By: Candess Zona-Mendola

The CDC announced an additional 7 illnesses linked to its outbreak of E. coli O157 reportedly linked to “leafy greens.” At this time, state and local public health officials continue to interview sick people in the US to determine what they ate in the week before their illnesses began. The preliminary findings show that, of the 13 people with completed interviews, all of them reported eating leafy greens – five of these reported eating romaine. The CDC commented on the results that:

“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.”

Meanwhile, our northern neighbors in Canada have deemed their outbreak over, based on the shelf life of the linked product.

FDA Response

The FDA also responded to the outcry for more transparency in its investigations. According to FDA representative Scott Gottlieb, MD, via tweet:

“#FDA will continue to update on the recent e coli outbreak. Illness onsets among reported cases occurred in late Nov & early Dec, so the source of these cases is likely no longer on the market. We’re working closely with partners to identify that source.”

At this time, there no report (or hunch) where the romaine was grown or what manufacturer may be involved.  Details have not been released about where the contamination (may have) occurred or if subsequent lots of “leafy greens” may be still for sale or contaminated.

Outbreak Stats

Currently, there are 24 illnesses have been reported in 15 states: 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). The United States’ illnesses are reported to have been from November 15 through December 12, 2017. Of these, 5 have been hospitalized, 2 developed HUS, and there has been 1 death in California. The CDC, FDA, and Canadian government agencies continue to investigate these potentially linked outbreaks. It is likely the numbers will grow, as it takes about 3 weeks for confirmed links to be finalized.

In Canada, the numbers are even higher. Currently, there are 41 cases in five eastern Canadian provinces: Ontario (8), Quebec (14), New Brunswick (5), Nova Scotia (1), and Newfoundland and Labrador (13). Of those that have confirmed cases, their illnesses range from November and early December 2017. Of these, 17 have been hospitalized, and one person has died.

A Timeline of Events

On December 11, 2017, the Public Health Agency of Canada launched a website and issued an alert of its collaboration with other agencies to investigate an outbreak of E. coli O157. At the time, only three provinces were involved and the alert implicated romaine right away. With 21 cases of illness, the PHAC recommended, “…Canadians are reminded to follow safe food handling practices for lettuce to avoid becoming ill. Most people with an E. coli infection will become ill for a few days and then recover fully. Some E. coli infections can be life threatening, though this is rare.”

Three days later, on December 14, 2017, two more provinces were added by the PHAC. The case count rose to 30 and news broke that one person died as a result of the outbreak.

On December 21, 2017, the PHAC notified the public that 10 more cases were linked – bringing the case count to 40. The agency commented, “Individuals in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador are advised to consider consuming other types of lettuce, instead of romaine lettuce, until more is known about the outbreak and the cause of contamination.” With the ongoing outbreak investigating and lack of recall, the PHAC recommended that “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 December 28, 2017, the PHAC updated its page to confirm another illness. They also released information that the United States Centers for Disease Control and Prevention was not involved, conducting its own investigation, and had launched its own media statement. The CDC informed the public that, although Canada had implicated romaine, they were still in the determination stage. According to their statement:

“Whole genome sequencing is being performed on samples of bacteria making people sick in the United States to give us information about whether these illnesses are related to the illnesses in Canada. Preliminary results show that the type of E. coli making people sick in both countries is closely related genetically, meaning the ill people are more likely to share a common source of infection.

The Public Health Agency of Canada has identified romaine lettuce as the source of the outbreak in Canada. In the United States, state and local public health officials are interviewing sick people to determine what they ate in the week before their illness started. CDC is still collecting information to determine whether there is a food item in common among sick people, including leafy greens and romaine.

Because we have 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.”

With the lack of recalls in either country, Consumer Reports felt the need to take a stance. On January 3, 2018, the organization’s food safety experts issued their first warning for Americans to avoid eating romaine lettuce. The following day, they posted an article that not even washing lettuce could not 100% protect against an E. coli infection. James Rogers, Ph.D., a food safety expert, commented:

“It is very difficult to remove bacteria from leafy greens,” he says. “Bacteria have the ability to adhere to the surface of the leaves, and to get stuck in microscopic crevices.”

On January 5, 2018, Consumer Reports again reminded the nation that the E. coli outbreak was likely linked to the Canadian one.

During this time, several Canadian and American outlets have opted to forgo romaine sales and have removed romaine lettuce from their shelves. Food Service Giant Compass Group suspended lettuce sales late last week.

On January 10, 2018, the PHAC posted and updated notice. In its notice, the agency commented:

“This notice is being updated to reflect that the outbreak appears to be over. The risk to Canadians has returned to low and the Public Health Agency of Canada is no longer advising individuals in affected provinces to consider consuming other types of lettuce, instead of romaine lettuce.

… The investigation into the possible source of the contaminated product remains active in the United States.”

On the same day, the CDC issued its own media statement. According to the CDC:

“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.

… 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.”

UnsafeFoods will continue its reporting on this outbreak – and any potential recalls.