The Illinois Department of Public Health (IDPH), along with the Centers for Disease Control and Prevention, the Food and Drug Administration, and other state and local health departments, is investigating a recent cluster of Salmonella ser. Montevideo infections.  Two cases have been identified in Illinois residents.  People in Illinois reported becoming ill on December 20 and 26, 2017.  Based on a review of produce, suppliers, and items consumed, investigators believe the most likely source of the infection is sprouts from multiple Jimmy John’s locations.

To reduce the risk to additional customers, IDPH has requested that all Jimmy John’s restaurants in Illinois remove sprouts from their menus until the investigation is complete.  IDPH is also reminding restaurants not to let food handlers with diarrhea work.  If you have developed symptoms of Salmonella infection after eating food at a Jimmy John’s restaurant please contact your health care provider or local health department.

Symptoms of Salmonella may include headache, muscle aches, diarrhea, vomiting, abdominal cramping, chills, fever, nausea, and dehydration.  Symptoms usually appear 6 to 72 hours after ingesting the bacteria, but can be longer.  Most illnesses resolve on their own and do not require treatment other than drinking fluids to stay hydrated.  If your symptoms persist or are severe, promptly contact your health care provider.

Salmonella bacteria live in the intestinal tracts of humans and other animals.  Almost any food can be contaminated with Salmonella.  Person-to-person transmission of Salmonella occurs when an infected person’s feces, from his or her unwashed hands, contaminates food during preparation, or comes into direct contact with another person.

2014 Outbreak of E. coli O121 Linked to Raw Clover Sprouts from Evergreen Fresh Sprouts

On May 21, 2014 an outbreak of E. coli O121 linked to consumption of clover sprouts was announced by health officials in Washington and Idaho. On August 1, 2014 the CDC declared the outbreak over. In total 19 patients had been confirmed with E. coli…Read More »

2013 E. coli O157:H7 outbreak at Denver area Jimmy John’s Restaurants

Public health officials investigated an outbreak of E. coli O157:H7 that occurred among customers of three Denver area Jimmy John’s restaurants. A total of 8 people became sick. Meal dates ranged between October 5 and October…Read More »

Jimmy John’s Restaurants Raw Clover Sprouts 2011

On February 15, 2012, the Centers for Disease Control first announced an ongoing investigation into illnesses linked to the consumption of raw clover sprouts consumed at Jimmy John’s Restaurants in several states. The illnesses were caused by E. co…Read More »

Sprouters Northwest/Jimmy John’s Restaurants Clover Sprouts 2010

Sprouters Northwest of Kent, Washington, issued a product recall after the company’s clover sprouts had been implicated in an outbreak of Salmonella Newport in Oregon and Washington. At least some of the cases had consumed clover sprouts while at a …Read More »

Multistate Outbreak, Tiny Greens Organic Farm, Jimmy John’s Restaurants Alfalfa Sprouts 2010

On December 17, the Illinois Department of Health announced that an investigation was underway into an outbreak of Salmonella, serotype I4,[5],12:i:-. Many of the Illinois cases had eaten alfalfa sprouts at various Jimmy John’s restaurants in the …Read More »

Jimmy John’s Restaurant Alfalfa Sprouts and Iceberg Lettuce 2008

Several University of Colorado students from one sorority became ill with symptoms of bloody diarrhea and cramping. Additional illnesses were reported. E.coli O157:NM(H-) was determined to be the cause. Consumption of alfalfa sprouts at the Jimmy …Read More »

Jimmy John’s today announced it has directed all locations chain-wide to temporarily stop serving sprouts as a precautionary measure while it investigates seven consumer complaints in Illinois and Wisconsin.

Jimmy John’s made the decision after an investigation in the last 24-hours indicated that sprouts purchased from two growers in Minnesota, originating from two common seed sub-lots, could be linked to seven food safety complaints received over a one-week period in December in Illinois and Wisconsin.

“Food safety and the welfare of our customers are our top priorities and not negotiable in our business,” said James North, President and CEO. “We have been working closely with the Departments of Health in Illinois and Wisconsin, as well as their federal counterparts, as they investigate the claims. While the results of the investigation are not conclusive and we are still gathering more information, we have voluntarily directed all franchisees to remove sprouts as a precautionary measure from all supply and distribution.”

North added, “Customers can have complete confidence that all of our ingredients are of the quality they have come to know and expect from our brand.”

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Salmonella infections.

As of January 12, 2018, 25 people infected with the outbreak strains of Salmonella I 4,[5],12:b:- (24 people) or Salmonella Newport (1 person) have been reported from 9 states – California, Colorado, Connecticut, Massachusetts, New Jersey, New York, Oklahoma, Pennsylvania, and Washington. One more ill person infected with the outbreak strain of Salmonella I 4,[5],12:b:- has been reported from Canada.

Illnesses started on dates ranging from May 11, 2017 to November 4, 2017. Ill people range in age from 1 year to 82, with a median age of 19. Among ill people, 19 (76%) are male. Six people (24%) report being hospitalized. No deaths have been reported.
Epidemiologic, laboratory, and traceback evidence indicates that Coconut Tree Brand frozen Shredded Coconut is the likely source of this multistate outbreak. This investigation is ongoing.

Throughout the outbreak investigation, state and local health officials have collected different food items from restaurants where ill people consumed Asian-style dessert drinks. In November 2017, laboratory testing of a sample from coconut milk made in one restaurant in New York did not identify the outbreak strain of Salmonella I 4,[5],12:b:-, but did identify a strain of Salmonella Newport. This sample was from coconut milk made with Coconut Tree Brand frozen Shredded Coconut, as well as other ingredients. WGS showed that the Salmonella Newport isolated from the coconut milk was closely related genetically to a Salmonella Newport isolate from an ill person from Massachusetts who had consumed an Asian-style dessert drink.

In December 2017, officials in Massachusetts collected food items from a restaurant where that ill person had consumed Asian-style dessert drinks. One sample from frozen shredded coconut identified a strain of Salmonella that was new to the PulseNet database and has not been linked to any illnesses. This sample was from an unopened package of Coconut Tree Brand Frozen Shredded Coconut. As a result, on January 3, 2018, Evershing International Trading Company recalled all Coconut Tree Brand Frozen Shredded Coconut. The recalled product was packaged in 16-ounce plastic bags.

Officials in Massachusetts returned to the restaurant and collected more Coconut Tree Brand frozen Shredded Coconut in January 2018. On January 12, laboratory testing confirmed that samples from that frozen shredded coconut identified the outbreak strain of Salmonella I 4,[5],12:b:-. Laboratory testing of other samples identified several types of Salmonella bacteria, including Salmonella Javiana, Salmonella Rissen, and Salmonella Thompson. These samples were from unopened packages of Coconut Tree Brand Frozen Shredded Coconut sold before January 3, 2018. CDC is reviewing the PulseNet database to determine if the other Salmonella isolates from the frozen shredded coconut are linked to any illnesses.

The frozen shredded coconut linked to this outbreak was used as an ingredient in Asian-style dessert drinks served at restaurants. The product was also sold in grocery stores and markets in several states. Frozen shredded coconut can last for several months if kept frozen and may still be in retail stores or in people’s homes. CDC recommends that retailers not sell, restaurants not serve, and consumers not eat recalled Coconut Tree Brand frozen Shredded Coconut.

SONY DSC

Tony Turnbull of the Times dropped this headscratcher on us the morning: “Cooking with your Mouth:  Why using a knife for chopping your carrots is so last year.” Like the story of drinking – very expensive – “raw water,” eating food that has been prepared in someone elses mouth sounds a bit more likely coming from the Onion, than the more conventional media.  And, as he pointed out deeper in the story, the video of the “cook” was in fact a spoof.

But in case you are wondering why it might have been a bad idea in any event, here is a bit on what can come from ones mouth to yours:

Infectious diseases can be spread through saliva or shared foods and drinks. When a person accidentally consumes microbe-contaminated items, such as saliva, the swallowing action of the tongue wipes the microbes against the back of the throat, allowing the microbe to enter the body. Infections, such as mononucleosis, caused by Epstein-Barr virus and cytomegalovirus are examples of infections spread via oral transmission from virus-containing saliva. Other infectious microbes that spread through saliva do so by sticking to the inner surface of the cheeks and mouth, the tongue, or teeth. An example is the bacterium Streptococcus, which can cause an array of infections, including gum disease strep throat. As a result, microbes that are found in the saliva can generally be found in other parts of the respiratory tract, including the nose and throat. Therefore, even colds and flu (and other respiratory infections) can potentially be spread through the saliva. Certain other infections causing ulcerations in the mouth can also be spread through saliva, such as cold sores (herpes virus) and hand, foot and mouth disease.

The South African National Institute of Communicable Diseases (NICD) revealed on Friday that the death toll has risen from 61 to 67‚ and still the source of the outbreak — said to be the worst on record in world history — remains unknown.

About 40% of those who have died were babies less than four weeks old‚ pregnant woman being 20 times more likely to contract listeriosis from eating food contaminated with the listeria pathogen than other healthy adults.

The NICD reported that “final data” was only available for 21% of the 748 confirmed cases of listeriosis‚ of which 42% had died; the average mortality rate is between 20% and 25%.

Those with confirmed listeriosis were patients in state and private hospitals — roughly two thirds in state hospitals (65%) and a third (35%) in private hospitals.

The NICD has warned that because of “recent challenges” in state laboratory information system data since mid-November “and a possible lag in reporting as a result of the public holidays”‚ case numbers for the last six weeks of 2017 were likely to change on a daily basis “and trends must be interpreted with caution”.

Via genome sequencing, the NICD has established that, in most cases‚ the listeria came from a single source‚ thought to be a particular product or range of products. Pretoria-based microbiologist and food safety expert Dr Lucia Anelich said the “culprit” was most likely a product eaten by consumers across the country and “extremely often”.

Listeriosis symptoms develop any time between two and 30 days after eating food contaminated with the listeria pathogen. In pregnant women, they include mild, flu-like symptoms‚ headaches‚ muscle aches‚ fever‚ nausea and vomiting‚ and if the infection spreads to the nervous system it can cause a stiff neck‚ disorientation or convulsions.

High on the list of foods known to have caused other listeriosis outbreaks are ready-to-eat foods that consumers don’t cook or heat before eating‚ primarily deli meats — such as slices of ham‚ polony and cooked chicken.

“Deli meats are obviously consumed by a wide variety of people in the population‚ whether it’s a cheaper cut or a more expensive one‚” Anelich said. “But other products might also be just as implicated‚ and it’s really difficult to point a finger in a specific direction‚ considering we have absolutely no other leads at this stage.”

The program includes three days of sessions facilitated by Frank Yiannas, Vice President of Food Safety & Health, Walmart, USA and Adjunct Professor in the Online Master of Science in Food Safety Program at MSU.The program also includes guest lectures by William “Bill” Marler, Managing Partner, Marler Clark LLP PS, and The Robert Leader Endowed Lecture with Guest Lecturer Dr. Patricia Griffin, Chief of the US Centers for Disease Control and Prevention’s (CDC) Enteric Diseases Epidemiology Branch.

Frank Yiannas  Patricia Griffin, CDC  Bill Marler

The program will be conducted at the James B. Henry Center for Executive Development at Michigan State University. Evening activities include a welcome reception at the University Club of MSU on Tuesday, May 22; dinner and a tour of the internationally celebrated Eli and Edythe Broad Art Museum on Wednesday, May 23 and a “tailgate” dinner at the Huntington Club at Spartan Stadium on Thursday, May 24.

Yiannas is the author of Food Safety Culture – Creating a Behavior-based Food Safety Management System and Food Safety = Behavior (30 Proven Techniques to Enhance Employee Compliance). He is also Vice–Chair of the Global Food Safety Initiative (GFSI) and past President of the International Association for Food Protection.

NOTE: Cancellations are subject to a $100.00 administrative fee. No refunds will be granted after May 1, 2018. Send cancellation requests in writing to Esther Haviland at estherh@msu.edu.

According to the Pierce County Department of Health, the week started with 41 reports of ill diners, which led to the closure of El Toro in Tacoma’s Westgate neighborhood Monday. By Wednesday, reports of ill customers had extended to its sister restaurant in University Place and that location also closed for sanitizing.

So far, about 10-15 people have reported illness after dining at the University Place location at 3820 Bridgeport Way W. The Tacoma location had 391 reports as of Thursday at its Westgate location at 5716 N. 26th St.

Diners who became ill reported they dined at the University Place location Jan. 6. At the Westgate location, diners became ill after visiting the restaurant between Dec. 31 and Jan. 8.

There might be more: The health department still is investigating reports. The numbers could increase.

“We don’t yet have an exact number because we have not interviewed all the people who have made illness reports. We continue to receive additional illness reports,” the health department said in a statement.

“We know two staff members at the Tacoma location worked while ill during the time customers there dined and later got sick. It’s still unclear if the outbreaks at the two locations are connected,” the health department reported. “Because of the nature of norovirus outbreaks, we may never know the exact affected items that caused illness. We know all the cases have dining at the El Toro Restaurants in common.”

If you ate at an El Toro and became ill, contact the health department to file a report at 253-798-4712. Email food@tpchd.org or make an online report at tpchd.org/reportfoodborneillness.

Vomiting, diarrhea and generally feeling horrible. Also, some patients will experience a fever and headache. If you’re struck with norovirus, staying hydrated is important. The illness usually lasts one to three days. Symptoms after an infection can appear between 12 to 48 hours later.

E. coli bacteria

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.

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.

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. As of January 10, 2018, there were 42 cases of E. coli O157 illness reported in five eastern provinces: Ontario (8), Quebec (15), New Brunswick (5), Nova Scotia (1), and Newfoundland and Labrador (13). Individuals became sick in November and early December 2017. Seventeen individuals were hospitalized. One individual died. Individuals who became ill were between the ages of 3 and 85 years of age. The majority of cases (74%) were female. It urged the public to avoid eating romaine lettuce until more is known about the contamination.

Clearly, tweeting is not just happening in the Oval Office.

Granted, assuming that the E. coli O157:H7 illnesses stopped in early December – CDC and Canadian health authorities have not yet updated the toll – 58 sick with two dead – and, given that romaine lettuce is a perishable product, Dr. Gottlieb may well be correct.  However, since there has been no report where the romaine was grown or processed, we do not really know where the contamination occurred and if subsequent lots of romaine (or other products) are at risk.

I’ll stick with the old CDC adage: “When in doubt, throw it out.”

Reuters reported today that the death toll from an outbreak of Listeria in South Africa has jumped to 61 in the past month from 36 in December.  In addition, the total numbers rose from 557 to 720.

The Department of Health said it had closed a poultry abattoir operated by Sovereign Foods in the capital Pretoria after detecting listeria there, and had banned the facility from preparing food in December.

The department said it did not yet know whether this abattoir was the source of the outbreak, which the NICD said was still unknown.

The department said it did not yet know whether this abattoir was the source of the outbreak, which the NICD said was still unknown.

Listeria food poisoning is a bacterial infection that can be treated with antibiotics if diagnosed in time. The bacteria can be found in animal products including cold cut meats, poultry and unpasteurised milk, as well as fresh fruits and vegetables.

The disease can cause flu-like symptoms and diarrhea, and in more severe cases spread from the intestine to the blood, causing bloodstream infections, or to the central nervous system, causing meningitis.

The Listeria strain known as ST6 had been identified in nine out of 10 of the South African cases. That should make tracing the source easier, “because now we know that it probably originates from one processing facility”.

The CDC, several states, and the FDA are investigating a multistate outbreak of Shiga toxin-producing E. coli O157:H7 infections in 13 states. Seventeen illnesses have been reported from California (3), Connecticut (2), Illinois (1), Indiana (1), Michigan (1), Nebraska (1), New Hampshire (2), New York (1), Ohio (1), Pennsylvania (1), Virginia (1), Vermont (1) and Washington (1). Illnesses started on dates from November 15 through December 8, 2017. Two individuals developed HUS and there has been one death in California.

On December 28, the CDC announced that because the CDC has not identified a source of the infections, CDC is unable to recommend whether U.S. residents should avoid a particular food. This investigation is ongoing, and more information will be released as it becomes available.

In Canada, the Public Health Agency of Canada has identified romaine lettuce as the source of the outbreak in Canada. Currently, there are 41 cases of E. coli O157 illness under investigation in five eastern provinces: Ontario (8), Quebec (14), New Brunswick (5), Nova Scotia (1), and Newfoundland and Labrador (13). Individuals became sick in November and early December 2017. Seventeen individuals have been hospitalized. One individual has died. Individuals who became ill are between the ages of 3 and 85 years of age. The majority of cases (73%) are female.

On December 28, the Public Health Agency of Canada announced that because of the ongoing risk in eastern Canada, the Public Health Agency of Canada is advising individuals in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador to consider consuming other types of lettuce, instead of romaine lettuce, until more is known about the outbreak and the cause of contamination.

On January 3, 2018, Food safety experts at Consumer Reports are advising that consumers stop eating romaine lettuce until the cause of the outbreak is identified and that product is removed from store shelves.

I certainly understand that many romaine lettuce growers would like the CDC to call the “outbreak over” because the last onset of illness – thus far in the US – was December 8, and given that lettuce is a perishable product, it is not likely the product is still in stores or restaurants.  Generally, I would agree with that, however, because neither Canada or the US has been able to confirm where the contamination occurred – on farm, in processing, in transit – I think I agree with the Canadian and Consumer Reports approach – “When in doubt, throw it out.”

There have been several romaine lettuce related E. coli outbreaks in both Canada and the United Sates in the past decades.

In April 2012, an outbreak of E. coli O157 which sickened 28 was linked to romaine lettuce grown and distributed by Amazing Coachella Inc., which is the parent company of Peter Rabbit Farms, both based in Coachella, California. Health officials in New Brunswick, Canada identified at least 24 people with bloody diarrhea beginning on April 23, 2012. Ill persons lived in the communities of Miramichi, St. John and Bathurst. Most of the patient’s laboratory confirmed with E. coli O157:H7 ate at Jungle Jim’s Restaurant in Miramichi. Food samples collected at Jungle Jim’s were negative for E. coli O157:H7. On June 29, 2012, the Government of New Brunswick issued a press release saying that a case control study involving 18 ill persons and 37 non-ill persons linked illness to consumption of romaine lettuce. The strain found in ill persons in this outbreak was also isolated in persons in Quebec and in at least 9 people California. Most of the California victims ate at a “single unnamed restaurant” according to California public health officials.

In October 2011, an outbreak of E. coli O157:H7 which sickened 58, was first identified in the region around Saint Louis, Missouri. Cases were found in Saint Louis, Jefferson, Saint Charles, and Saint Clair counties and in the city of Saint Louis. The cases ranged in age from 1 to 94. At least six persons were hospitalized. Many of the cases had eaten items from salad bars prior to becoming ill. On October 28, Illinois state health officials revealed that they were investigating an illness that might be linked to the outbreak in Missouri. The link was not described. On October 31, health department officials acknowledged that Schnucks salad bars were a focus of the investigation, however other sources had not been excluded. Cases were identified in Minnesota and Missouri that were linked to college campuses. Additional cases were found in other states; the exposure location in these states was not described. Traceback analysis determined that a common lot of romaine lettuce, from a single farm, was used to supply the Schnucks’ grocery stores and the college campuses. The lettuce was sold to Vaughn Foods, a distributor, that supplied lettuce to the university campus in Missouri, but records were not sufficient to confirm that this lot was sent to this university campus. Preliminary findings of investigation at farm did not identify the source of the contamination.

In May 2010, Cases of a genetically-identical strain of E. coli O145 which sickened 33 were identified in the states of Michigan, Ohio, Tennessee, Pennsylvania, and New York. Illness onsets occurred between April 10 and 26. Several of the cases were students at Ohio State University, the University of Michigan, and Daemen College (Buffalo, New York). Several of the ill in Ann Arbor, Michigan, had eaten at a common restaurant. At least four students in the Wappinger Central School District, in New York State, were also involved in the outbreak. Shredded lettuce served in the school district tested positive for E. coli bacteria. Romaine lettuce was named as the vehicle for this outbreak, on May 6, after the same strain of E. coli O145 was found in a Freshway Foods romaine lettuce sample in New York state. Freshway Foods issued a voluntary recall of various bagged lettuces. The traceback investigation suggested that the source of the lettuce was a farm in Yuma, Arizona. In Ohio, a second, independent strain, of pathogenic E. coli was isolated from Freshway Foods bagged, shredded, romaine lettuce, E. coli O143:H34. This strain was not linked to any known food-borne illness. The isolation of the second strain of E. coli led to an additional recall of lettuce. Andrew Smith Company, of California, launched a recall of lettuce sold to Vaughan Foods and to an unidentified third firm in Massachusetts. Vaughan Foods of Moore, Oklahoma, received romaine lettuce harvested from the same farm in Yuma, Arizona; the romaine lettuce had been distributed to restaurants and food service facilities.

In September, 2009, a cluster of 29 patients who had been infected with an indistinguishable strain of E. coli O157:H7 was identified. Initially case-patients were identified in Colorado, Utah, and New York State. Additional case-patients were identified subsequently in South Dakota, Wisconsin, and North Carolina. The Colorado case-patients had all eaten at the same Chipotle Restaurant in Boulder, Colorado, on September 4, 2009. In Utah, all case-patients had eaten at the Cafe Rio Restaurant located in Salt Lake City, Utah, between August 31 and September 4, 2009. The New York State case patient had eaten at a Chipotle Restaurant. A case control study involving Utah and Colorado case-patients was conducted; it showed that eating romaine, or iceberg, lettuce was associated with risk of illness. The New York State case-patient had eaten romaine lettuce at the Chipotle Restaurant. A traceback of the romaine lettuce led to a common harvester/shipper, Church Brothers, LLC, located in Salinas, California. No lettuce remained for testing and environmental samples collected at Church Brothers, LLC, did not show the presence of E. coli O157:H7. Investigation of the cases in South Dakota, Wisconsin, and North Carolina did not provide useful information for the trace-back investigation. Lettuce was the most likely vehicle for this outbreak because of the common lettuce source for the cases in Utah, Colorado, and New York State. These cases represented 16 out of the 19 confirmed cases. Although Cotija cheese, pinto beans, and pico de gallo consumption were also associated with illness, it was likely that these results reflected confounding as lettuce is usually served with these ingredients in Mexican style restaurants. Cotija cheese was not used in the Colorado and New York Chipotle Restaurants. A common source of cilantro, the most suspect ingredient in pico de gallo, was not identified for Cafe Rio or for the Chipotle Restaurants.

In September 2009, public health officials in Colorado, Minnesota, North Carolina, Iowa, Connecticut, and Missouri identified a cluster of 10 patients with an indistinguishable strain of E. coli O157. The cluster was assigned 0910MLEXH-1. Two Colorado cases ate at Giacomos, a restaurant located in Pueblo, Colorado on the same date, September 6. Cases in Minnesota and Iowa ate at the same restaurant in Omaha, Nebraska. The suspected source of the outbreak was romaine lettuce.

In October 2008, an outbreak of E. coli O157:H7 which sickened 12 was associated with eating at M.T. Bellies Restaurant, Welland, Ontario, Canada. This was one of four, concurrent, restaurant-associated, outbreaks of E. coli O157:H7 that occurred in Ontario, Canada. Romaine lettuce was the suspected outbreak vehicle in this outbreak.

In October 2008, Johnathan’s Family Restaurant in Burlington, Ontario, Canada, was implicated in an outbreak of E. coli O157:H7 which sickened 43 involving romaine lettuce. This outbreak was one of four, concurrent, restaurant-associated outbreaks in Ontario, Canada. The E. coli O157:H7 strain was said to be different from the strain of E. coli O157:H7 outbreak associated with the Harvey’s Restaurant (235 sick) in North Bay, Ontario, the largest of the four outbreaks. The E. coli O157:H7 strain from Johnathan’s was said to be the same as the strain implicated in the restaurant outbreaks occurring at Little Red Rooster (21 sick) and M.T. Bellies Restaurants (12 sick).

In September 2005, genetic fingerprinting test results for an E. coli O157:H7 isolate were posted by the state of Minnesota on the national PulseNet website. Later the state of Minnesota received additional reports of illness among persons who were found to carry the same strain of E. coli O157:H7 bacteria. Epidemiologists, through food histories and a case control study, identified pre-packaged, bag lettuce, produced by the Dole Food Company, Inc., as the likely vehicle of transmission. E. coli O157:H7 was subsequently found in bagged lettuce samples and a public health alert and a FDA recall about the product was issued. Oregon and Wisconsin also found case-patients who had eaten the lettuce. The total number of sickened was 32.

In July 2002, an outbreak of E. coli O157:H7 which sickened 78 occurred among attendees of a dance camp held between July 11-14 on the campus of Eastern Washington University. The camp was for middle and high school girls. Attendees were from Washington, Montana, and Minnesota. Some of the ill girls attended a church camp in Spokane at the conclusion of the dance camp. Secondary cases were subsequently reported at the church camp and also in the girls’ home communities. The cases shared a Pulsed Field Gel Electrophoresis (PFGE), genetic fingerprint, pattern. Case-control study results strongly showed that the Caesar salad, made with Romaine lettuce and served during the July 11 dinner meal and the July 12 lunch, was associated with illness.