Multi-State E. Coli Outbreak from Romaine Lettuce

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Multi-State E. Coli Outbreak from Romaine Lettuce

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Multi-State E. Coli Outbreak from Romaine Lettuce

The CDC and FDA are investigating an outbreak of Shiga toxin-producing E. Coli O157:H7 that started with New Jersey local and state public health authorities reporting cases, but has now rapidly expanded to 11 states sharing 35 cases (click on link for details) https://www.cdc.gov/ecoli/2018/o157h7-04-18/map.html.  On April 10, the first notice from the CDC announced the outbreak with 17 people infected in 7 states; so, in 3 days, the cases doubled.

Talking to the sick patients have led the CDC and FDA to believe that the contaminated food is pre-chopped romaine lettuce (not whole or hearts of lettuce), since of the 28 infected people they have interviewed so far, 26 of them (93%) reported eating chopped romaine lettuce a week before getting sick.  Although they have not been able to identify a specific farm(s) or brand name(s), they do believe that it is probably from the Yuma, Arizona growing area; many report eating the lettuce at a restaurant.  The first illnesses were reported on March 22 and, at least so far, the latest on March 31.  More cases are expected to be reported since there is a lag between when the illness starts and reporting.

E. Coli is a bacterium and this strain is known for making people ill, including a complication of hemolytic uremic syndrome (HUS), a life-threatening threat to the kidneys. So, far, 22 patients have been hospitalized, including 3 with HUS. Although E. Coli O157:H7 was also responsible for a leafy green/romaine lettuce outbreak in the US and Canada in November and December, that one had a different DNA profile than the current one.  The outbreaks are unrelated.

The incubation period (time from exposure to the E. Coli to symptom onset) is from 2-8 days, most typically from 3-4.  The most common symptoms include stomach cramps, diarrhea (which may be bloody), and vomiting; there may also be a fever.  Illness usually lasts about a week.  About 5-10% of those infected develop HUS, with symptoms of fever, abdominal pain, fatigue, decreased urination both in frequency and amount, paleness, unexplained small bruises or bleeding from the mouth or nose.  Severe disease and/or HUS is more common in those under 5 years old or over 65, and in those with compromised immune systems, but anyone at any age can get sick.  Permanent kidney damage and deaths can occur.

Anyone who feels that they may have E. Coli infection should contact their health care provider; those with more severe symptoms should go to an emergency department for evaluation.

For Consumers:  The CDC recommends that anyone who bought chopped romaine lettuce ANYWHERE in the US, including in salads and leafy green mixes, not eat it and throw it away (even in no one has gotten sick).  Before buying it at a store or eating it in a restaurant, ask where it came from and do not buy/eat, if it came from around Yuma, AZ.  If the origin cannot be determined for sure, do not buy/eat it.

Note:  See recent outbreak information on Salmonella located in the Outbreaks/Emerging Diseases Section for specific recommendations for managing patients with possible E. Coli infection.  

For more info, including updates from the CDC:  https://www.cdc.gov/ecoli/2018/o157h7-04-18/index.html

Info from the FDA: https://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm604254.htm

Download the Full Update, and Read EMS Specific Recommendations

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