The Centres for Disease Control has an ominous warning for the U.S. this week: Please, for the love of god, do not consume romaine lettuce of any kind.
In a statement, the agency wrote that it has determined an outbreak of a strain of E. coli has resulted in infections in at least 32 people in 11 states across the United States, as well as an additional 18 people in two Canadian provinces. The CDC added that “epidemiologic evidence” in both countries suggests that the most likely culprit is romaine lettuce:
Ill people in this outbreak were infected with E. coli bacteria with the same DNA fingerprint as the E. coli strain isolated from ill people in a 2017 outbreak linked to leafy greens in the United States and to romaine lettuce in Canada. The current outbreak is not related to a recent multistate outbreak of E. coli O157:H7 infections linked to romaine lettuce.
This appears to be a particularly nasty outbreak, with the CDC writing that 13 people have been hospitalized in the U.S., with one developing kidney failure.
Outbreak Alert: Do not eat any romaine lettuce, including whole heads and hearts, chopped, organic and salad mixes with romaine until we learn more. If you don’t know if it’s romaine or can’t confirm the source, don’t eat it. https://t.co/NrFOIxG8hx pic.twitter.com/FuzkHv4bd3
— CDC (@CDCgov) November 20, 2018
The CDC further advised that since it has not determined which manufacturers or distributors are involved in the outbreak, absolutely no one should engage in the preparation or consumption of “all types or uses of romaine lettuce, such as whole heads of romaine, hearts of romaine, and bags and boxes of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad.”
In a statement to CNN on Tuesday, U.S. Food and Drug Administration Commissioner Scott Gottlieb conceded it was “frustrating” that federal health agencies had not nailed down the source of the illness, but that officials “have confidence that it’s tied to romaine lettuce… Most of the romaine lettuce being harvested right now is coming from the California region, although there’s some lettuce coming in from Mexico.”
Gottlieb added that investigators have determined it is the same strain of E. coli as the 2017 outbreak, but that “This year, we’re a month earlier, so we’re earlier in the process, earlier in the throes of an outbreak. So we’re able to actually get real-time information and conduct effective trace back and isolate what the source is.”
E. coli O157:H7 produces the Shiga toxin, which can lead to severe gastrointestinal symptoms including stomach cramps and hemorrhagic diarrhoea, and in severe cases, kidney failure. While some cases are mild, and most resolve in five to seven days, the FDA wrote in a release that children under five, adults older than 65, and immunocompromised individuals are the most likely to come down with “severe illness.”
According to CNN, while the 21 multi-state foodborne illness outbreaks the CDC has investigated this year is a record, Gottlieb said that the number reflects increased detection:
“I think that the issue isn’t that there’s more unsafe food,” Gottlieb said. “I think what’s happening is that we have better technology than ever before to link outbreaks of human illness to a common pathogen.”
In all 50 states, the CDC has the capacity to do genomic testing on samples from infected patients (such as blood samples). It also can genetically link the identified pathogens in human illness to actual food sources.
What is lagging is the ability to do track and trace to a single distributor or grower “because we don’t have as good a technology as we would like in our supply chain,” Gottlieb said.