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Romaine Lettuce

Romaine Lettuce

Romaine Lettuce

Outbreak of E. coli Infections Linked to Romaine Lettuce

Posted November 22, 2019 at 7:30 PM ET

CDC, public health and regulatory officials in several states, and the >U.S. Food and Drug Administrationexternal icon(FDA) are investigating a multistate outbreak of E. coli O157:H7 infections linked to romaine lettuce harvested from the Salinas, California growing region.

Recall and Advice to Consumers, Restaurants, and Retailers

Example of a harvest region label.

Based on new information, CDC is advising that consumers not eat and retailers not sell any romaine lettuce harvested from the Salinas, California growing region.

  • Most romaine lettuce products are labeled with a harvest location showing where they were grown.
  • This advice includes all types of romaine lettuce harvested from Salinas, California such as whole heads of romaine, hearts of romaine, and packages of precut lettuce and salad mixes which contain romaine, including baby romaine, spring mix, and Caesar salad.
  • If you have romaine lettuce at home:
    • Look for a label showing where the romaine lettuce was grown. It may be printed on the package or on a sticker.
    • If the label says “Salinas” (whether alone or with the name of another location), don’t eat it, and throw it away.
    • If it isn’t labeled with a growing region, don’t eat it, and throw it away.
    • If you don’t know if the lettuce is romaine or whether a salad mix contains romaine, don’t eat it, and throw it away.
    • Wash and sanitize drawers or shelves in refrigerators where romaine lettuce was stored. Follow these five steps to clean your refrigerator.
  • If you are buying romaine lettuce at a store:
    • Look for a label showing where the romaine lettuce was grown. It may be printed on the package or on a sticker.
    • If the label says “Salinas” (whether alone or with the name of another location), don’t buy it.
    • If it isn’t labeled with a growing region, don’t buy it.
  • Restaurants and retailers should check the label on bags or boxes of romaine lettuce, or ask their suppliers about the source of their romaine lettuce.
    • Look for a label showing where the romaine lettuce was grown. It may be printed on the package or on a sticker.
    • If the label says “Salinas” (whether alone or with the name of another location), don’t sell or serve it.
    • If it isn’t labeled with a growing region, don’t sell or serve it.
  • Suppliers, distributors, and others in the supply chain should not ship or sell romaine harvested in Salinas, California.

 

On November 21, 2019, Missa Bay, LLC, recalledexternal icon salad products due to possible E. coli contamination.

 

Do not eat or sell any of the recalled salad products, which were sold under many different brand names.

  • The recalled salad products have “Use By” dates ranging from October 29, 2019, to November 1, 2019.
  • The recalled products have establishment number “EST. 18502B” inside the USDA mark of inspection.
  • Visit the USDA website pdf icon[PDF – 1 page]external icon for a full list of recalled products.
    • This recall includes salad products that contained contaminated romaine lettuce. The romaine lettuce was tested by the Maryland Department of Health as part of a foodborne illness outbreak in Maryland.

Take action if you have symptoms of an E. coli infection.

  • Talk to your healthcare provider.
  • Write down what you ate in the week before you started to get sick.
  • Report your illness to your local health department.
  • Assist public health investigators by answering questions about your illness.
  • Prevent infections in others by practicing proper hygiene, especially good handwashing.

Latest Outbreak Information

  • A total of 40 people infected with the outbreak strain of E.coli O157:H7 have been reported from 16 states.
    • A total of 28 hospitalizations have been reported. Five people have developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.
  • Epidemiologic, laboratory, and traceback evidence collected to date indicate that romaine lettuce from the Salinas, California growing region may be contaminated with E. coli O157:H7 and is making people sick.
  • Whole genome sequencing shows that the E. coli strain in romaine lettuce tested by the Maryland Department of Health is closely related genetically to the E. coli found in sick people in this outbreak. The romaine lettuce was harvested from the Salinas, California growing region.
  • The investigation is ongoing to determine the source of contamination and if additional products are linked to illness.
  • CDC will provide more information as it becomes available.

Symptoms of E. coli Infection

  • People usually get sick from Shiga toxin-producing E. coli 2 to 8 days (average of 3 to 4 days) after swallowing the germ.
  • Some people with E. coli infections may get a type of kidney failure called hemolytic uremic syndrome (HUS).
  • E. coli infection is usually diagnosed by testing a stool sample.
  • Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out. Some studies have shown that administering antibiotics to patients with E. coli infections might increase their risk of developing HUS, and a benefit of treatment has not been clearly demonstrated.
  • For more information, see Symptoms of E. coli Infection.

Investigation Details

 

November 22, 2019

 

Since the initial investigation notice, 23 additional ill people have been reported. As of November 21, 2019, a total of 40 people infected with the outbreak strain of E. coli O157:H7 have been reported from 16 states. A list of the states and the number of cases in each can be found on the Map of Reported Cases page.

 

Illnesses started on dates ranging from September 24, 2019, to November 10, 2019. Ill people range in age from 3 to 89 years, with a median age of 22. Sixty-five percent of ill people are female. Of 39 ill people with information available, 28 hospitalizations have been reported, including 5 people who developed hemolytic uremic syndrome (HUS), a type of kidney failure. No deaths have been reported.

 

Investigation of the Outbreak

 

Epidemiologic, laboratory, and traceback evidence indicate that romaine lettuce from the Salinas, California growing region is a likely source of this outbreak.

 

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Eight (80%) of 10 people interviewed reported eating romaine lettuce. This percentage is significantly higher than results from a survey pdf icon[PDF – 787 KB] of healthy people in which 47% reported eating romaine lettuce in the week before they were interviewed. Ill people in Maryland reported eating Ready Pac Foods Bistro® Chicken Caesar Salad. To date, ill people in other states have not reported eating this particular salad, which contained romaine lettuce from the Salinas, California growing region.

 

As reported on November 20, 2019, the Maryland Department of Healthexternal icon identified E. coli O157 in romaine lettuce from an unopened package of Ready Pac Foods Bistro® Chicken Caesar Salad collected from a sick person’s home in Maryland. Whole genome sequencing has been completed and shows that the E. coli strain in the romaine lettuce is closely related genetically to the E. coli found in sick people in this outbreak. This provides additional evidence that people in this outbreak got sick from eating romaine lettuce.

 

FDA and states are tracing the
source of the romaine lettuce eaten by ill people. Preliminary information indicates that some of the ill people ate lettuce grown in Salinas, California. No common grower, supplier, distributor, or brand of romaine lettuce has been identified.

 

CDC is advising that consumers not eat and retailers not sell any romaine lettuce harvested from Salinas, California until more information is available. The investigation is ongoing to determine the source of contamination and if additional products are linked to illness.

 

This outbreak is caused by the same strain of E. coli O157:H7 that caused outbreaks linked to leafy greens in 2017 and to romaine lettuce in 2018.

 

Page last reviewed: November 22, 2019

 

Content source: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Foodborne, Waterborne, and Environmental Diseases (DFWED)