CDC
issues warning of e-coli contamination
Outbreak has already sickened people in Massachusetts and Connecticut
Outbreak has already sickened people in Massachusetts and Connecticut
US
Centers for Disease Control
·
Consumers who have any
type of romaine lettuce in their home should not eat it and should throw it
away, even if some of it was eaten and no one has gotten sick.
o This advice includes all types or uses of
romaine lettuce, such as whole heads of romaine, hearts of romaine, and bags
and boxes of precut lettuce and salad mixes that contain romaine, including
baby romaine, spring mix, and Caesar salad.
o If you do not know if the lettuce is romaine or
whether a salad mix contains romaine, do not eat it and throw it away.
o Wash and sanitize drawers or shelves in
refrigerators where romaine was stored. Follow these five steps to clean your refrigerator.
·
Restaurants and
retailers should not serve or sell any romaine lettuce, including salads and
salad mixes containing romaine.
UPDATE ON OUTBREAK From Dr. Scott Gottlieb of the CDC: The romaine
implicated in the current outbreak is likely from California based on growing
and harvesting patterns. The goal now is to withdraw the product that’s at risk
of being contaminated from the market, and then re-stock the market.
New romaine from different growing regions, including Florida and Arizona,
will soon be harvested. We’re working with growers and distributors on labeling
produce for location and harvest date and possibly other ways of informing
consumers that the product is “post-purge.”
We want to help unaffected growers get back into production and enable
stores and consumers to re-stock. One goal we’re seeking is to make this type
of labeling the new standard rather than a short-term fix; as a way to improve
idenfitifaction and traceability in the system.
·
Take action if you have symptoms
of an E. coli infection:
o Talk to your healthcare provider.
o Write down what you ate in the week before you
started to get sick.
o Report your illness to the health department.
o Assist public health investigators by answering
questions about your illness.
Advice to Clinicians
·
Antibiotics
are not recommended for patients with E. coli O157
infections. Antibiotics are also not recommended for patients in whom E.coli O157
infection is suspected, until diagnostic testing rules out this infection.
·
Some studies have shown
that administering antibiotics to patients with E. coli O157
infections might increase their risk of developing hemolytic uremic syndrome (a
type of kidney failure), and the benefit of antibiotic treatment has not been
clearly demonstrated.
Latest Outbreak Information
At A Glance
·
Reported Cases: 32
·
States: 11
·
Hospitalizations: 13
·
Deaths: 0
·
Recall: No
·
Thirty-two people
infected with the outbreak strain of Shiga toxin-producing E. coliO157:H7
have been reported from 11 states.
o Illnesses started on dates ranging from October
8, 2018 to October 31, 2018.
o Thirteen people were hospitalized, including one
person who developed hemolytic uremic syndrome, a type of kidney failure. No
deaths have been reported.
·
The Public Health Agency of Canada has
identified 18 ill people infected with the same DNA fingerprint of E.
coli O157:H7 bacteria in two Canadian provinces: Ontario and Quebec.
·
Epidemiologic evidence from the United
States and Canada indicates that romaine lettuce is a likely source of the
outbreak.
·
Ill people in this
outbreak were infected with E. coli bacteria with the same DNA
fingerprint as the E. coli strain isolated from ill people in
a 2017 outbreak linked to leafy greens in the United States and
to romaine lettuce in Canada.
The current outbreak is not related to a recent multistate outbreak of E.
coli O157:H7 infections linked to romaine lettuce.
·
CDC is advising that
consumers do not eat any romaine lettuce because no common grower, supplier,
distributor, or brand of romaine lettuce has been identified.
·
This investigation is
ongoing, and CDC will provide more information as it becomes available.
Symptoms of E. coli Infection
· People usually get sick
from Shiga toxin-producing E. coli (STEC) 2–8 days (average of
3–4 days) after swallowing the germ.
·
Some people with a STEC
infection 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
November 20, 2018
CDC, public health and regulatory officials in several states,
Canada, and the FDA are investigating a multistate outbreak of Shiga
toxin-producing Escherichia coli O157:H7 (E. coli O157:H7)
infections.
Public health investigators are using the PulseNet system
to identify illnesses that may be part of this outbreak. PulseNet is the
national subtyping network of public health and food regulatory agency
laboratories coordinated by CDC. DNA fingerprinting is performed on E.
coli bacteria isolated from ill people by using techniques
called pulsed-field gel electrophoresis (PFGE)
and whole genome sequencing (WGS).
CDC
PulseNet manages a national database of these DNA fingerprints to identify
possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE. WGS
performed on E. coli bacteria from ill people in this outbreak
showed that the strains were closely related genetically. This means that the
ill people were more likely to share a common source of infection.
As of November 20, 2018, 32 people infected with the outbreak
strain of E. coli O157:H7 have been reported from 11 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 October 8, 2018 to October 31, 2018. Ill
people range in age from 7 to 84 years, with a median age of 24. Sixty-six
percent of ill people are female. Of 26 people with information available, 13
(50%) were hospitalized, including one person who developed hemolytic uremic
syndrome, a type of kidney failure. No deaths have been reported.
Illnesses that occurred after October 30, 2018, might not yet be
reported due to the time it takes between when a person becomes ill with E.
coliinfection and when the illness is reported. This takes an average
of two to three weeks.
Investigation of the Outbreak
Epidemiologic evidence indicates that
romaine lettuce is a likely source of this outbreak.
In interviews, ill people answered questions about the foods they ate and other exposures in
the week before they became ill. Eleven (79%) of 14 people interviewed reported
eating romaine lettuce. This percentage is significantly higher than results
from a survey[PDF – 787 KB] of healthy people in which
47% reported eating romaine lettuce in the week before they were interviewed.
Ill people reported eating different types of romaine lettuce in several
restaurants and at home.
Whole genome sequencing (WGS) results showed that the E.
coli O157:H7 strain isolated from ill people in this outbreak is
closely related genetically to the E. coli strain isolated
from ill people in a 2017 outbreak linked to leafy greens in the United States and
to romaine lettuce in Canada.
The current outbreak is not related to a recent multistate outbreak of E.
coli O157:H7 infections linked to romaine lettuce. People in the spring outbreak
were infected with E. coli O157:H7 bacteria with a different
DNA fingerprint.
FDA and states are working to trace back romaine lettuce that ill
people ate in the current outbreak. At this time, no common grower, supplier,
distributor, or brand of romaine lettuce has been identified. CDC is advising
that consumers not eat any romaine lettuce, and restaurants and retailers not
sell any, until we learn more about this outbreak and the source of the contaminated
lettuce.
This investigation is ongoing, and CDC will provide more
information as it becomes available.