King 5 TV just reported that the Washington State Department of Health announced that nine confirmed cases of E. coli O157:H7 infection found in north Thurston and south Pierce counties (appears to be college students – food service) have been traced to bagged, commercial romaine lettuce.  Health officials say it’s not the same type of lettuce you would buy in a grocery store.  The Health Department says four cases of E. coli O157:H7 infection were identified in Thurston County, and six in Pierce County. Some of the people infected were hospitalized.  The people who got sick all had salad or lettuce at different places, which means all of those places probably got their lettuce from a single source.

E. coli O157:H7 outbreaks associated with leafy greens such as lettuce are by no means a new phenomenon.  FDA San Francisco District director, Dr. Barbara Cassens, reported that in the last 12 years, 22 E. coli O157:H7 outbreaks have been linked to consumption of contaminated leafy greens.  Consumers were first notified that a large and deadly outbreak of E. coli O157:H7 was underway on September 14, 2006 when the FDA issued a notice that 14 states were reporting 45 cases of E. coli O157:H7 and that pre-bagged spinach was the likely vehicle.  Ultimately 26 states and one province in Canada would report 205 spinach-associated cases of E. coli O157:H7 to the CDC.

Only weeks after the spinach scare in September 2006, an outbreak of E. coli O157:H7 "allegedly" occurred among customers of Taco Bell restaurants located in Delaware, Pennsylvania, New Jersey and New York.  The first cases were identified in late November. By year’s end, 78 probable and confirmed cases of E. coli O157:H7 had been reported to health officials.  At least 53 victims were hospitalized and 8 developed HUS.   Within weeks another multi-state outbreak of E. coli O157:H7 associated with iceberg lettuce, shredded by Bix, and  incorporated into meals manufactured at Taco John restaurants.  The outbreak sickened 81 people.  Illnesses were reported in Minnesota (33), Iowa (47) and Wisconsin (1).  Twenty six people were hospitalized, and two suffered from HUS.

It is clear that the risks associated with E. coli O157:H7 and leafy greens are well known to both public health and industry.  A review of pre-2006 foodborne illness outbreaks is telling. In October 2005 the Minnesota Department of Health investigated an outbreak of E. coli O157:H7 that would grow to include ill persons in Wisconsin and Oregon.  Thirty-two cases were identified as being part of the outbreak.  Case control study data showed a statistically significant association between illness and consuming Dole pre-packaged lettuce.

In October 2003, 13 residents of a California retirement center were sickened and 2 died after eating E. coli-contaminated “pre-washed” spinach.  In September 2003, nearly 40 patrons of a California restaurant chain became ill after eating salads prepared with bagged, “pre-washed” lettuce. In July 2002, over 50 young women were stricken with E. coli O157:H7 at a dance camp after eating “pre-washed” lettuce, leaving several hospitalized and 1 with life-long kidney damage.  The Center for Science in the Public Interest found that, of 225 food-poisoning outbreaks from 1990 to 1998, nearly 20 percent (55 outbreaks) were linked to fresh fruits, vegetables, or salads.  This chart provides an overview of some of the reported E. coli O157:H7 outbreaks linked to consumption of leafy greens.

For years the FDA has been aggressively trying to get the produce industry to address serious deficiencies that are creating a critical risk to consumers.  In 1998, the FDA issued guidance to industry entitled “Guide to Minimize Microbial Food Safety Hazards for Fruits and Vegetables.”  The guide was specifically designed to assist growers and packers in the implementation of safer manufacturing practices.  Since the release of this document in 1998, the FDA has undertaken a number of initiatives on produce safety and issued a series of letters to industry.

On February 5, 2004, the FDA issued a letter to the lettuce and tomato industries to “make them aware of [FDA’s] concerns regarding continuing outbreaks associated with these two commodities and to encourage the industries to review their practices.”  In November 2005, the FDA addressed its concerns to California lettuce producers in its “Letter to California Firms that Grow, Pack, Process, or Ship Fresh and Fresh-Cut Lettuce.”  The letter begins:

This letter is intended to make you aware of the Food and Drug Administration’s (FDA’s) serious concern with the continuing outbreaks of foodborne illness associated with the consumption of fresh and fresh-cut lettuce and other leafy greens.

In the letter the FDA counted at that time 18 outbreaks (now 22 or 23) of E. coli O157:H7 associated with fresh or fresh-cut lettuce occurring between 1995 and 2005, which resulted in 409 illnesses and two deaths.  The FDA stated that industry’s role in preventing these illnesses is crucial because “these products are commonly consumed in their raw state without processing to reduce or eliminate pathogens.”