Déjà vu, Romaine and E. coli Unfortunate Bedfellows Once Again. Romaine and E. coli Unfortunate Bedfellows Once Again. Wait…

Posted in E. coli,Outbreaks & Recalls on April 18, 2018

It feels like déjà vu. Romaine lettuce and E. coli are threatening our lives again, one salad at a time.  This E. coli outbreak affecting romaine lettuce DOES NOT appear to be linked to the previous outbreak experienced across two countries (United States and Canada) we saw in January.  The same cautions, however, are being followed.

Consumer Reports has chimed in once again urging consumers to pay attention to the origin of chopped salad mixes or avoid this particular leafy green all together.  A story we have heard not that long ago.  This particular outbreak follows the same storyline as the January outbreak, though we hope that it does not follow the same unfortunate end.  The Public Health Agency of Canada identified romaine lettuce earlier on than the United States Center for Disease Control and Prevention (CDC), warning citizens to avoid this product and requesting retailers and restaurants to offer different lettuce varieties instead.  

What’s the Same in This Outbreak?

We are seeing many of the same indicators observed in the January multi-state, multi-national outbreak we shared with our neighbors to the north, Canada.  So far, we can tell that we have the same bacteria, the same general source, and are given the same guidance from authorities and consumer advocates.

• Same Bacteria: The same deadly bacteria, Shiga toxin-producing coli (STEC) O157:H7 is indicated in this multi-state outbreak as it was in the previous multi-state and multi-national outbreak. E. coli is part of a diverse group of bacteria that is commonly found in the human gut.  Some species within E. coli are harmful, while many are harmless.  The E. coli O157:H7 indicated in this outbreak falls into the harmful category.  The shiga toxin, in particular, causes terrible illness in humans, leading to complications like hemolytic uremic syndrome HUS, and even death. Symptoms begin anywhere between 1 and 10 days after consuming contaminated food, though patients tend to become symptomatic at around 3 to 4 days.  Symptoms often include severe stomach cramps, vomiting, and bloody diarrhea, though symptoms may vary from person to person. If a fever is present, it is usually a low-grade fever less than 101⁰F.  Most people recover within 5 to 7 days, often without medical treatment.  An unfortunate 5 to 10% of those diagnosed with STEC infection develop HUS about 7 days after exposure.  Symptoms of HUS include decreased urination, loss of pink color inside the lower eyelids and on the cheeks.  Those showing symptoms of HUS should seek medical attention immediately or they may have kidney failure and infection could be fatal.  Most patients recover from HUS within a few weeks, though some may suffer more permanent damage and die.
• Same Lettuce: Lettuces are prone to E. coli because they grow directly in the ground. Fields where lettuces grow could become infected when animals make their way into crop fields and deposit contaminated feces. The lettuce in this outbreak and the multi-state, multi-national outbreak is the same romaine lettuce.  If you are a fan, you are out of luck.  You will need to find another leafy green once again to add to your salad mix.  As this keeps happening, chances are you have a second on your list already.
• Same Guidance: At this point investigators have narrowed the source to romaine lettuce. But again, the exact source has not been identified.  We do not know at this time if a specific distribution center may be the cause or perhaps a specific farm has contamination.  Perishable products with short growing seasons pose their own problem when it comes to traceback of an outbreak.  The tainted product could be consumed or perished before investigators get on the right track.  This means that the evidence literally vanishes without a trace.  Well…  In compost fashion that is.  As there is no source to avoid, other than the vague “Yuma, Arizona growing region” which isn’t usually printed on bags of chopped lettuce or on tags in the produce department, many are erring on the side of caution and saying to avoid romaine lettuce all together until more information can become available.  The CDC even recommends discarding any lettuce that has already been eaten in the home, even if those who have consumed it have not fallen ill.  Guidance to avoid romaine lettuce is yet again in the news.

What’s Different in This Outbreak?

• Different DNA Fingerprint: While the pathogenic bacteria is the same, the strain of STEC O157:H7 is different from the outbreak investigated in January involving 15 states and 2 countries. PulseNet, a database local and state health departments use to upload DNA fingerprints (particular genome sequences specific to a strain of a pathogen), shows that the illness in the current outbreak affecting 35 people is different from the DNA fingerprints responsible for sickening 25 in the United States and 42 in Canada.  The strain involved in the current outbreak presents the same STEC symptoms as the pervious one, which gives us a sense of déjà vu.  We feel like we have heard this new story before because we have heard this news story before.
• Limited to United States Consumers: At this time, the outbreak seems limited to the United States. No neighboring countries have indicated an outbreak of E. coli linked to romaine or any other foodborne carrier.
• Source is Clearer to Investigators: Recalls were not issued during the last outbreak because it was never clear to investigators that the illness on our side of the border were related to romaine. Investigators compare patient interview questions with those of otherwise healthy and unaffected people.  There was no clear consensus in the last outbreak of continuity of consuming romaine lettuce compared to others who had not fallen ill.  In this caseit was overwhelmingly clear.  A whopping 96% of patients interviewed indicated eating romaine lettuce in the week they became ill, while only 46% of healthy individuals reported eating romaine lettuce.
• Voluntary Recall in the United States: One produce manufacturing company out of Pennsylvania, Fresh Foods Manufacturing, has issued a voluntary recall of 8,757 pounds of retail salad products out of extreme caution. None of the cases have been linked to Fresh Foods Manufacturing, but the company expressed concern that their romaine supplier could be involved in the outbreak.  No recalls on the United States side of the outbreak were issued in the last outbreak, though on the Canadian side of the border, recalls were issued out of caution.

While this episode of déjà vu plays out, we remain cautious and vigilant about our salad choices and keep an eye out for ourselves and our family.  The investigators on the outbreak are working hard to find a source before the evidence perishes and help prevent others from becoming ill.  

By: Heather Van Tassell, Contributing Writer (Non-Lawyer)