Since the previous update on November 26, an additional 35 ill people have been reported. As of December 2, 2019, a total of 102 people infected with the outbreak strain of E. coli O157:H7 have been reported from 23 states. 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).

Illnesses started on dates ranging from September 24, 2019, to November 18, 2019. Ill people range in age from less than 1 to 89 years, with a median age of 25. Sixty-five percent of ill people are female. Of 98 ill people with information available, 58 hospitalizations have been reported, including 10 people who developed hemolytic uremic syndrome (HUS), a type of kidney failure. No deaths have been reported.

Epidemiologic, laboratory, and traceback evidence indicate that romaine lettuce from the Salinas, California, growing region is the likely source of this outbreak.

FDA and states continue to trace the source of the romaine lettuce eaten by ill people. Preliminary information indicates that some of the ill people ate lettuce grown in Salinas, California. No common grower, supplier, distributor, or brand of romaine lettuce has been identified.

CDC continues to advise that consumers not eat and retailers not sell any romaine lettuce grown in Salinas, California. The investigation is ongoing to determine the source of contamination and if additional products are linked to illness.

This outbreak is caused by the same strain of E. coli O157:H7 that caused outbreaks linked to leafy greens in 2017 and to romaine lettuce in 2018.

We need to take a hard look at the safety of romaine and what we can do to make is safe.

At this time, there is no outbreak of E. coli occurring in Canada. There is one Canadian illness related to the U.S. outbreak that has been identified in the province of Manitoba. This individual became ill in mid-October.

A bit of recent problems with romaine:

 2019

23 people sickened and 11 hospitalized. The FDA, CDC, along with state and local partners, investigated the illnesses associated with the outbreak. A total of 23 people infected with the outbreak strain of E. coli O157:H7 were reported from 12 states: Arizona, California, Florida, Georgia, Illinois, Maryland, North Carolina, Nevada, New York, Oregon, Pennsylvania  and South Carolina. Eleven people were hospitalized, and no deaths were reported. Illnesses started on dates ranging from July 12, 2019 to Sept. 8, 2019. No illnesses were reported after CDC began investigating the outbreak on Sept. 17, 2019.

2018

218 people sickened, 96 hospitalized, 27 with HUS and 5 deaths. 210 people infected with the outbreak strain were reported from 36 states. 96 people were hospitalized, including 27 people who developed a type of kidney failure called hemolytic uremic syndrome. 5 deaths were reported from Arkansas, California, Minnesota, and New York. In total, there were eight Canadian cases of E. coli O157 that were genetically similar to the U.S. outbreak linked to romaine lettuce coming from the Yuma growing region in the U.S. The eight Canadian illnesses were reported in five provinces: British Columbia, Alberta, Saskatchewan, Ontario, and Quebec. Individuals became sick between March and April 2018. One of the Canadian cases was hospitalized, and no deaths were reported in Canada. Individuals who became ill were between 11 and 76 years of age. The majority of cases (75%) were female.

91 people sickened, 35 hospitalized, 4 with HUS. Sixty-two people infected with the outbreak strain of Shiga toxin-producing E. coli O157:H7 were reported from 16 states and the District of Columbia. Illnesses started on dates ranging from October 7, 2018, to December 4, 2018. Twenty-five people were hospitalized, including two people who developed hemolytic uremic syndrome, a type of kidney failure. No deaths were reported. In Canada, there were a total of 29 confirmed cases of E. coli illness investigated in Ontario, Quebec, New Brunswick, and British Columbia. The illnesses in British Columbia were related to travel to Quebec, Ontario and the United States. Individuals became sick between mid-October and mid-November 2018. Ten individuals were hospitalized, and two individuals suffered from hemolytic-uremic syndrome (HUS), which is a severe complication that can result from an E. coli infection. No deaths were reported. Individuals who became ill were between 2 and 93 years of age. The majority of cases (52%) were female.

2017

76 people sickened, 9 people hospitalized, 2 with HUS and 2 deaths. Twenty-five people infected with the outbreak strain of E. coli O157:H7 were reported from 15 states. Illnesses started on dates ranging from November 5, 2017 to December 12, 2017. Nine people were hospitalized, including two people who developed hemolytic uremic syndrome, a type of kidney failure. One death was reported from California. In total, there were 42 cases of E. coli O157:H7 illness reported in five eastern provinces: Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador. 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.

Additional Resources

Niagara County Public Health Director Daniel J. Stapleton announces a case of Hepatitis A virus in a local restaurant worker. The Niagara County Department of Health (NCDOH) launched a disease investigation on December 3, 2019 directly after receiving notification of the suspected case. Following laboratory testing, interviews and a restaurant inspection, an employee who handles food at Taco Bell on Niagara Falls Boulevard in Niagara Falls was identified with the Hepatitis A virus. The establishment has been notified of the potential exposure and the manager has sent the sick employee home. Additionally, the NCDOH has advised the manager to send any staff reporting Hepatitis A virus related symptoms for medical evaluation before returning to work. Employees of the restaurant will be offered post exposure prophylaxis (PEP). Taco Bell in Niagara Falls will be subject to additional inspections over the coming weeks and is complying with NCDOH recommendations.

As a result of this potential Hepatitis A virus exposure, NCDOH is advising anyone who ate food as a dine-in, takeout, delivery or utilized the restroom at Taco Bell in Niagara Falls (7300 Niagara Falls Boulevard, Niagara Falls, NY 14304) between November 21, 2019 and December 1, 2019 to receive free Hepatitis A vaccine from the Niagara County Department of Health to prevent potentially exposed individuals from becoming infected. The Point of Dispensing (POD) will be held at:

Where: Doris W. Jones Family Resource Building, 3001 Ninth Street, Niagara Falls, NY 14305

When: Thursday December 5th & Friday December 6th from 9AM to 4PM

“We encourage those who may have been exposed in this specific timeframe to visit the Point of Dispensing to receive free post exposure prophylaxis,” stated Public Health Director Daniel J. Stapleton. Those attending the Point of Dispensing are encouraged to pre-register to save time during the onsite registration process. Pre-registration may be completed prior to arrival by visiting, http://www.niagaracounty.com/Health and look for the pre-registration link at the top.

The Genesee County Health Department in conjunction with the Saginaw County Health Department has confirmed a case of hepatitis A in a foodservice worker who was employed at both the Kentucky Fried Chicken located at 6021 Dort Hwy in Grand Blanc Township and 9230 Birch Run Road in Birch Run, Michigan.

Both facilities are cooperating with the local health departments during this investigation. Anyone who consumed food or drink from the Birch Run KFC between November 14-16, 2019, or the Grand Blanc KFC from November 20-26, 2019, may have been exposed to hepatitis A.

The Genesee County Health Department and Saginaw County Health Department recommend anyone who visited KFC in Grand Blanc or Birch Run during these dates and has not been vaccinated for hepatitis A or has a sudden onset of any symptoms of Hepatitis A should contact their doctor. Vaccination can prevent the disease if given within 14 days after exposure. People who were possibly exposed at the Birch Run KFC location are outside the 14 days to get post exposure vaccination to prevent illness; however they should seek medical attention if any hepatitis A symptoms develop. For people who may have been exposed at the Grand Blanc KFC location it is important to get the vaccination as soon as possible.

The Genesee County Health Department will host a special hepatitis A vaccination clinic at the Genesee County Health Department Burton Branch, G-3373 S. Saginaw St., Burton, on Tuesday December 3rd from 4-7:00 pm and Thursday December 5th from 8-11:00 am and 1-3:30 pm. Regular clinic hours for hepatitis A vaccinations at the Genesee County Health Department Burton Branch are as follows: Monday, Wednesday, Thursday, & Friday: 8:00 – 11:00 am and 1:00 – 4:00 pm Tuesday: 1:00 – 4:00 pm and Thursday evening 4:00-6:00 pm by appointment.

This week, the Saginaw County Health Department will hold immunization clinics at 1600 N. Michigan Avenue, Saginaw, by appointment as follows: Tuesday: 1:30 – 4:00 pm Wednesday: 9:00 – 11:30 am & 1:30 – 4:00 pm Thursday: 1:15 – 4:00 pm Friday: 8:30 – 11:00 am & 1:30 – 4:00 pm People can call the Saginaw County Health Department at (989) 758-3840 to make an appointment.

The hepatitis A vaccine is also available through some healthcare providers and many pharmacies. Call ahead to ensure your provider or pharmacy has the vaccine available.

Hepatitis A is an infection of the liver caused by a virus. The virus is shed in feces and is most commonly spread if a person who has the virus does not wash their hands properly after using the bathroom and before preparing or touching food. Symptoms of infection may include sudden abdominal pain, diarrhea, nausea, headache, dark urine, and/or vomiting often followed by yellowing of the skin and eyes (jaundice). Symptoms may appear from 14-50 days after exposure, with an average of about one month.

To reduce the risk of hepatitis A:

Get the hepatitis A vaccine.

Wash hands frequently, especially after using the bathroom, changing diapers, and before preparing and eating food. Rub hands vigorously with soap and warm running water for at least 20 seconds.

Clean and disinfect all surfaces areas, especially while someone in the household or workplace has symptoms. Particular care needs to be taken with areas such as toilets, sinks, trash, door knobs, and faucet handles.

Do not prepare food if you have symptoms, and refrain from food preparation for at least three days after symptoms have ended.

I spent the weekend talking to people who have been hospitalized in this most recent version of “romaine-ecoli-apocalypse .”

Op-ed from Washington Post, posted without permission – but its that important.

Exactly a year ago, during Thanksgiving week, I was involved in the government’s decision to recommend removing romaine lettuce from grocery store shelves and restaurants. We also advised people not to eat any romaine they had purchased and to throw it away instead.

Now, right before Thanksgiving, it’s happening again.

Nobody wants to scratch romaine off the nation’s Thanksgiving menu. But these recommendations were easy ones to make.

Last year, an outbreak of E. coli bacteria linked to romaine was sweeping the country. Contaminated romaine was likely still on the market. We were unsure where the contaminated product came from, so all of it had to be removed. Even if we knew its origin, romaine wasn’t labeled to allow consumers to determine where it was grown. At least the labeling has improved since last year. But more needs to change.

During the 2018 Thanksgiving outbreak, the government’s actions clearly prevented additional illnesses. But, unfortunately, 62 people still became ill. Symptoms of an E. coli infection can include severe stomach cramps, bloody diarrhea, vomiting and fever. Some people experience only mild symptoms, but for others a severe infection can be life-threatening.

Fast forward to now, and there’s another outbreak of the same strain of E. coli linked to romaine, likely from California’s central coast. As of Nov. 22, 40 cases had been reported across 16 states, with 28 hospitalizations but no deaths. The Food and Drug Administration and Centers for Disease Control and Prevention are recommending that consumers avoid romaine from the Salinas region.

Remarkably, the specific E. coli strain (O157:H7) causing the new outbreak is genetically indistinguishable from last year’s and another one in late 2017. Last month, the FDA retroactively identified an outbreak involving romaine lettuce that occurred in late summer, causing 23 illnesses. The CDC has not posted information about that outbreak, so the epidemiologic patterns of illness and causative strain are unknown.

Notably, the 2018 Thanksgiving outbreak was not the first one that year either. It was preceded by the biggest outbreak in the United States of E. coli illness in more than a decade, with 210 illnesses, including five deaths, linked to romaine from the winter growing region around Yuma, Ariz.

With five multistate outbreaks in less than two years, it’s clear there’s a serious continuing problem with E. coli O157:H7 and romaine lettuce. The natural reservoir for this pathogen is ruminant animals, especially cattle. Moreover, one particular strain of E. coli seems to have found a home in the growing regions of central coastal California, returning each fall near the end of the growing season.

It’s not clear where this strain is hiding. Cattle? Water sources? Elsewhere? What is clear is that additional steps must be taken to make romaine safer.

Other commodities such as meat and flour also cause foodborne illness. But at least with these, cooking and baking eliminate the risk. That isn’t the case with romaine. Washing the lettuce may remove surface contamination, but the crinkly leaves make eliminating all of it almost impossible.

The Food Safety Modernization Act, signed into law in 2011, places the responsibility on food producers to prevent contamination from occurring and to assure their product is safe. The leafy greens industry, with input from the FDA, the CDC and others, has recently taken steps to meet this obligation. In September, an industry-led task force issued a set of recommendations to address the problem.

One of the most significant recommendations is that any open-source water in contact with edible lettuce in the three weeks before harvest should be treated to remove contamination. E. coli O157:H7 was found in untreated surface water in both the Yuma and 2018 Thanksgiving outbreaks.

The task force recommendations should be immediately adopted and implemented. But even more should be done. Surface water used for romaine irrigation should be treated throughout the growing cycle, not just in the three weeks before harvest. The FDA should also quickly issue agricultural water standards that have been postponed but are required by FSMA’s produce-safety rules.

Another concern that must be addressed: concentrated animal feeding operations, where tens of thousands of cattle potentially carrying E. coli O157:H7 are housed, if they are located near leafy green growing areas. Buffers between the cattle operations and growing fields are required, but bigger ones may be needed.

E. coli can cause terrible illness. Just ask any of the victims of the five most recent outbreaks. The romaine lettuce market has managed to rebound from outbreak after outbreak. But consumer loyalty is unlikely to be limitless. The industry should not take this resilience as a given.

Stephen M. Ostroff is a former deputy commissioner for foods and veterinary medicine at the Food and Drug Administration.

Since the previous update on November 22, an additional 27 ill people have been reported. As of November 25, 2019, a total of 67 people infected with the outbreak strain of E. coli O157:H7 have been reported from 19 states.

Illnesses started on dates ranging from September 24, 2019, to November 14, 2019. Ill people range in age from 3 to 89 years, with a median age of 25. Sixty-seven percent of ill people are female. Of 50 ill people with information available, 39 hospitalizations have been reported, including six people who developed hemolytic uremic syndrome (HUS), a type of kidney failure. No deaths have been reported.

Epidemiologic, laboratory, and traceback evidence indicate that romaine lettuce from the Salinas, California, growing region is the likely source of this outbreak.

FDA and states continue to trace the source of the romaine lettuce eaten by ill people. Preliminary information indicates that some of the ill people ate lettuce grown in Salinas, California. No common grower, supplier, distributor, or brand of romaine lettuce has been identified.

CDC continues to advise that consumers not eat and retailers not sell any romaine lettuce grown in Salinas, California. The investigation is ongoing to determine the source of contamination and if additional products are linked to illness.

This outbreak is caused by the same strain of E. coli O157:H7 that caused outbreaks linked to leafy greens in 2017 and to romaine lettuce in 2018.

With nearly 450 sickened, 259 hospitalized and 7 deaths, is it time for a Romaine Warning Label?

Or, are the illnesses and deaths simply a cost of doing business?

 2019

41 people sickened, 28 hospitalization and 5 with HUS. A total of 40 people infected with the outbreak strain of E. coli O157:H7 have been reported from 16 states: Arizona, California, Colorado, Idaho, Illinois, Maryland, Michigan, Minnesota, Montana, New Jersey, Ohio, Pennsylvania, Virginia, Washington and Wisconsin. A total of 28 hospitalizations have been reported. Five people have developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.  Canada has reported one illness.

23 people sickened and 11 hospitalized. The FDA, CDC, along with state and local partners, investigated the illnesses associated with the outbreak. A total of 23 people infected with the outbreak strain of E. coli O157:H7 were reported from 12 states: Arizona, California, Florida, Georgia, Illinois, Maryland, North Carolina, Nevada, New York, Oregon, Pennsylvania  and South Carolina. Eleven people were hospitalized, and no deaths were reported. Illnesses started on dates ranging from July 12, 2019 to Sept. 8, 2019. No illnesses were reported after CDC began investigating the outbreak on Sept. 17, 2019.

2018

218 people sickened, 96 hospitalized, 27 with HUS and 5 deaths. 210 people infected with the outbreak strain were reported from 36 states. 96 people were hospitalized, including 27 people who developed a type of kidney failure called hemolytic uremic syndrome. 5 deaths were reported from Arkansas, California, Minnesota, and New York. In total, there were eight Canadian cases of E. coli O157 that were genetically similar to the U.S. outbreak linked to romaine lettuce coming from the Yuma growing region in the U.S. The eight Canadian illnesses were reported in five provinces: British Columbia, Alberta, Saskatchewan, Ontario, and Quebec. Individuals became sick between March and April 2018. One of the Canadian cases was hospitalized, and no deaths were reported in Canada. Individuals who became ill were between 11 and 76 years of age. The majority of cases (75%) were female.

91 people sickened, 35 hospitalized, 4 with HUS. Sixty-two people infected with the outbreak strain of Shiga toxin-producing E. coli O157:H7 were reported from 16 states and the District of Columbia. Illnesses started on dates ranging from October 7, 2018, to December 4, 2018. Twenty-five people were hospitalized, including two people who developed hemolytic uremic syndrome, a type of kidney failure. No deaths were reported. In Canada, there were a total of 29 confirmed cases of E. coli illness investigated in Ontario, Quebec, New Brunswick, and British Columbia. The illnesses in British Columbia were related to travel to Quebec, Ontario and the United States. Individuals became sick between mid-October and mid-November 2018. Ten individuals were hospitalized, and two individuals suffered from hemolytic-uremic syndrome (HUS), which is a severe complication that can result from an E. coli infection. No deaths were reported. Individuals who became ill were between 2 and 93 years of age. The majority of cases (52%) were female.

2017

76 people sickened, 9 people hospitalized, 2 with HUS and 2 deaths. Twenty-five people infected with the outbreak strain of E. coli O157:H7 were reported from 15 states. Illnesses started on dates ranging from November 5, 2017 to December 12, 2017. Nine people were hospitalized, including two people who developed hemolytic uremic syndrome, a type of kidney failure. One death was reported from California. In total, there were 42 cases of E. coli O157:H7 illness reported in five eastern provinces: Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador. 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.

E. coli outbreaks associated with lettuce, specifically the “pre-washed” and “ready-to-eat” varieties, are by no means a new phenomenon. In fact, the frequency with which this country’s fresh produce consuming public has been hit by outbreaks of pathogenic bacteria is astonishing. Here is just a sample of E. coli outbreaks based on information gathered by the Center for Science in the Public Interest, Kansas State University, and the Centers for Disease Control and Prevention (CDC ) – NOTE: It is very likely that there or dozens of other outbreaks that the CDC and FDA did not make public:

Date Vehicle Etiology Confirmed
Cases		 States/Provinces
July 1995 Lettuce (leafy green; red; romaine) E. coli O157:H7 74 1:MT
Sept. 1995 Lettuce (romaine) E. coli O157:H7 20 1:ID
Sept. 1995 Lettuce (iceberg) E. coli O157:H7 30 1:ME
Oct. 1995 Lettuce (iceberg; unconfirmed) E. coli O157:H7 11 1:OH
May-June 1996 Lettuce (mesclun; red leaf) E. coli O157:H7 61 3:CT, IL, NY
May 1998 Salad E. coli O157:H7 2 1:CA
Feb.-Mar. 1999 Lettuce (iceberg) E. coli O157:H7 72 1:NE
Oct. 1999 Salad E. coli O157:H7 92 3:OR, PA, OH
Oct. 2000 Lettuce E. coli O157:H7 6 1:IN
Nov. 2001 Lettuce E. coli O157:H7 20 1:TX
July-Aug. 2002 Lettuce (romaine) E. coli O157:H7 29 2:WA, ID
Nov. 2002 Lettuce E. coli O157:H7 13 1:Il
Dec. 2002 Lettuce E. coli O157:H7 3 1:MN
Oct. 2003-May 2004 Lettuce (mixed salad) E. coli O157:H7 57 1:CA
Apr. 2004 Spinach E. coli O157:H7 16 1:CA
Nov. 2004 Lettuce E. coli O157:H7 6 1:NJ
Sept. 2005 Lettuce (romaine) E. coli O157:H7 32 3:MN, WI, OR
Sept. 2006 Spinach (baby) E. coli O157:H7 and other serotypes 205 Multistate and Canada
Nov./Dec. 2006 Lettuce E. coli O157:H7 71 4:NY, NJ, PA, DE
Nov./Dec. 2006 Lettuce E. coli O157:H7 81 3:IA, MN, WI
July 2007 Lettuce E. coli O157:H7 26 1:AL
May 2008 Romaine E. coli O157:H7 9 1:WA
Oct. 2008 Lettuce E. coli O157:H7 59 Multistate and Canada
Nov. 2008 Lettuce E. coli O157:H7 130 Canada
Sept. 2009 Lettuce: Romaine or Iceberg E. coli O157:H7 29 Multistate
Sept. 2009 Lettuce E. coli O157:H7 10 Multistate
April 2010 Romaine E. coli O145 33 5:MI, NY, OH, PA, TN
Oct. 2011 Romaine E. coli O157:H7 60 Multistate
April 2012 Romaine E. coli O157:H7 28

1:CA

Canada
June 2012 Romaine E. coli O157:H7 52 Multistate
Sept. 2012 Romaine E. coli O157:H7 9 1:PA
Oct. 2012 Spinach and Spring Mix Blend E. coli O157:H7 33 Multistate
Apr. 2013 Leafy Greens E. coli O157:H7 14 Multistate
Aug. 2013 Leafy Greens E. coli O157:H7 15 1:PA
Oct. 2013 Ready-To-Eat Salads E. coli O157:H7 33 Multistate
Apr. 2014 Romaine E. coli O126 4 1:MN
Apr. 2015 Leafy Greens E. coli O145 7 3:MD, SC, VA
June 2016 Mesclun Mix E. coli O157:H7 11 3:IL, MI, WI
Nov. 2017 Leafy Greens E. coli O157:H7 67 Multistate and Canada
Mar. 2018 Romaine E. coli O157:H7 219 Multistate and Canada
Nov. 2018 Romaine E. coli O157:H7 91 Multistate and Canada
Sept. 2019 Romaine E. coli O157:H7 23 Multistate
Nov. 2019 Romaine E. coli O157:H7 41 Multistate and Canada

We need to take a hard look at the safety of romaine and what we can do to make is safe.

“When in doubt, throw it out,” says William (Bill) Marler, managing partner at the Food Safety Law Firm, Marler Clark.

“It is past time for the leafy green industry to take the safety of greens, especially romaine lettuce, seriously.  The FDA must require, and the industry must implement, better environmental controls and more rigorous testing of products.  There have been too many outbreaks leaving hundreds of consumers with life-long complications,” said Bill Marler.

“Over the last decades, and recently, I have represented the families of people who have died as a result of consuming a product deemed ‘healthy.’  I have also represented dozens of children who face a lifetime of complications – including kidney failure – due to eating leafy greens.  This has to stop,” added Marler.

What to know about the E. coli outbreak:

The FDA, CDC, state and Canadian health authorities are presently investigating an outbreak of illnesses caused by E. coli O157:H7 tainted romaine lettuce in the United States and Canada. Thus far at least 41 people have been sickened in the United States and Canada.  This is in addition to 23 people sickened by E. coli O157:H7 tainted romaine lettuce in September.  Both outbreaks involve romaine lettuce grown in Salinas California.

Epidemiologic, laboratory, and traceback evidence indicates that romaine lettuce from the Salinas, California growing region is a likely source of this outbreak.

Consumers should not eat romaine lettuce harvested from Salinas, California.

Additionally, consumers should not eat products identified in the recall announced by the USDA on November 21, 2019 related to Missa Bay, LLC, products and Ready Pac Bistro Chicken Raised Without Antibiotics Caesar Salad.

Restaurants and retailers should not serve or sell romaine harvested from Salinas, California.  If you do not know the source of your romaine lettuce, and if you cannot obtain that information from your supplier, you should not serve, nor sell it.

Romaine lettuce may be voluntarily labeled with a harvest region. If this voluntary label indicates that the romaine lettuce was grown in “Salinas” (whether alone or with the name of another location) do not eat it. Throw it away or return it to the place of purchase.  If romaine lettuce does not have information about harvest region or does not indicate that it has been grown indoors (i.e., hydroponically- and greenhouse-grown), throw it away or return it to the place of purchase. Consumers ordering salad containing romaine at a restaurant or at a salad bar should ask the staff whether the romaine came from Salinas.  If it did, or they do not know, do not eat it.

What to know about the E. coli:

Shiga toxin–producing E. coli (STEC) cause approximately 100,000 illnesses, 3,000 hospitalizations, and 90 deaths annually in the United States. Most reported STEC infections in the United States are caused by E. coli O157:H7, with an estimated 73,000 cases occurring each year.

What to know about the E. coli complications:

Hemolytic Uremic Syndrome, or HUS, occurs in around 10 percent of hospitalized  E. coli O157:H7 infections. HUS occurs when Shiga toxins get into the bloodstream and cause the part of the kidney that filters toxins out of the blood to break down, causing kidney injury and sometimes kidney failure. Some HUS patients also suffer damage to the pancreas and central nervous system impairment.

E. coli outbreaks associated with lettuce, specifically the “pre-washed” and “ready-to-eat” varieties, are by no means a new phenomenon. In fact, the frequency with which this country’s fresh produce consuming public has been hit by outbreaks of pathogenic bacteria is astonishing. Here is just a sample of E. coli outbreaks based on information gathered by the Center for Science in the Public Interest, Kansas State University, and the Centers for Disease Control and Prevention (CDC ) – NOTE: It is very likely that there or dozens of other outbreaks that the CDC and FDA did not make public:

Date Vehicle Etiology Confirmed
Cases		 States/Provinces
July 1995 Lettuce (leafy green; red; romaine) E. coli O157:H7 74 1:MT
Sept. 1995 Lettuce (romaine) E. coli O157:H7 20 1:ID
Sept. 1995 Lettuce (iceberg) E. coli O157:H7 30 1:ME
Oct. 1995 Lettuce (iceberg; unconfirmed) E. coli O157:H7 11 1:OH
May-June 1996 Lettuce (mesclun; red leaf) E. coli O157:H7 61 3:CT, IL, NY
May 1998 Salad E. coli O157:H7 2 1:CA
Feb.-Mar. 1999 Lettuce (iceberg) E. coli O157:H7 72 1:NE
Oct. 1999 Salad E. coli O157:H7 92 3:OR, PA, OH
Oct. 2000 Lettuce E. coli O157:H7 6 1:IN
Nov. 2001 Lettuce E. coli O157:H7 20 1:TX
July-Aug. 2002 Lettuce (romaine) E. coli O157:H7 29 2:WA, ID
Nov. 2002 Lettuce E. coli O157:H7 13 1:Il
Dec. 2002 Lettuce E. coli O157:H7 3 1:MN
Oct. 2003-May 2004 Lettuce (mixed salad) E. coli O157:H7 57 1:CA
Apr. 2004 Spinach E. coli O157:H7 16 1:CA
Nov. 2004 Lettuce E. coli O157:H7 6 1:NJ
Sept. 2005 Lettuce (romaine) E. coli O157:H7 32 3:MN, WI, OR
Sept. 2006 Spinach (baby) E. coli O157:H7 and other serotypes 205 Multistate and Canada
Nov./Dec. 2006 Lettuce E. coli O157:H7 71 4:NY, NJ, PA, DE
Nov./Dec. 2006 Lettuce E. coli O157:H7 81 3:IA, MN, WI
July 2007 Lettuce E. coli O157:H7 26 1:AL
May 2008 Romaine E. coli O157:H7 9 1:WA
Oct. 2008 Lettuce E. coli O157:H7 59 Multistate and Canada
Nov. 2008 Lettuce E. coli O157:H7 130 Canada
Sept. 2009 Lettuce: Romaine or Iceberg E. coli O157:H7 29 Multistate
Sept. 2009 Lettuce E. coli O157:H7 10 Multistate
April 2010 Romaine E. coli O145 33 5:MI, NY, OH, PA, TN
Oct. 2011 Romaine E. coli O157:H7 60 Multistate
April 2012 Romaine E. coli O157:H7 28

1:CA

Canada
June 2012 Romaine E. coli O157:H7 52 Multistate
Sept. 2012 Romaine E. coli O157:H7 9 1:PA
Oct. 2012 Spinach and Spring Mix Blend E. coli O157:H7 33 Multistate
Apr. 2013 Leafy Greens E. coli O157:H7 14 Multistate
Aug. 2013 Leafy Greens E. coli O157:H7 15 1:PA
Oct. 2013 Ready-To-Eat Salads E. coli O157:H7 33 Multistate
Apr. 2014 Romaine E. coli O126 4 1:MN
Apr. 2015 Leafy Greens E. coli O145 7 3:MD, SC, VA
June 2016 Mesclun Mix E. coli O157:H7 11 3:IL, MI, WI
Nov. 2017 Leafy Greens E. coli O157:H7 67 Multistate and Canada
Mar. 2018 Romaine E. coli O157:H7 219 Multistate and Canada
Nov. 2018 Romaine E. coli O157:H7 91 Multistate and Canada
Sept. 2019 Romaine E. coli O157:H7 23 Multistate
Nov. 2018 Romaine E. coli O157:H7 41 Multistate and Canada

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of E. coli outbreaks and hemolytic uremic syndrome (HUS). The E. coli lawyers of Marler Clark have represented thousands of victims of E. coli and other foodborne illness infections and have recovered over $650 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our E. coli lawyers have litigated E. coli and HUS cases stemming from outbreaks traced to ground beef, raw milk, lettuce, spinach, sprouts, and other food products.  The law firm has brought E. coli lawsuits against such companies as Jack in the Box, Dole, ConAgra, Cargill, and Jimmy John’s.  We have proudly represented such victims as Brianne Kiner, Stephanie Smith and Linda Rivera.

To contact Bill Marler, email: bmarler@marlerclark.com or call: 1-206-794-5043.

The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) is issuing a public health alert due to illnesses caused by E. coli O157:H7 associated with romaine lettuce from the Salinas, California, growing region. FSIS warns against consuming any wraps, sandwiches, prepackaged salad, salad kits, or other product containing romaine lettuce harvested from the Salinas, California, growing region. Additionally, consumers should not eat any salad products identified in a Missa Bay, LLC, recall announced by FSIS on November 21, 2019.

On November 22, 2019, the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA)advised consumers, retailers, and restaurants not eat or sell any romaine lettuce harvested from the Salinas, California, growing region. Most romaine lettuce products at retail are labeled with a harvest location showing where they were grown. CDC and the FDA are advising that if this voluntary label indicates that the romaine lettuce was grown in “Salinas” (whether alone or with the name of another location) do not eat it. If the romaine does not have information about harvest region or does not indicate that it has been grown indoors (i.e. hydroponically- and greenhouse-grown), throw it away or return it to the place of purchase.

FSIS-regulated establishments are advised not to serve, ship, or sell products that contain romaine lettuce from the Salinas, California, growing region. This advice includes all types of romaine lettuce from the Salinas, California, growing region, such as whole heads of romaine, hearts of romaine, and packages of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad. If you do not know the source of your romaine lettuce, and if you cannot obtain that information from your supplier, you should not serve, ship, or sell the product.

Anyone concerned about an illness should contact a healthcare provider. E. coli O157:H7 is a potentially deadly bacterium that can cause dehydration, bloody diarrhea and abdominal cramps 2–8 days (3–4 days, on average) after exposure the organism. While most people recover within a week, some develop a type of kidney failure called hemolytic uremic syndrome (HUS). This condition can occur among persons of any age but is most common in children under 5-years old and older adults. It is marked by easy bruising, pallor, and decreased urine output. Persons who experience these symptoms should seek emergency medical care immediately.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of E. coli outbreaks and hemolytic uremic syndrome (HUS). The E. coli lawyers of Marler Clark have represented thousands of victims of E. coli and other foodborne illness infections and have recovered over $650 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our E. coli lawyers have litigated E. coli and HUS cases stemming from outbreaks traced to ground beef, raw milk, lettuce, spinach, sprouts, and other food products.  The law firm has brought E. coli lawsuits against such companies as Jack in the Box, Dole, ConAgra, Cargill, and Jimmy John’s.  We have proudly represented such victims as Brianne Kiner, Stephanie Smith and Linda Rivera.

If you or a family member became ill with an E. coli infection or HUS after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark E. coli attorneys for a free case evaluation.

Since the initial investigation notice, 23 additional ill people have been reported. As of November 21, 2019, a total of 40 people infected with the outbreak strain of E. coli O157:H7 have been reported from 16 states.

Illnesses started on dates ranging from September 24, 2019, to November 10, 2019. Ill people range in age from 3 to 89 years, with a median age of 22. Sixty-five percent of ill people are female. Of 39 ill people with information available, 28 hospitalizations have been reported, including 5 people who developed hemolytic uremic syndrome (HUS), a type of kidney failure. No deaths have been reported.

Epidemiologic, laboratory, and traceback evidence indicate that romaine lettuce from the Salinas, California growing region 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. Eight (80%) of 10 people interviewed reported eating romaine lettuce. This percentage is significantly higher than results from a survey of healthy people in which 47% reported eating romaine lettuce in the week before they were interviewed. Ill people in Maryland reported eating Ready Pac Foods Bistro® Chicken Caesar Salad. To date, ill people in other states have not reported eating this particular salad, which contained romaine lettuce from the Salinas, California growing region.

As reported on November 20, 2019, the Maryland Department of Health identified E. coli O157 in romaine lettuce from an unopened package of Ready Pac Foods Bistro® Chicken Caesar Salad collected from a sick person’s home in Maryland. Whole genome sequencing has been completed and shows that the E. coli strain in the romaine lettuce is closely related genetically to the E. coli found in sick people in this outbreak. This provides additional evidence that people in this outbreak got sick from eating romaine lettuce.

On November 21, 2019, Missa Bay, LLC,  salad products due to possible E. coli contamination.

Do not eat or sell any of the recalled salad products, which were sold under many different brand names.

  • The recalled salad products have “Use By” dates ranging from October 29, 2019, to November 1, 2019.
  • The recalled products have establishment number “EST. 18502B” inside the USDA mark of inspection.

This recall includes salad products that contained contaminated romaine lettuce. The romaine lettuce was tested by the Maryland Department of Health as part of a foodborne illness outbreak in Maryland.

FDA and states are tracing the source of the romaine lettuce eaten by ill people. Preliminary information indicates that some of the ill people ate lettuce grown in Salinas, California. No common grower, supplier, distributor, or brand of romaine lettuce has been identified.

This outbreak is caused by the same strain of E. coli O157:H7 that caused outbreaks linked to leafy greens in 2017 and to romaine lettuce in 2018.