Romaine Lettuce E. coli Outbreak has now sickened nearly a hundred people, that we know about, in 22 states.  The 98 confirmed cases are, by CDC estimates, only the tip of the iceberg in terms of the number of individuals who have become ill, with the estimated number of E. coli victims likely nearing 3000 if the one-in-thirty estimate of reported./confirmed verses actual illnesses holds true.  Each victim to be counted, must present to a medical professional who suspects E. coli and who chooses to identify the strain or confirm the presence of E. coli through a stool culture.  Many medical professionals will either assume a viral infection or treat a bacteria infection general, and diagnose the individual with gastroenteritis.  A general diagnosis of gastroenteritis, however, like a more genric food-poisoning diagnosis, does not identify the pathogen and does not get reported to the local health agency, whose job it is to follow up on reportable communicable pathogens.

If a stool culture is performed, a positive is reported to the local health agency who has jurisdiction and that sample is often sero-typed if an outbreak is suspected.  For Salmonella, there are over 2000 serotypes.  There are many fewer for E. coli, with the most common being predominant – E. coli O157: H7.

Th Romaine lettuce E. coli outbreak is in fact the E. coli O157:H7 strain, and hence very common.  As such, the sample is often subjected to further analysis at a state laboratory or the Centers for Disease Control and Prevention, where it is subjected to Pulsed-field gel electrophoresis (PFGE) that determines its genetic fingerprint.  The PFGE allows health personnel across the world to identify what product is linked to an outbreak.  FIrst, victims are given a broad food questionnaire and asked numerous categorical questions to narrow the focus.  These are often called shot-gun questionnaires.  A more targeted questionnaire is used one, say, lettuce is identified bu statistical analysis (a control groups purchases and consumption verses the infected populations’ purchases and consumption).  Then the type of lettuce is determined by specific questioning, and the source of each person’s purchase or consumed Romaine Lettuce then identified.  The CDC and FDA work with state and local health agencies to find the source as quickly as possible.

In the case of the Romaine Lettuce E. coli Outbreak, investigators now know that the contaminated Romaine lettuce comes from the Yuma area i Arizona, but they have yet to identify a specific vendor or distributor.  This will eventually happen according ot the opinion of most food safety experts, but it can take time.  As of now, the easiest part of the supply chain has been the local establishments, such as Wal-Mart and other grocery stores who sold the tainted Romaine lettuce to the public.  These companies will likely fact E. coli lawsuits, but may end up indemnified up the chain in the stream of commerce (most retail outlets have an indemnity agreement with the companies that sell product at their stores).

The victims in this outbreak come mostly from Pennsylvania and California, with eighteen and  sixteen identified victims, respectively.  Idaho, Alaska, Montana and New Jersey follow with between 7 and 10 each, and then Arizona, Colorado, Connecticut, Georgia, Illinois, Louisiana, Michigan, Mississippi, New York, Ohio, South Dakota, Tennessee, Virginia, Washington and Wisconsin each have one of more.

Ironically, another recent outbreak, E coli O157:H7 was linked to leafy greens in the end of 2017. Also in late 2017 and early 2018, a Romaine lettuce outbreak of E. coli was identified in Canada.  The twelve month period 2017/2018 is likely to be one of the largest lettuce-induced E. coli on record,  though not unprecedented.  Lettuce, and especially Romaine lettuce, is hard to clean and not subject to heat treatment.  For this reason, health professionals encourage the public to wash all lettuce very well prior to consuming it.  In Romaine lettuce e. coli lawsuits, recently filed, companies are being held accountable for damages this outbreak has caused – including one death and 172 illnesses in 32 states.