, whether chopped, whole head or hearts, that originated from the Yuma growing region. If you cannot confirm the source of the romaine lettuce, do not buy it or eat it. If you have already purchased romaine lettuce or products containing romaine lettuce and cannot confirm the source, throw them away.
The FDA has received confirmation from the Arizona Leafy Greens Marketing Agreement administered by the Arizona Department of Agriculture that romaine lettuce is no longer being produced and distributed from the Yuma growing region. However, due to the 21-day shelf life, we cannot be certain that romaine lettuce from this region is no longer in the supply chain.
The FDA is continuing to investigate this outbreak and will share more information as it becomes available.
Consumers who have symptoms of STEC infection should contact their health care provider to report their symptoms and receive care. Although many infections resolve in 5-7 days, they can result in serious illness, including a potentially serious condition called hemolytic uremic syndrome.
The current outbreak is not related to a recent multistate outbreak of E. coli O157:H7 infections from November to December 2017 linked to leafy greens consumption. People in the previous outbreak were infected with a different DNA fingerprint of E. coli O157:H7 bacteria.
What is the Problem and What is being Done About It?
The FDA and the CDC, along with state and local health officials, are investigating an outbreak of Shiga toxin-producing E. coli O157:H7 infections.

There are 149 cases in 29 states: Alaska (8), Arizona (8), California (30), Colorado (2), Connecticut (2), Florida (1), Georgia (5), Idaho (11), Illinois (2), Kentucky (1), Louisiana (1), Massachusetts (3), Michigan (4), Minnesota (10), Mississippi (1), Missouri (1), Montana (8), New Jersey (8), New York (4), North Dakota (2), Ohio (3), Pennsylvania (20), South Dakota (1), Tennessee (1), Texas (1), Utah (1), Virginia (1), Washington (7), and Wisconsin (2). 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. coliO157:H7 bacteria.

The most recent information collected by the FDA, in conjunction with federal, state, and local partners, indicates that the romaine lettuce that ill people ate was likely grown or originated from the winter growing areas in or around the Yuma region. This region generally supplies romaine lettuce to the U.S. during November-March each year.

The FDA has identified Harrison Farms as the source of the whole-head romaine lettuce that made several people ill at a correctional facility in Alaska. However, the agency has not determined where in the supply chain the contamination occurred. The FDA is examining all possibilities, including that contamination may have occurred at any point along the growing, harvesting, packaging, and distribution chain before reaching the Alaska correctional facility where it was served.

All of the lettuce in question from Harrison Farms was harvested during March 5-16 and is past its 21-day shelf life. Because the growing season in the Yuma region is at its end, the farm is not growing any lettuce at this time.

The remainder of illnesses in this outbreak are not linked to whole head romaine lettuce from Harrison Farms. The agency is investigating dozens of fields as potential sources of the chopped romaine lettuce.

In a typical traceback effort, CDC and the FDA identify clusters of people who became ill, especially in different geographical regions and work to trace the food eaten by those made ill to a common source. For this outbreak investigation, we have been able to identify romaine lettuce as the common food source, but the available packaging provides very limited information on the source of the products. With limited packaging information, FDA scientists and investigators are working with federal and state partners and companies as quickly as possible to collect, review and analyze hundreds of records in an attempt to traceback the source of the contaminated romaine lettuce. To date, our traceback has revealed that romaine lettuce potentially contaminated with E. coli O157:H7 came from the Yuma growing region, but was supplied to restaurants and retailers through multiple processors, grower/shipper companies, and farms.

When we are executing a full traceback investigation, as we are currently, we are working to identify multiple distribution channels that can explain the entirety of the outbreak. We are tracing back from multiples groupings of ill people located in diverse geographic areas. The reason for this is to find unique distribution channels that converge on a single source or grower. Our investigations are constantly evolving, with new information coming in and we communicate this information as appropriate. The FDA continues to recommend that the public not consume romaine lettuce grown in the Yuma growing region. To date, the available information indicates that romaine lettuce from the Yuma growing region is the source of the current outbreak of E. coli O157:H7 infections.

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