Just when we thought the E.coli O157:H7 outbreak involving romaine lettuce was over: Today CDC issued a Food Safety Alert informing consumers not to eat ANY romaine lettuce. Retailers and restaurants shouldn’t serve any either.
“Thirty-two people infected with the outbreak strain of Shiga toxin-producing E. coli O157:H7 have been reported from 11 states.
Illnesses started on dates ranging from October 8, 2018 to October 31, 2018.
Thirteen people were hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.” – CDC
The agency is urging against the consumption of romaine lettuce because they haven’t been able to identify a common grower, supplier, distributor or brand.
Could we be in for another widespread outbreak? Just last week during a panel discussion at the Food Safety Consortium, the FDA and CDC said that when the last outbreak occurred they knew it would get bad really quickly.
This year’s multistate outbreak of E.coli O157:H7 infections linked to romaine lettuce affected 210 people, killing five. Although the outbreak was officially declared over by the end of June, questions still remain as to the exact source. Given the widespread nature of the outbreak and the speed with which illnesses occurred, there are many lessons to be learned from the case.
During last week’s annual Food Safety Consortium, industry stakeholders from the FDA, CDC and produce associations gathered to discuss agency action upon learning of the outbreak and where there is room for improvement.
The investigation began in April 2018 when the New Jersey Department of Health contacted the CDC about a cluster of E.coli O157:H7 illnesses from people who said they ate salads at various locations of the same restaurant chain. Three days later, the agency was able to confirm eight O157 isolates from six states with the same patterns using PulseNet. And five days after that, the CDC posted a notice on its website about the investigation of 17 cases across seven states.
“We knew right away that this was going to get bad and that it would get bad quickly,” said Matthew Wise, deputy branch chief for outbreak response at the Outbreak Response and Prevention Branch of the CDC. “We saw illnesses ramp up quickly.” He added that the agency saw a lot of illness subclusters, all with romaine lettuce as the common ingredient.
The epidemiological evidence clearly indicated chopped romaine lettuce, and it appeared that all the affected romaine was coming from the Yuma, Arizona growing region, noted Stic Harris, director of the Coordinated Outbreak Response & Evaluation Network at FDA. But then things got even more confusing, as an Alaskan correctional facility was also investigating a cluster of cases. This allowed the agency to trace the source directly back to Harrison Farms as the sole supplier to the correctional facility. However, as the multi-agency investigation continued, they uncovered that the source was not just one farm. “There were three dozen farms in the Yuma region that supplied romaine lettuce,” said Harris, adding that we may never know which exact farm, and even if it was one farm, that was the source of the outbreak.
During June, July and August, the FDA sent a multidisciplinary team of 16-18 people to conduct an environmental assessment of the affected area. Upon taking 111 samples, they found 13 different Shiga toxin-producing E. coli strains, but only three matched the strain of the outbreak. Water from 14 locations, including discharge, reservoir and canal water, was also tested. The environmental assessment found pervasive contamination in the water. But here was the big problem, said Harris: “There was no smoking gun. We don’t know how the E.coli got into the water, and we don’t know how the water got onto the lettuce.” He added that additional research is needed, and that government and non-government work must continue to identify the source.
There are several challenges associated with the complexity of this type of produce outbreak, said Harris and Wise:
The production lot information disappears at the point of service
Having a commingled product hinders traceback
Records present a challenge because agencies try to look at each company and their individual records, and every company has their own way of doing things—this takes time
The breadth of the impacted area—trying to do an environmental assessment for that area was staggering work
People who eat lettuce eat it often
Many people don’t remember what type of lettuce they ate
The product has a short shelf life
Communication: The packaging isn’t transparent on where it’s grown
Scott Horsfall, CEO, California Leafy Green Products Handler Marketing Agreement, chimed in on the challenges posed by the complexity of the outbreak. “If you compare these numbers with the 2016 spinach outbreak…they’re very similar [in the] total number of illnesses [and] number of states involved. But in [the spinach outbreak], it led to a specific farm. What we saw this time was very different.”
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One of the large successes in dealing with the outbreak is that the agencies issued public warnings quickly, said Wise. The produce industry also came together to form the Leafy Greens Food Safety Task Force. In addition, FDA is expanding its sampling for the coming harvests, according to Harris. “I think that in terms of the speed of the environmental assessment, we need to be quicker with that. We apparently hadn’t done one in quite a long time at FDA,” he said.
Harris and Wise also stressed that for industry to work more effectively together, they need to work with the FDA and CDC before there is an outbreak.
“This outbreak was a frustrating experience for all of us,” said Horsfall. “We have to communicate more and better when we can. And as an industry, stop these outbreaks from happening.”
These issues highlight how the increasingly complex supply chain further complicates problems once they arise. Ostroff emphasized the necessity of end-to-end tracing, from product origination to where the consumer can access the product, and that it needs to be efficient, standardized and rapid, especially for commodities. Regarding the E. coli O157:H7 outbreak involving romaine lettuce, FDA is still trying to determine the source and mode of the contamination. And while the recent finding of the outbreak strain in the irrigation canal water is important, it still does not answer the question of how the contamination got into the canal, said Ostroff.
The latest FDA update on the outbreak investigation stated that additional samples are being analyzed on an ongoing basis and any new matches would be publicly disclosed. As of June 28, the CDC announced that the outbreak was over.
Following the multi-state E. coli O157:H7 outbreak linked to romaine lettuce from the Yuma, Arizona region, several groups have come together in the hopes of preventing future outbreaks. Despite the fact that the FDA announced that the outbreak was likely over weeks ago, 4 more deaths have occurred (bringing the total to 5 dead), and three more states have reported ill people.
Now the Arizona and California leafy greens industries, the Produce Marketing Association, Western Growers, United Fresh and other groups have created a special task force to improve food safety systems across the supply chain. The Leafy Greens Food Safety Task Force will consist of industry members, food safety experts, researchers and representatives from government.
“It is very difficult to identify an issue weeks or months after the fact, primarily because of the expediency with which our product is harvested and in the marketplace,” said Arizona Leafy Greens Marketing Agreement Chair Jerry Muldoon in a press release. “With our industry knowledge, scientific experts and the collaboration of state and federal agencies, we believe we can help get to the bottom of this and make changes to processes after our product leaves the farm, as well as closely examine other factors at play.”
The latest update from CDC puts the case count at 197 ill, five dead, 89 hospitalizations, with a span of illnesses across 35 states.
The multi-state E.coli O15:H7 outbreak linked to romaine lettuce may be nearly over. According to the FDA, romaine lettuce from the Yuma growing region is no longer being harvested or distributed, which means “it is unlikely that any romaine lettuce from the Yuma growing region is still available in stores or restaurants due to its 21-day shelf life,” the agency states. The last harvest date was April 16.
Spanning across 32 states, thus far the case count of infections is at 172, with 75 hospitalizations and one death, according to the CDC.
The FDA investigation continues, and the agency is looking at all potential avenues of contamination throughout the chain—including growing, harvesting, packaging and distribution.
The number of illness cases linked to the E.Coli 0157:H7 outbreak has jumped to 98. Fourteen more people from eight states were added since Wednesday, and three more states have reported sick people: Mississippi, Tennessee and Wisconsin. The current number of states affected is 22, and hospitalizations have increased to 46. No deaths have been reported.
Now the CDC is advising consumers, restaurants and retailers to get rid of all romaine lettuce—not just chopped romaine, but also whole heads and hearts of romaine, and salads and salad mixes containing the variety—if they cannot confirm the source. “Information collected to date indicates that romaine lettuce from the Yuma, Arizona growing region could be contaminated with E. coli O157:H7 and could make people sick,” the CDC states on its website.
The most current illness case count is 53, with illnesses reported in 16 states. There have been 31 hospitalizations thus far and no deaths, according to the CDC.
At least 35 people in 11 states have been infected with E.coli O157:H7, according to the CDC, and the FDA is investigating a likely link to these infections and chopped romaine lettuce from Yuma, Arizona. The reported illnesses occurred between March 22 and March 31, and 93% of the 28 people interviewed reported eating romaine lettuce (mainly from a restaurant) during the week that they became ill.
The FDA and CDC are advising consumers to ask restaurants and other food service establishments where they source their romaine lettuce from and to avoid any that came from Yuma, Arizona. In addition, they should not buy or eat it if they cannot confirm the source.
“Retailers, restaurants, and other food service operators should not sell or serve any chopped romaine lettuce from the winter growing areas in Yuma, Arizona. If you cannot determine the source of your chopped romaine lettuce, do not sell or serve it. The FDA currently does not have information to indicate that whole-head romaine lettuce or hearts of romaine have contributed to this outbreak.” – FDA
The agencies will continue to investigate this outbreak. FDA emphasized that this outbreak is not related to a multistate outbreak that occurred last November to December involving leafy greens, as those infections had a different DNA fingerprint of the E. coli O157:H7 bacteria.
Steer clear of romaine lettuce, urged Consumer Reports yesterday. An E.coli O157 outbreak in Canada traced to romaine lettuce has sickened 41 people in the country, according to the Public Health Agency of Canada. In the United States, a multi-state outbreak of Shiga toxin-producing E. coli O157:H7 has hit 13 states and infected at least 17 people. However, the CDC has not issued an alert, because it has not yet confirmed the source of the infection. The latest CDC media statement was issued on December 28, but Consumer Reports stated that the CDC confirmed “the strain of E. coli detected in the U.S. is ‘a virtual genetic match’ with the one that has caused illnesses in Canada.”
The Consumer Reports article also quotes the head of the CDC’s Outbreak Response Team, Matthew Wise, Ph.D., who said that the agency is examining romaine lettuce and other leafy greens and that the investigation in Canada gave the CDC a “good starting point.” He also said that the CDC’s investigation should be completed within the next two weeks.
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