United States & Canadian Health Safety Alert/Public Health Notice on 11/20/18 of E. Coli O157: H7 Outbreak Linked to Romaine Lettuce

IN THE NEWS

The CDC, Public Health Officials for multiple states, the FDA, the Public Health Agency of Canada, Provincial Health Partners, Health Canada, and the Canadian Food Inspection Agency are collaborating on an investigation into a new outbreak of Shiga toxin producing E. Coli O157: H7 in 11 states (32 cases with 13 hospitalizations) and 2 provinces (18 confirmed cases with 5 hospitalizations).  The US and Canada are each reporting one (1) case each of hemolytic uremic syndrome (HUS), a type of kidney failure considered a serious complication of this strain of E. Coli.  There have been no deaths in either country.  The U.S’s cases so far range from 10/8/18 and 10/31/18, while Canada’s range from mid-October through early November with more expected since a source (grower, processor, distributor, or retailer has not been determined.

Importantly, this outbreak is genetically related to the outbreak that started in November of 2017, which also affected the US and Canada.   The US found this outbreak related to leafy greens while, Canada narrowed it to romaine lettuce.  It is not, however, related to the E Coli outbreak associated with the Yuma region in the Spring/Summer of 2017.  Since the actual source of the romaine lettuce has not been identified, the health alert is very broad.   Investigation continues and updates will be given when new information is available.

Cases in this current outbreak are expected to continue and, this time, both countries believe that it is related to romaine lettuce and that this romaine lettuce is likely still on the market, including in stores, restaurants, and homes.  The CDC has issued a Safety Alert advising ALL Consumers to not eat any romaine lettuce and that grocery stores (or other retailers) and restaurants should not sell or serve ANY romaine lettuce.  This includes all forms of romaine lettuce (whole heads, leaves, and hearts of romaine, bags/boxes of precut romaine lettuce, as well as salad mixes that contain any romaine such as baby or regular, spring mix and Caesar salad.  If you cannot be sure that a lettuce is not romaine or that a salad mix doesn’t contain it, it should be considered part of this alert.  The Public Health Agency of Canada is advising its citizens and visitors of Ontario or Quebec to avoid eating ANY romaine lettuce and any salad mixes containing romaine lettuce until there has been a determination about the cause of the contamination.

The CDC provides this advice:

1. Consumers who have any romaine lettuce in their homes should discard it, even if some of it has been eaten and no one is ill.
2. Wash and sanitize any shelves or drawers where romaine lettuce was kept or had any contact.
3. Restaurants and stores (retailers) should not sell or serve any romaine lettuce, including mixes containing romaine.
4. If you have symptoms (see below) of E. Coli infection:
   1. Talk to your healthcare provider
   2. Log what you ate for the week before you started getting sick
   3. Report (or assure the HCP does) your illness to the local health department and assist them by answering questions about your illness and food log; provide specimens as requested.

Incubation period (the time from exposure to signs of illness):  most begin to feel sick in 3 to 4 days after eating or drinking something with the E. Coli bacteria, but it can actually occur from1 to 10 days after exposure.

Symptoms:  vary from person to person but often include severe stomach/intestinal cramps, diarrhea, which may be bloody, and/or vomiting. There may be a fever but it’s usually less than 101^oF (38.5^o C)

Infections may range from mild to severe and some may be life threatening.  The illness usually lasts 5-7 days but visit your HCP or 911 should be called if the diarrhea lasts more than 3 day or is combined with a high fever, blood in the stool, or continuous vomiting that prevents liquids from staying down or results in very little urine output.

5-10% of those with Shiga-toxin E. Coli, will develop the complication of hemolytic uremic syndrome approximately a week after symptoms first begin and when the diarrhea is improving.  Signs of HUS include decreased urination, fatigue, and/or becoming pale in the cheeks and lower eyelids.  Anyone with these signs should be evaluated by a HCP, often in an emergency department and, if diagnosed with HUS, will typically be admitted.  Renal failure or other problems may occur and supportive therapy is usually needed.  Most people will recover in a few weeks but some have permanent damage or die.

CDC Media statement on current Shiga-toxin E. Coli O157:H7:
https://www.cdc.gov/media/releases/2018/s1120-ecoli-romain-lettuce.html

CDC Info on this Outbreak and Investigation:
https://www.cdc.gov/ecoli/2018/o157h7-11-18/index.html

CDC US Map and State Case Totals:
https://www.cdc.gov/ecoli/2018/o157h7-11-18/map.html

Public Health Agency of Canada info on this Outbreak and Investigation:
https://www.canada.ca/en/public-health/services/public-health-notices/2018/outbreak-ecoli-infections-linked-romaine-lettuce.html

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