And, they forgot the eight sick in Canada.

Today, the FDA came out with its “Environmental Assessment of Factors Potentially Contributing to the Contamination of Romaine Lettuce Implicated in a Multi-State Outbreak of E. coli O157:H7.”

I shortened it a bit and bolded the highlights.

In early April 2018, the Food and Drug Administration (FDA), in conjunction with the Centers for Disease Control and Prevention (CDC) and state partners, began to investigate a multi-state outbreak of E. coli O157:H7 infections. When this outbreak was declared over by the CDC two months later, it was the largest outbreak of E. coli O157:H7 infections in the United States since 2006, with 210 reported illnesses from 36 states, resulting in 96 hospitalizations, 27 cases of hemolytic uremic syndrome (HUS) and five deaths.

Traceback of the romaine lettuce consumed by ill people determined that it originated in the Yuma produce growing region which consists of farms in Imperial County, California, and Yuma County, Arizona. The traceback identified a total of 36 fields on 23 farms in the Yuma growing region as supplying romaine lettuce that was potentially contaminated and consumed during the outbreak. With the exception of one instance where one of the legs of the traceback led to a single farm, it was not possible to determine which, or how many, of these farms shipped lettuce that was contaminated with the outbreak strain of E. coli O157:H7.

The epidemiological and traceback analyses performed during this outbreak informed an FDA-led Environmental Assessment (EA) of the Yuma produce growing region in collaboration with CDC and state partners from June through August 2018. The EA was conducted to assist FDA in identifying factors that potentially contributed to the introduction and spread of the outbreak strain of E. coli O157:H7 that contaminated the romaine lettuce associated with this outbreak.

The EA team made several visits to the Yuma growing region to conduct its work. During these visits, the team collected numerous environmental samples. Three of these samples were found to contain E. coli O157:H7 with the same rare genetic fingerprint (by whole genome sequencing) as that which made people sick. These three samples were collected in early June from a 3.5 mile stretch of an irrigation canal near Wellton in Yuma County that delivers water to farms in the local area, including several identified in the traceback as having potentially shipped romaine lettuce contaminated with the outbreak strain.

The romaine lettuce that ill individuals consumed was likely harvested between early March and mid-April 2018 based on the fact that reported illness onset dates occurred from March 13 – June 7, 2018. The traceback indicates that the contaminated lettuce had to have been grown on multiple farms and processed at multiple off-farm fresh-cut produce manufacturing/processing facilities.

FDA considers that the most likely way romaine lettuce became contaminated was from the use of water from this irrigation canal, since the outbreak strain of E. coli O157:H7 was found in the irrigation canal and in no other sampled locations. How this process occurred is uncertain, but based on interviews with growers and pesticide applicators, plausible explanations include direct application of irrigation canal water to the lettuce crop or the use of irrigation canal water to dilute crop protection chemicals applied to the lettuce crops through both aerial and land-based spray applications.

Information collected by the EA team indicates that, among the Yuma area farms identified in the traceback and that were interviewed, irrigation canal water was only directly applied during germination. However, aerial and ground-based spraying of crop protection pesticides diluted with irrigation canal water occurred at various times during the growing season on a number of these farms, including after a freeze event that occurred in late February. This freeze event likely led to damage of some portion of the romaine lettuce crop, which may have rendered it more susceptible to microbial contamination.

It is uncertain how the outbreak strain of E. coli O157:H7 was introduced into this 3.5-mile stretch of irrigation canal water. The first illnesses in this outbreak occurred in March 2018, and therefore the outbreak strain may have been present in the irrigation canal months before the EA team collected the positive samples, or the outbreak strain may have been repeatedly introduced into the irrigation canal. A large concentrated animal feeding operation (CAFO) is located adjacent to this stretch of the irrigation canal. The EA team did not identify an obvious route for contamination of the irrigation canal from this facility; in addition, the limited number of samples collected at the CAFO also did not yield the outbreak strain.

Low-level E. coli O157:H7 contamination of the romaine lettuce from some of the growing fields identified in the traceback could have been amplified by commingling cut romaine lettuce in wash systems at fresh-cut produce manufacturing/processing facilities. Washing of romaine lettuce either at a fresh-cut produce manufacturing/processing facility or at home by consumers may reduce but will not eliminate pathogens, including STEC, from romaine lettuce. The commingling of romaine lettuce from various farm growing fields at fresh-cut produce manufacturing/processing facilities complicated traceback efforts and made it impossible for FDA to definitively determine which farm or farms identified in the traceback supplied romaine lettuce contaminated with the E. coli O157:H7 outbreak strain.

FDA recommends that growers and processors of leafy greens:

  • assure that all agricultural water (water that directly contacts the harvestable portion of the crop) used by growers is safe and adequate for its intended use (including agricultural water used for application of crop protection chemicals);
  • assess and mitigate risks related to land uses near or adjacent to growing fields that may contaminate agricultural water or leafy greens crops directly (e.g. nearby cattle operations or dairy farms, manure or composting facility);
  • verify that food safety procedures, policies and practices, including supplier controls for fresh-cut processors, are developed and consistently implemented on farms (both domestic and foreign) and in fresh-cut produce manufacturing/processing food facilities to minimize the potential for contamination and/or spread of human pathogens;
  • when a foodborne pathogen is identified in the growing or processing environment, in agricultural inputs (e.g., agricultural water), in raw agricultural commodities or in fresh-cut ready-to-eat produce, a root cause analysis should be performed to determine the likely source of the contamination, if prevention measures have failed, and whether additional measures are needed to prevent a reoccurrence; and
  • Local in-depth knowledge and actions are critical in helping resolve potential routes of contamination of leafy greens in the Yuma growing region, including Imperial County and Yuma County moving forward. FDA urges other government and non-government entities, produce growers and trade associations in Yuma and Imperial Counties to further explore possible source(s) and route(s) of contamination associated with the outbreak pathogen and with other foodborne pathogens of public health significance. This information is critical to developing and implementing short- and long-term remediation measures to reduce the potential for another outbreak associated with leafy greens or other fresh produce commodities.

Given the size of the outbreak, at least 218 in the US and Canada, and the number of unnamed farms and fields implicated, I am not surprised that the source of the outbreak was broad environmental contamination – like water.  As a study that was performed in the Yuma growing area from 2007-2009 said: “Despite the fact that Arizona leafy greens has never been associated with foodborne outbreaks, this study is contributing with relevant information that can be used for future regulatory guidelines”.  Well, that clearly has changed. Survey of Selected Bacteria in Irrigation Canal Water – Third Year_0

This outbreak appears to be over as of June 28, 2018.

Epidemiologic, laboratory, and traceback evidence indicated that romaine lettuce from the Yuma growing region was the likely source of this outbreak.

The FDA and state and local regulatory officials traced the romaine lettuce to many farms in the Yuma growing region. The FDA, along with CDC and state partners, started an environmental assessment in the Yuma growing region and collected samples of water, soil, and manure. CDC laboratory testing identified the outbreak strain of E. coli O157:H7 in water samples taken from a canal in the Yuma growing region. WGS showed that the E. coli O157:H7 found in the canal water is closely related genetically to the E. coli O157:H7 from ill people. Laboratory testing for other environmental samples is continuing. FDA is continuing to investigate to learn more about how the E. coli bacteria could have entered the water and ways this water could have contaminated romaine lettuce in the region.

As of June 27, 2018, 210 people infected with the outbreak strain of E. coli O157:H7 were reported from 36 states. Illnesses started on dates ranging from March 13, 2018 to June 6, 2018. Ill people ranged in age from 1 to 88 years, with a median age of 28. Sixty-seven percent of ill people were female. Of 201 people with information available, 96 (48%) were hospitalized, including 27 people who developed hemolytic uremic syndrome, a type of kidney failure. Five deaths were reported from Arkansas, California, Minnesota (2), and New York.  (PHAC) identified 8 ill people in several Canadian provinces infected with the same DNA fingerprint of E. coli O157:H7. On June 22, 2018, PHAC reported that the outbreak in Canada appears to be over.

Canada called the imported romaine lettuce E. coli outbreak over after eight people were sickened.  It is expected that the CDC will update the US part of the outbreak in the morning.  The numbers of ill are likely to be far above 200 and the number of deaths may likely rise as well.  Those with long-term complications – (HUS) will still be extraordinary high, as will be the percent of hospitalizations.

Thus far the FDA has been “somewhat silent” on the chain of distribution and will unfortunately remain so.  Here is what they have told the public as of the end of May:

We have been busy doing both a trace forward and trace back.  With over 100 clients, most can identify the specific place that they consumed romaine (point of service) in the 3-5 days before the onset of illness.  Some have multiple purchases and consumptions, which for now, make linking the supply chain a challenge.  But I like a challenge.

I expect that the various retailers (points of service) will continue to provide information on the supply chain (distribution center, processor, grower/harvester) – either willingly or by subpoena.  And, once we have that information (trace back), we can than trace forward to eliminate situations where E. coli culture matched victims had multiple purchases in the incubation period.

Check back for more information.

Retailers above, please give me a call.

I have spoken to and been retained by, people in Idaho, Missouri, Montana, New Jersey, New York and Pennsylvania. Also, I have spoken to people in California and Utah that also may be linked to the outbreak.

On Friday, according to the CDC, as of April 12, 2018, 35 people infected with the outbreak strain of E. coli O157:H7 have been reported from 11 states. Connecticut 2, Idaho 8, Illinois 1, Michigan 1, Missouri 1, New Jersey 7, New York 2, Ohio 2, Pennsylvania 9, Virginia 1 and Washington 1. Illnesses started on dates ranging from March 22, 2018 to March 31, 2018. Ill people range in age from 12 to 84 years, with a median age of 29. Sixty-nine percent of ill people are female. Twenty-two ill people have been hospitalized, including three people who developed hemolytic uremic syndrome, a type of kidney failure.

Today the Arizona Department of Health Services (ADHS) is advising residents to not eat and dispose of store-bought chopped romaine lettuce, including salads and salad mixes containing chopped romaine lettuce. The Centers for Disease Control and Prevention and the Food and Drug Administration indicated a multi-state outbreak of E. coli O157 is likely associated with chopped romaine lettuce from the Yuma, Arizona growing region. Three cases of E. coli in Arizona have been linked to this multistate outbreak.

Also, today the Montana Department of Health announced that there has been an increase in reports of STEC O157 cases in Montana, with onset dates between 3/28 and 4/7. These cases are linked to a multi-state outbreak of STEC O157 sickening at least 29 individuals in 11 states. This total includes three confirmed STEC O157 cases (2 in Missoula, 1 in Ravalli) with patterns matching the national outbreak strain. An additional five PCR positive cases are pending culture confirmation with the state laboratory (3 in Flathead, 1 in Lincoln, and 1 in Gallatin). Further analysis will be needed to determine if they part of the outbreak. Please see the information below for recommendations.

According to the CDC, epidemiologic evidence collected to date indicates that chopped romaine lettuce is the likely source of this outbreak. Most people reported eating a salad at a restaurant, and romaine lettuce was the only common ingredient identified among the salads eaten. The restaurants reported using bagged, chopped romaine lettuce to make salads.

Traceback investigations are ongoing to determine the source of chopped romaine lettuce supplied to restaurant locations where ill people ate. At this time, no common grower, supplier, distributor, or brand has been identified. However, preliminary information indicates that the chopped romaine lettuce was from the Yuma, Arizona growing region. Information collected to date indicates that chopped romaine lettuce from the Yuma, Arizona growing region could be contaminated with E. coli O157:H7 and could make people sick.

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.

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.

Health officials are investigating a series of recent illnesses from a dangerous strain of E. coli bacteria that may be linked to romaine lettuce.  Five people in the U.S. have been hospitalized and one has died, according to the Centers for Disease Control and Prevention (CDC).  There has also been one death reported in Canada.

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.

Over the past seven weeks, 58 people in the U.S. and Canada have become ill from the strain of E. coli (0157:H7). In the U.S., the infections have occurred in 13 states — California, Connecticut, Illinois, Indiana, Michigan, Nebraska, New Hampshire, New York, Ohio, Pennsylvania, Virginia, Vermont, and Washington state.

Canadian health authorities identified romaine lettuce as the source of the outbreak in Canada, and are advising people in the country’s eastern provinces to consider eating other types of salad greens until further notice. In the U.S., government health officials are investigating the outbreaks, but have stopped short of recommending people avoid romaine lettuce or any other food.

Affected states include California, Connecticut, Illinois, Indiana, Michigan, Nebraska, New Hampshire, New York, Ohio, Pennsylvania, Virginia, Vermont, and Washington.  Link to recent Canadian Outbreak.

Federal and state health officials are investigating a multistate Escherichia coli O157:H7 outbreak that has sickened 17 people in 13 states, and preliminary tests by the US Centers for Disease Control and Prevention (CDC) show that the outbreak strain is closely related to one in Canada that has been associated with romaine lettuce.

The CDC said illness onsets range from Nov 15 through Dec 8, according to a press release today sent to journalists.

State and local authorities are interviewing sick people to see what they ate in the week before they became ill. Because a source of the US infections hasn’t been identified, the CDC said it is unable to recommend if US residents should avoid a particular food. “This investigation is ongoing, and more information will be released as it becomes available,” it said.

The Public Health Agency of Canada (PHAC) issued its first announcement about an E coli outbreak linked to romaine lettuce on Dec 11. In a Dec 21 update, it said it is so far investigating 41 cases from five provinces: Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador. There was one reported death. It urged the public to avoid eating romaine lettuce until more is known about the contamination.

Public Health England has linked a 12 cases of E. coli to Sainsbury’s Taste the Difference Aberdeen Angus quarter-pounder burgers, 454g packets, which are sold in the frozen section. Product: Taste the Difference 4 pack Aberdeen Angus British Beef Quarter Pounders (Frozen). Batches with ‘Best Before’ dates: July 2018, September 2018 and October 2018

The Public Health Agency of Canada says 40 E. coli illnesses are under investigation as possibly being linked to romaine lettuce. People who have reported illnesses have said that they ate romaine at home, at restaurants and in prepared salads purchased from grocery stores. The people infected are between the ages of 4 to 80 years of age and 70 % are women. One person has died.

So, where did the romaine lettuce come from?

The Public Health Agency of Canada is collaborating with provincial public health partners, the Canadian Food Inspection Agency and Health Canada to investigate an outbreak of Escherichia coli O157:H7. The outbreak involves five provinces and is linked to romaine lettuce. At this time, there are no product recalls associated with this outbreak. The outbreak investigation is ongoing, and this public health notice will be updated on a regular basis as the investigation evolves

Currently, there are 30 cases of E. coli O157 illness under investigation in five provinces: Ontario, (6), Quebec (5), New Brunswick (5), Nova Scotia (1), and Newfoundland and Labrador (13). Individuals became sick in November and December 2017. Twelve individuals have been hospitalized. One individual has died. Individuals who became ill are between the ages of 4 and 80 years of age. The majority of cases (70%) are female.

So, where did the romaine lettuce come from?