E. coli Outbreak Linked With Romaine Lettuce Claims a Life as It Expands to Include Half the US

The first fatality in the multistate Escherichia coli (E. coli) outbreak linked with romaine lettuce was reported by the Centers for Disease Control and Prevention (CDC) on May 2, 2018. Furthermore, the outbreak has expanded to include half of the United States.

Since the last update, 23 more illnesses have been reported, bringing the total to 121 cases; 52 out of 102 (52%) individuals with available information have required hospitalization for their illnesses. Of those hospitalized, 14 individuals went on to develop hemolytic uremic syndrome (HUS).

One death has been reported in California; however, the CDC has not yet provided any additional information about the individual. The California Department of Public Health reportedly said that they cannot provide any more details due to patient privacy laws.

As discussed by Matthew Wise, PhD, MPH, deputy branch chief for Outbreak Response at the CDC in last week’s media telebriefing, the outbreak strain “is one that tends to cause more severe illness based on the kind of toxin it produces.” This is why the percentage of those requiring hospitalization is higher than what is typically seen with E. coli outbreaks, where, on average, only 30% of individuals end up in the hospital.

In addition, 3 more states have reported illnesses associated with the outbreak—Kentucky, Massachusetts, and Utah—bringing the total states affected to 25, half of the country.

The US Food and Drug Administration (FDA) has received confirmation from the Arizona Leafy Greens Marketing Agreement administered by the Arizona Department of Agriculture that “romaine lettuce is no longer being produced and distributed from the Yuma growing region [one of the confirmed sources], reducing the potential for exposure to the contaminated product.”

However, the FDA is still working on identifying additional sources responsible for the outbreak. “We are working to identify multiple distribution channels that can explain the entirety of the nationwide outbreak and are tracing back from multiple groupings of ill people located in diverse geographic areas,” the most recent statement reads.

As reported in last week’s media telebriefing, health officials were able to identify at least 1 of the sources, Harrison Farms. Contaminated whole heads of romaine lettuce were sold from the farm to a prison in Nome, Alaska, where 8 inmates subsequently fell ill. In the most recent update, the FDA says that the agency has not been able to determine where in the supply chain contamination of the lettuce occurred.

“The agency is examining all possibilities, including that contamination may have occurred at any point along the growing, harvesting, packaging, and distribution chain before reaching the Alaska correctional facility where it was served,” they said. However, the FDA reports that the majority of the illnesses in the outbreaks are associated with chopped romaine, not the whole heads.

As of the publishing date, the FDA does not suspect that any other types of lettuce are involved in the outbreak, and there is no evidence to support that any other romaine lettuce grown outside of the Yuma growing region is responsible for outbreak illnesses.