Tracking the E. coli Outbreaks - 3 Current Outbreaks

There are three current E. coli outbreaks that are being tracked by governmental agencies.  They appear to be unrelated. All are E. coli O157:H7, but they have been identified as different strains due to genetic differences. 
(Perhaps it is time to name these outbreaks like the Weather Channel has done with hurricanes and now does with storms.)

1. Salinas Romaine Lettuce

• 102 cases with 58 hospitalizations in 23 states
• Last case - November 18
• Source Romaine lettuce from Salinas CA

2. Salad kits from Fresh Express

• 8 cases with 3 hospitalizations in 3 states
• Last case - November 15
• Source Salad item, possibly Romaine lettuce

3. Washington Evergreen Restaurant

• 13 cases with 3 hospitalizations in one state (WA), Multiple outlets of one restaurant chain
• Last onset case - November 15
• Source not yet known

https://www.fda.gov/food/outbreaks-foodborne-illness/investigation-e-coli-o157h7-outbreak-linked-romaine-salinas-california-november-2019
Investigation of E. coli O157:H7 Outbreak Linked to Romaine from Salinas, California, November 2019
FDA continues to warn against eating romaine from Salinas; farm investigations continue
Updated December 12, 2019
Case Counts

• Total Illnesses: 102
• Hospitalizations: 58
• Deaths: 0
• Last illness onset: November 18, 2019
• States with Cases: AZ (3), CA (4), CO (6), FL (1), IA (1), ID (3), IL (1), MD (4), MI (1), MN (3), MT (1), NE (1), NJ (7), NC (1), NM (2), OH (12), OR (1), PA (8), SD (1), TX (4), VA (4), WA (2), WI (31)

Update
Based on the information indicating that ill people in Maryland were exposed to romaine lettuce harvested in Salinas, California, FDA, with the assistance of staff from the California Department of Public Health and the California Department of Food and Agriculture, immediately deployed investigators to three farms in the Salinas area that were identified based on the traceback investigation.

FDA continues to actively investigate the cause of this outbreak. Additionally, FDA is investigating two other E. coli outbreaks, each caused by strains that are different from each other and different from the larger outbreak. One of the additional outbreaks, in Washington state, is linked to romaine lettuce, and the other outbreak, with cases in the U.S. and Canada, is linked to Fresh Express Sunflower Crisp Chopped Salad Kits. As part of these investigations, FDA and state partners are conducting traceback investigations to trace romaine exposures to the source.

Currently, the tracebacks on all three outbreaks have identified a common grower in Salinas. FDA, CDC, and California partners are deploying a team to conduct new investigations at several ranches used by this grower as we try to identify the source of the contamination.


https://www.fda.gov/food/outbreaks-foodborne-illness/investigation-e-coli-o157h7-outbreak-linked-salad-mix-november-2019
Investigation of E. coli O157:H7 Outbreak Linked to Salad Mix, November 2019
FDA warns against eating Fresh Express brand Sunflower Crisp Chopped Salad Kits
Updated Dec 9, 2019
Case Counts

• Total Illnesses: 8
• Hospitalizations: 3
• Deaths: 0
• Last illness onset: November 15, 2019
• States with Cases: MN (4), ND (1), WI (3)

According to the CDC, as of December 9, 2019, eight people infected with this outbreak strain of E. coli O157:H7 have been reported from three states. The case patients report that illnesses started on dates ranging from November 5, 2019 to November 15, 2019. This outbreak strain found in case patients is different from the outbreak strain of the larger E. coli O157:H7 outbreak linked to romaine from the Salinas, California growing region.

Preliminary information indicates that the romaine lettuce in the salad kits eaten by some sick people may have contained romaine from the Salinas growing region, though the romaine and other ingredients in the kit may have come from another growing region as well.

Authorities are investigating the source of the ingredients in the kits and are trying to determine which ingredient may have been contaminated.

Further information will be provided as the investigation progresses.

https://www.kingcounty.gov/depts/health/communicable-diseases/disease-control/outbreak/evergreens.aspx
Shiga toxin-producing E. coli O157:H7 (STEC) outbreak associated with 6 Evergreens restaurants
Updated December 6, 2019

• Cases: 13
• Hospitalizations: 3
• Deaths: 0
• Status: Investigation is ongoing
• Last onset case - November 15, 2019

Locations:
Evergreens restaurants:
◦Pioneer Square (106 1st Ave S, Seattle)
University District (4609 Village Ter NE, Seattle)
Downtown (823 3rd Ave, Seattle)
Chinatown-International District (504 5th Ave S, Seattle)
Sammamish Highlands (600 228th Ave NE, Sammamish)
Seattle-Tacoma International Airport (17801 International Blvd, Seattle)
•Meal dates: November 5-11, 2019
•Prior food safety inspections and current rating? ◦Pioneer Square: EXCELLENT

• University District: EXCELLENT
• Downtown Seattle (3rd and Marion): EXCELLENT
• Chinatown-International District: EXCELLENT
• Sammamish Highlands: EXCELLENT
• Seattle-Tacoma International Airport: EXCELLENT

Highlights
Updated December 6, 2019
Summary

Public Health is continuing to investigate an outbreak of Shiga toxin-producing E. coli O157:H7 (STEC) potentially associated with six Evergreens restaurants in Seattle. We do not yet have conclusive results about what caused the outbreak.

Genetic testing on isolates from ten of the thirteen cases indicates that the strains are closely related, suggesting a common source. The other three cases were among people who were sick with symptoms suggestive of E. coli infection but never were tested.

Currently available data indicates that these closely related strains among people who ate at Evergreens are different from the strain currently causing a national outbreak of E. coli associated with romaine lettuce grown in Salinas, California.

Illnesses

Since November 20, 2019, we have learned of thirteen people in Washington (12 in King County and one in Snohomish County) who developed symptoms consistent with an E. coli illness after consuming food from six different Evergreens restaurants in King County.

Illness onsets occurred during November 8–15, 2019. Meal dates were during November 5–11, 2019.

Three people were hospitalized. Everyone who reported illness has recovered.

E. coli symptoms include diarrhea (bloody or non-bloody), stomach cramps, and nausea.

Public Health actions
During November 21 to December 4, 2019, Environmental Health investigators visited 5 of the Evergreens locations where the ill people reported eating and are planning to visit the 6th location. During their field inspections, investigators did not observe environmental or behavioral risk factors associated with the spread of E. coli, such as poor handwashing practices or improper time and temperature control of foods. Public Health identified one employee who experienced symptoms consistent with an E. coli infection after eating at Evergreens but who was not tested. There is no evidence indicating the person is the source of the outbreak.

Public Health investigators reviewed with staff at five locations proper sanitizing practices to help prevent the spread of E. coli. In accordance with CDC’s recommendations, Evergreens restaurants discarded all romaine lettuce products from their stores, including romaine on the line and in coolers. During their visits, investigators also reviewed the requirement that restaurant employees are not allowed to work while having vomiting or diarrhea; restaurant management reviewed their sick policy with all employees.

As per our protocol, Public Health investigators have revisited five Evergreens restaurant locations where ill cases reported eating to confirm that these actions were taken. Out of an abundance of caution, Environmental Health investigators plan to visit all Evergreens restaurants (total of 15 locations) in King County in the next two weeks.

This local outbreak could be the result of a contaminated product delivered to and served at Evergreens. Public Health collected samples of various produce samples from two Evergreens locations where the ill people ate. E. coli testing of these food products at Washington State Public Health Laboratory were negative.

Public Health is working with the Washington State Department of Agriculture and United States Food and Drug Administration to trace back the distributors and sources for ingredients consumed by the people who became ill. Trace back is used to identify other points of contamination up the supply chain.

Laboratory testing

Ten of 13 people reporting illness tested positive for E. coli O157:H7. All 10 isolates shared closely related E. coli genetic fingerprints, suggesting that they have a common source of infection. Genetic testing completed on these 10 isolates did not match the genetic fingerprint of the strain currently associated with the national outbreak linked to romaine lettuce. The remaining three people who got sick were not tested for STEC, but their symptoms are suggestive of an E. coli infection.