U.S. FDA and CDC Investigating Multistate Outbreak of E. coli O157:H7 Illnesses Likely Linked to Romaine Lettuce

PRESS RELEASE   NO.: 2019-016

U.S. FDA and CDC Investigating Multistate Outbreak of E. coli O157:H7 Illnesses Likely Linked to Romaine Lettuce

The U.S. Food and Drug Administration (FDA), the U.S. Centers for Disease Control and Prevention (CDC), and state and local health departments, are investigating a multistate outbreak of Escherichia coli O157:H7 illnesses likely linked to romaine lettuce.  Similarly, the Public Health Agency of Canada (PHAC) and the Canadian Food Inspection Agency, are also coordinating with U.S. agencies in investigating a similar outbreak in Canada.

As of November 20, 2018, 32 people infected with the outbreak strain of E. coli O157:H7 have been reported from 11 states.  Illnesses started on dates ranging from October 8, 2018 to October 31, 2018.  Thirteen individuals were hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure.  No deaths have been reported.  Illnesses that occurred after October 30, 2018, might not yet be reported due to the time it takes between when a person becomes ill with E. coli O157:H7 infection and when the illness is reported.  This takes an average of two to three weeks.

FDA and state health authorities are working to traceback romaine lettuce that ill people ate in the current outbreak.  Currently, FDA does not have enough traceback information to identify the source of the contamination.  Thus, no common grower, supplier, distributor, or brand of romaine lettuce has been identified.  At this stage in the investigation, the most efficient way to ensure that contaminated romaine is off the market would be for industry to voluntarily withdraw product from the market, and to withhold distribution of romaine lettuce until public health authorities can ensure the outbreak is over and/or until FDA can identify a specific source of contamination.

The symptoms of Shiga toxin-producing E. coli (STEC) infections vary for each person, but often include severe stomach cramps and bloody diarrhea.  If there is fever, it is usually not very high (less than 101 °F/38.5 °C).  Most people get better within 5–7 days.  Some infections are very mild, but others are severe or even life-threatening.  Around 5–10 percent of those who are diagnosed with STEC infection develop a potentially life-threatening complication, known as hemolytic uremic syndrome (HUS).  Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor.  Most people with HUS recover within a few weeks, but some suffer permanent damage or die.  People who experience these symptoms should seek emergency medical care immediately.  Persons with HUS should be hospitalized because their kidneys may stop working (acute renal failure), but they may also develop other serious problems such as hypertension, chronic kidney disease, and neurologic problems.

People of any age can become infected with Shiga toxin-producing E. coli (STEC). Children under the age of 5 years, adults older than 65, and people with weakened immune systems are more likely than others to develop severe illness, including HUS, but even healthy older children and young adults can become seriously ill.

DEH has not received any local report of injuries or illnesses associated with the use of romaine lettuce.  This investigation is on-going.  More information will be shared with the public as it becomes available. 

Recommendations by FDA, CDC, and DPHSS:   

For consumers:

Consumers who have any type of romaine lettuce in their home should not eat it and should throw it away, even if some of it was eaten and no one has gotten sick.  This advice includes all types or uses of romaine lettuce, such as whole heads of romaine, hearts of romaine, and bags and boxes of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad.  Wash and sanitize drawers or shelves in refrigerators where romaine was stored. 

If consumers do not know if the lettuce is romaine or whether a salad mix contains romaine, do not eat it and throw it away. (Please note that these are recommendations by FDA, CDC, and DPHSS)

For retailers, restaurants, distributors, and other food service operators:

Do not sell, distribute, or serve romaine lettuce until more is known about this outbreak. (Please note again, that these are recommendations by FDA, CDC, and DPHSS)

Consumers are encouraged to keep abreast of this investigation by logging on to FDA’s website at www.fda.gov, CDC’s website at www.cdc.gov, or by contacting the Consumer Commodities Program at the DEH at 735-7221 or via dphss-deh@dphss.guamdev.com.


       LEO G. CASIL

       Acting Director

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