When the Michigan State Department of Health announced on September 26th the link between over two dozen E. coli cases with first onset of September 8th, it appeared to be an event isolated to just Michigan with 26 genetically linked cases in eight Michigan counties including seven at Michigan State University (Ingham County), five inmates at the Lenawee County Jail, three students at the University of Michigan (Washtenaw County), four in Macomb County, three each in Wayne, two in Kent counties, and one each in St. Clair and Oakland counties.

Since then the outbreak has mushroomed to include at least 50, including ill people in Illinois and Canada. All have been linked to the consumption of Aunt Mid’s bagged lettuce that was sourced from California. Press reports linked cases in New York, Ohio and Oregon at one time or another. The names of any restaurants where people consumed the contaminated lettuce have not been named. Interestingly, people who have contacted us report eating at a Jimmy John’s in Michigan in the days before they became ill.

Coincidentally, on October 9th Boulder County Public Health announced that it was investigating an outbreak of E. coli cases in Boulder County. At that time, there were 17 outbreak-related cases with illness onset about September 21. These cases were eventually linked to one or more Boulder Jimmy John’s. Lettuce, nor any other food product, has been identified as the likely contaminated product.

Is There an Epidemiological Link Between Aunt Mid’s, Jimmy John’s and California Lettuce? Wikipedia tells us that:

Epidemiology is the study of factors affecting the health and illness of populations, and serves as the foundation and logic of interventions made in the interest of public health and preventive medicine. It is considered a cornerstone methodology of public health research, and is highly regarded in evidence-based medicine for identifying risk factors for disease and determining optimal treatment approaches to clinical practice.

So, here are a few questions that need to be answered:

1. Does PFGE (genetic fingerprint) of the E. coli in the Michigan/Illinois/Canada outbreak match the outbreak in Colorado?

2. Did Aunt Mid’s, or another food supplier, provide product to both Michigan and Colorado in the relevant time frame?