CDC Expands E. coli Alert to Warn Against Consuming All Forms of Romaine Lettuce

Public health officials have upgraded an alert and are now telling consumers to avoid all types of romaine lettuce because of increase risk of serious illness from the consumption of common salad vegetable. The upgraded alert was activated after an Escherichia coli (E. coli) outbreak linked to the lettuce spread to at least 16 states and sickened at least 60 people, including eight inmates at an Alaska prison.

The Centers for Disease Control and Prevention (CDC) said Friday, April 20, 2018 that new information about the illnesses in Alaska discovery led health authorities to expand a warning beyond chopped romaine to include any type of romaine lettuce, including whole heads and hearts of romaine. The inmates who became sick at the Anvil Mountain Correctional Center in Nome ate lettuce from whole heads of romaine grown in Yuma, Arizona, according to the CDC.

Consumers anywhere in the United States who have store-bought romaine in their homes or refrigerators, including salads and salad mixes containing romaine lettuce, should throw it away immediately, federal health officials. The romaine lettuce should be discarded even if portions have already been eaten with no ill effects.

Officials also said consumers should throw away any lettuce of unknown type. Consumers also should not buy or eat romaine lettuce at a grocery store or restaurant unless they can confirm it is not from the Yuma or southwest Arizona area.

Pennsylvania has been the state with the most illness incidents, with 12 reported cases. There have been 10 reports of illness in Idaho. The case count includes one of the infected Alaska inmates; the remaining seven cases there will be included when the CDC provides its next count update, which is expected next week.

Clinical Alert Thursday April 18, 2018

As of Wednesday, April 17, 2018 the hospitalization rate for the outbreak was about 58 percent, much higher than the 30 percent normally associated with infections involving E. coli O157: H7.

— CDC update

The number of cases of illness has grown in the last several days. As of Wednesday, April 18, 2018, the CDC reported 53 people were infected with the E.coli outbreak. At least 31 people have been hospitalized, including five who developed a type of potentially life-threatening kidney failure known as hemolytic uremic syndrome. No deaths have been reported connected to this outbreak of foodborne illness.

Symptoms of E.coli infection include bad stomach cramps, diarrhea (often bloody) and vomiting. Occasionally, more serious complications can occur, including kidney failure.

Most E. coli bacteria are harmless and play a role as part of a healthy human intestinal tract. But a small number, including the strain in this outbreak, produce a toxin called Shiga that can cause serious illness or death. Shiga toxins halt protein synthesis in a cell by disrupting cellular instructions. Shiga toxins act on target cells by a mechanism similar to that of ricin — a biological warfare agent that is derived from the castor bean plant.

E. coli O157: H7 strain has been responsible for many high-profile outbreaks in the past. Health officials are working to determine why the strain is causing a higher percentage of serious conditions requiring hospitalizations, according to the CDC.

Although the exact source of the tainted lettuce hasn’t been identified, federal health officials have said information indicates the contaminated lettuce was grown in the southwest corner of Arizona. Initially no common grower, supplier, distributor or brand was connected to the outbreak.

The bacteria live in the intestines of cows, pigs and other ruminants. Infections start when a person swallows a small amount of human or animal feces, for example via contaminated food, consumption of unpasteurized (raw) milk, unclean water or via contact with the feces of infected people.

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