Spinach - E. Coli Outbreak Consolidated Information.

For convenience, the following information includes recent news releases issued by FDA, a Q & A, and information about the variety of E. coli that is in the news. Learn more right here.
News and FDA reports about spinach & E. coli outbreak continue to be updated.

For convenience, the following information includes some of the recent news releases issued by FDA, a Q & A, and information about the variety of E. coli (Escherichia coli O157:H7) that is in the news.

For the most recent information you can visit FDA's hot topic webpage at:

www.fda.gov

For you can also visit FDA's Bad Bug Book online for more information about the variety or E. coli reported to be implemented in this outbreak, and information about other varieties of E. coli and other common pathogens found in food.

www.cfsan.fda.gov

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FOR IMMEDIATE RELEASE
FDA STATEMENT
September 24, 2006


FDA Statement On Foodborne E. Coli O157:H7 Outbreak In Spinach

This statement is current as of September 24, 2006. The U.S. Food and Drug Administration (FDA) will continue to provide the public with regular updates on the E. coli O157:H7 outbreak each day until further notice.


Click To Enlarge.
E coli.

Update:

    To date, 173 cases of illness due to E. coli O157:H7 infection have been reported to the Centers for Disease Control and Prevention (CDC), including 27 cases of Hemolytic Uremic Syndrome (HUS), 92 hospitalizations and one death.

    To date, 25 states have reported cases of E. coli O157:H7 infection.

    The Utah Department of Health (UDOH) and the Salt Lake Valley Health Department (SLVHD) have confirmed that E. coli O157:H7, the same strain as that associated with the outbreak, has been found in a bag of Dole baby spinach purchased in Utah with a use by date of August 30, 2006. Laboratory tests were conducted by the Utah Public Health Laboratory (UPHL).

    On September 22, 2006, two (2) more firms initiated voluntary recalls: Triple B Corporation, doing business as S.T. Produce, of Seattle, Washington and Pacific Coast Fruit Company of Portland, Oregon. Triple B is recalling its fresh spinach salad products with a "Use By" date of 8/22/2006 thru 9/20/2006 (see list below). Spinach used in these products may have been supplied from Natural Selections Foods of California.

    The recalled products were distributed in Washington, Oregon, Idaho and Montana to retail stores and delis and sold in a hard plastic clamshell container. Pacific Coast Fruit Company of Portland, Oregon is recalling products that may include spinach supplied by Natural Selections Foods (see list below).

    All salad products will have a "USE BY DATE" on or before Sept 20, 2006. Pizza products will have a "USE BY DATE" on or before September 23, 2006. Pacific Coast Fruit Company stopped making all products with spinach supplied from California on September 14, 2006. The products listed were distributed in Alaska, Oregon, Washington and Idaho.

    FDA is working closely with CDC and the state of California. FDA has determined that the spinach implicated in the outbreak was grown in three counties: Monterey, San Benito and Santa Clara in California. Spinach grown in the rest of the United States has not been implicated in the current E. coli O157:H7 outbreak. The public can be confident that spinach grown in the non-implicated areas can be consumed.

    Consumers are advised not to purchase or consume fresh spinach if they cannot verify that it was grown in areas other than the three California counties implicated in the outbreak.

    Other produce grown in these counties is not implicated in this outbreak. Processed spinach (e.g., frozen and canned spinach) is also not implicated in this outbreak.

    Industry is working to get spinach from areas not implicated in the current E. coli O157:H7 outbreak back on the market.

    Investigators from FDA, CDC and the state of California are working to narrow the area implicated in the current E. coli O157:H7 outbreak even further.

States Affected:

    The 25 affected states are:

    • Arizona (7)
    • California (1)
    • Colorado (1)
    • Connecticut (3)
    • Idaho (4)
    • Illinois (1)
    • Indiana (8)
    • Kentucky (8)
    • Maine (3)
    • Maryland (3)
    • Michigan (4)
    • Minnesota (2)
    • Nebraska (9)
    • Nevada (1)
    • New Mexico (5)
    • New York (11)
    • Ohio (20)
    • Oregon (6)
    • Pennsylvania (8)
    • Tennessee (1)
    • Utah (18)
    • Virginia (2)
    • Washington (3)
    • Wisconsin (43)
    • Wyoming (1)

Laboratory Findings:

    The Utah Department of Health (UDOH) and the Salt Lake Valley Health Department (SLVHD) have confirmed that E. coli O157:H7, the same strain as that associated with the outbreak, has been found in a bag of Dole baby spinach purchased in Utah with a use by date of August 30, 2006. Laboratory tests were conducted by the Utah Public Health Laboratory (UPHL).

    The New Mexico Department of Health announced on September 20, 2006, that it had linked a sample from a package of spinach with the outbreak strain of E. coli O157:H7. The spinach was eaten by one of New Mexico's patients before becoming sick. DNA fingerprinting tests determined that the strain from the spinach matches the strain from patients in the outbreak. The package of spinach that tested positive was "Dole Baby Spinach, Best if Used by August 30."

Five (5) Recalls:

    On September 22, 2006, Pacific Coast Fruit Company of Portland, Oregon initiated a voluntary recall of products that may include spinach supplied by Natural Selections Foods. Pacific Coast Fruit Company stopped making all products with spinach supplied from California on September 14, 2006. The recalled products are:

    • Baby Spring Mix Salad Kit (4.6 lbs)
    • Chef on the Run- Bacon Spinach Salad (9 oz. plus 2 fl. oz. dressing)
    • Chef on the Run - Spring Greens Salad (5 oz. plus 2 fl. oz. dressing)
    • Chef on the Run - Willamette Valley Salad (10 oz. plus 2 fl. oz. dressing)
    • Trader Joe's - Baby Spinach and Greens with Bleu Cheese, Candied Pecans and Cranberries with Raspberry Vinaigrette Dressing (10 oz.)
    • Trader Joe's - Baby Greens and Spinach Salad with Wild Maine Blueberry Dressing (10 oz.)
    • Mediterranean Veggie Blend Kit - 15 lbs
    • My Brothers Pizza Spinach and Garlic - 15 oz. and 36 oz.

    Most of the salad products can be identified by the labels Trader Joe's, My Brothers Pizza or Chef on the Run and are in clam shell containers. Pizza products are in round cardboard bottoms with a plastic over wrap. All salad products will have a "USE BY DATE" on or before Sept 20, 2006. Pizza products will have a "USE BY DATE" on or before September 23, 2006.

    The products were distributed through various retail outlets in Alaska, Oregon, Washington and Idaho. There is no international distribution.

    On September 22, 2006,Triple B Corporation, doing business as S.T. Produce, of Seattle, Washington, initiated a voluntary recall of its fresh spinach salad products with a "Use By" date of 8/22/2006 thru 9/20/2006. Spinach used in these products may have been supplied from Natural Selections Foods of California. The recalled products were distributed in Washington, Oregon, Idaho and Montana to retail stores and delis and sold in a hard plastic clamshell container.

    The products recalled by S.T. Produce are:

    • NWG Spinach Salad (5 oz.)
    • Spinach Salad, QFC (5 oz.)
    • Charlie's Spinach Salad (5 oz.)
    • Charlie's Tabouli & Goat Cheese Salad (10 oz.)
    • NWG Tabouli & Goat Cheese Salad (10 oz.)
    • Tabouli & Goat Cheese Salad, QFC (10 oz.)
    • T/H Spring Mix Salad (5.5 oz.)
    • T/H Mozzarella Spring Mix Salad (5.5 oz.)
    • T/H Baby Spinach Salad (5.5 oz.)
    • Walnut and Blue Cheese Salad w/ Grilled Chicken Breast (6.5 oz.)
    • Larry's Market Tabouli & Goat Cheese Salad (10 oz.)
    • Charlie's Seasonal Greens Salad (2.5 oz.)
    • Charlie's Seasonal Greens Salad (4 oz.)
    • Charlie's Baby Spinach Salad (6 oz.)
    • Charlie's Baby Spinach Salad (5 oz.)
    • Caesar Bowtie Noodle Salad Kit with Grilled Chicken Breast (6.9 lbs)

    On September 19, 2006, RLB Food Distributors, L.P., West Caldwell, NJ, initiated a voluntary recall of certain salad products that may contain spinach with an 'Enjoy Thru' date of 9/20/06. See: www.fda.gov. The products recalled by RLB are:

    • Balducci's Mesclun Mix 5 oz.
    • Balducci's Organic Baby Spinach 5 oz.
    • Balducci's Mixed Greens 5 oz.
    • FreshPro Mesclun Mix 5 oz.
    • FreshPro Organic Baby Spinach 5 oz.
    • FreshPro Mixed Greens 5 oz.
    • FreshPro Salad Mix with Italian Dressing 4.75 oz.
    • FreshPro Salad Mix with Ranch Dressing 5.25 oz.

    On September 17, 2006, River Ranch, of Salinas, California, announced a voluntary recall of packages of spring mix containing spinach. River Ranch obtained bulk spring mix containing spinach from Natural Selections. The following brands are involved: Fresh N' Easy Spring Mix and Hy-Vee Spring mix containing baby spinach, distributed to retailers in Texas, Iowa, New Mexico, Georgia and Ohio. Product was packed in 5 oz. bags and 5 oz. plastic trays. Products that do not contain spinach are not part of this recall.

    On September 15, 2006, Natural Selection Foods, LLC, of San Juan Bautista, California, announced a voluntary recall of all products containing spinach in all brands they pack with "Best if Used by Dates" of August 17, 2006 through October 1, 2006. These products include spinach and any salad with spinach in a blend, both retail and food service products. Products that do not contain spinach are not part of this recall.

    Natural Selection Foods, LLC brands include:

    • Natural Selection Foods
    • Pride of San Juan
    • Earthbound Farm
    • Bellissima
    • Dole
    • Rave Spinach
    • Emeril
    • Sysco
    • O Organic
    • Fresh Point
    • River Ranch
    • Superior
    • Nature's Basket
    • Pro-Mark
    • Compliments
    • Trader Joe's
    • Ready Pac
    • Jansal Valley
    • Cheney Brothers
    • D'Arrigo Brothers
    • Green Harvest
    • Mann
    • Mills Family Farm
    • Premium Fresh
    • Snoboy
    • The Farmer's Market
    • Tanimura & Antle
    • President's Choice
    • Cross Valley
    • Riverside Farms

    The affected products were also distributed to Canada, Mexico, Taiwan, Hong Kong and Iceland. No illnesses have been reported from these countries. FDA continues to investigate whether other companies and brands are involved.

Symptoms Of E. Coli O157:H7 Illness:

    E. coli O157:H7 causes diarrhea, often with bloody stools. Although most healthy adults can recover completely within a week, some people can develop a form of kidney failure called HUS. HUS is most likely to occur in young children and the elderly. The condition can lead to serious kidney damage and even death.

Lettuce Safety Initiative:

    The FDA developed the Lettuce Safety Initiative www.cfsan.fda.gov/~dms/lettsafe.html in response to recurring outbreaks of E. coli O157:H7 in lettuce. As a result of this outbreak, the initiative has been expanded to cover spinach. The primary goals of the initiative are to reduce public health risks by focusing on the product, agents and areas of greatest concern and to alert consumers early and respond rapidly in the event of an outbreak. This initiative is based on the 2004 Produce Safety Action Plan, intended to minimize the incidence of food borne illness associated with the consumption of fresh produce.

    FDA continues to work closely with the CDC and state and local agencies to determine the cause and scope of the E. coli 0157:H7 outbreak in spinach. Please check www.fda.gov for updates.

FOR IMMEDIATE RELEASE
FDA STATEMENT
September 21, 2006


FDA Statement On Foodborne E. Coli O157:H7 Outbreak In Spinach

The U.S. Food and Drug Administration (FDA) will continue to provide the public with regular updates on the E. coli O157:H7 outbreak each day until further notice.

Case Reports:

    To date, 157 cases of illness due to E. coli infection have been reported to the Centers for Disease Control and Prevention (CDC), including 27 cases of Hemolytic Uremic Syndrome (HUS), 83 hospitalizations, and one death. Illnesses continue to be reported to CDC. This is considered to be an ongoing investigation.

States Affected:

    The 23 affected states are:

    • Arizona (4)
    • California (1)
    • Colorado (1)
    • Connecticut (3)
    • Idaho (4)
    • Illinois (1)
    • Indiana (8)
    • Kentucky (7)
    • Maine (2)
    • Michigan (4)
    • Minnesota (2)
    • Nebraska (8)
    • Nevada (1)
    • New Mexico (5)
    • New York (11)
    • Ohio (20)
    • Oregon (5)
    • Pennsylvania (7)
    • Utah (17)
    • Virginia (1)
    • Washington (3)
    • Wisconsin (41)
    • Wyoming (1)

Consumer Advice:

    The FDA, in working closely with the CDC and the State of California, has determined that the spinach implicated in the outbreak was grown in the following California counties: Monterey, San Benito, and Santa Clara.

    Other produce grown in these counties is not implicated in this outbreak. Processed spinach (e.g., frozen and canned spinach) is also not implicated in this outbreak.

Laboratory Findings:

    The New Mexico Department of Health announced on September 20 that it had linked a sample from a package of spinach with the outbreak strain of E. coli O157. The spinach was eaten by one of New Mexico's patients before becoming sick. DNA fingerprinting tests determined that the strain from the spinach matches the strain from patients in the outbreak. The package of spinach that tested positive was "Dole Baby Spinach, Best if Used by August 30."

Three (3) Recalls:

    On September 19, 2006, RLB Food Distributors, L.P., West Caldwell, NJ, initiated a voluntary recall of certain salad products that may contain spinach with an 'Enjoy Thru' date of 9/20/06. See: www.fda.gov. The products recalled by RLB are:

    • Balducci's Mesclun Mix 5 oz.
    • Balducci's Organic Baby Spinach 5 oz.
    • Balducci's Mixed Greens 5 oz.
    • FreshPro Mesclun Mix 5 oz.
    • FreshPro Organic Baby Spinach 5 oz.
    • FreshPro Mixed Greens 5 oz.
    • FreshPro Salad Mix with Italian Dressing 4.75 oz.
    • FreshPro Salad Mix with Ranch Dressing 5.25 oz.

    On September 17, 2006, River Ranch, of Salinas, California, announced a voluntary recall of packages of spring mix containing spinach. River Ranch obtained bulk spring mix containing spinach from Natural Selections. The following brands are involved: Fresh N' Easy Spring Mix and Hy-Vee Spring mix containing baby spinach, distributed to retailers in Texas, Iowa, New Mexico, Georgia and Ohio. Product was packed in 5 oz. bags and 5 oz. plastic trays. Products that do not contain spinach are not part of this recall.

    On September 15, 2006, Natural Selection Foods, LLC, of San Juan Bautista, California, announced a voluntary recall of all products containing spinach in all brands they pack with "Best if Used by Dates" of August 17, 2006 through October 1, 2006. These products include spinach and any salad with spinach in a blend, both retail and food service products. Products that do not contain spinach are not part of this recall.

    Natural Selection Foods, LLC brands include:

    • Natural Selection Foods
    • Pride of San Juan
    • Earthbound Farm
    • Bellissima
    • Dole
    • Rave Spinach
    • Emeril
    • Sysco
    • O Organic
    • Fresh Point
    • River Ranch
    • Superior
    • Nature's Basket
    • Pro-Mark
    • Compliments
    • Trader Joe's
    • Ready Pac
    • Jansal Valley
    • Cheney Brothers
    • D'Arrigo Brothers
    • Green Harvest
    • Mann
    • Mills Family Farm
    • Premium Fresh
    • Snoboy
    • The Farmer's Market
    • Tanimura & Antle
    • President's Choice
    • Cross Valley
    • Riverside Farms

    The affected products were also distributed to Canada, Mexico, Taiwan, Hong Kong and Iceland. No illnesses have been reported from these countries. FDA continues to investigate whether other companies and brands are involved.

Symptoms Of E. Coli O157:H7 Illness:

    E. coli O157:H7 causes diarrhea, often with bloody stools. Although most healthy adults can recover completely within a week, some people can develop a form of kidney failure called HUS. HUS is most likely to occur in young children and the elderly. The condition can lead to serious kidney damage and even death.

Lettuce Safety Initiative:

    The FDA developed the Lettuce Safety Initiative www.cfsan.fda.gov/~dms/lettsafe.html in response to recurring outbreaks of E. coli O157:H7 in lettuce. As a result of this outbreak, the initiative has been expanded to cover spinach. The primary goals of the initiative are to reduce public health risks by focusing on the product, agents and areas of greatest concern and to alert consumers early and respond rapidly in the event of an outbreak. This initiative is based on the 2004 Produce Safety Action Plan, intended to minimize the incidence of food borne illness associated with the consumption of fresh produce.

    FDA continues to work closely with the CDC and state and local agencies to determine the cause and scope of the E. coli outbreak in spinach. Please check www.fda.gov for updates.

September 16, 2006; Updated September 21, 2006


Nationwide E. Coli O157:H7 Outbreak: Questions & Answers

An outbreak of E. coli O157:H7 infection continues to be investigated. The FDA, working closely with the CDC and the State of California, has determined that the fresh spinach implicated in the outbreak was grown in the following three California counties: Monterey, San Benito, and Santa Clara. Spinach products other than raw or fresh are not implicated in this outbreak.

Three U.S. firms that package and distribute fresh spinach and fresh spinach containing salad blends have announced voluntary recalls as follows: On September 19, 2006, RLB Food Distributors L.P. of New Jersey recalled its salad products that contain spinach with an "Enjoy Thru" date of 9/20/06. On September 17, 2006, River Ranch, of California, recalled its spring mix containing spinach. On September 15, Natural Selection Foods, LLC of California recalled its products containing spinach with "Best if Used by Dates" of August 17, 2006 through October 1, 2006. The brand names associated with each of these recalls are listed below.

To date, 157 cases of illness related to this outbreak have been reported to the Centers for Disease Control and Prevention (CDC) in 23 states including 27 cases involving a type of kidney failure called hemolytic uremic syndrome (HUS), 83 hospitalizations, and one death.

Consumer And Industry Advice And General Information Q & A's:

  • What is E. coli O157:H7
    • E. coli O157:H7 is a bacterium that causes diarrhea that is often bloody; the diarrhea can be accompanied by abdominal cramps. Fever may be absent or mild. Symptoms usually occur within 2-3 days following exposure, but may occur as soon as 1 day following exposure or up to one week following exposure. Healthy adults can typically recover completely from E. coli O157:H7 exposure within a week. However, some people, especially young children and the elderly, can develop Hemolytic Uremic Syndrome (HUS) as a result of exposure to E. coli O157:H7, a condition that can lead to serious kidney damage and even death.

  • Where was the spinach grown?
    • The FDA, in working closely with the CDC and the State of California, has determined that the spinach implicated in the outbreak was grown in the following California counties: Monterey, San Benito, and Santa Clara. Other produce grown in these counties is not implicated in this outbreak. Processed spinach (e.g., frozen and canned spinach) is also not implicated in this outbreak.

  • Are any other types of leafy greens included in this outbreak?
    • Any other type of leafy green (lettuce, collard greens, kale) are NOT implicated in this outbeak.

  • In what states have illnesses been reported?
    • To date, the states that have reported illnesses include:

      • Arizona
      • California
      • Colorado
      • Connecticut
      • Idaho
      • Illinois
      • Indiana
      • Kentucky
      • Maine
      • Michigan
      • Minnesota
      • Nebraska
      • Nevada
      • New Mexico
      • New York
      • Ohio
      • Oregon
      • Pennsylvania
      • Utah
      • Virginia
      • Washington
      • Wisconsin
      • Wyoming

      The implicated product was also distributed to Canada, Mexico, Taiwan, Hong Kong and Iceland. No illnesses have been reported from these countries.

      This outbreak is ongoing, therefore the number of illnesses and states involved may continue to increase.

      New Mexico's public health laboratory has isolated E. coli O157:H7 from a package of spinach. The package came from the refrigerator of a patient who ate some of the spinach before becoming ill. The New Mexico laboratory completed "DNA fingerprinting" tests. New Mexico and CDC determined that the "DNA fingerprint" matches that of the outbreak strain.

Outbreak Related Q & A's:

  • What is an outbreak?
    • An outbreak is defined by the CDC as two (2) or more cases of the same disease related to a common exposure.

  • When was the onset of the first illness related to this outbreak?
    • The first illness associated with this outbreak occurred on August 2, 2006, although most illnesses reported to date cluster with onsets from August 26 - September 9, 2006.

  • When did FDA first receive information regarding the current outbreak?
    • FDA first became aware of the current outbreak on September 13, 2006. FDA will continue to release additional information as it becomes available.

  • Who is investigating the current outbreak?
    • FDA continues to work closely with the U.S. Centers for Disease Control and Prevention (CDC) and state and local health departments to determine the cause and scope of this outbreak.

  • Have there been previous outbreaks involving fresh spinach?
    • Yes. A previous outbreak involving fresh spinach occurred in California in October of 2003. Sixteen (16) cases of illness were reported and two (2) people died. The causative agent was E. coli O157:H7.

  • How is the cause or source of an E. coli O157:H7 outbreak determined?
    • In the current spinach E. coli O157:H7 outbreak, the fact that illnesses are so dispersed (over 23 states to date) suggests that the contamination likely happened early in the distribution chain. The investigation into the possible source and cause of contamination is ongoing, including on the farm and in processing plants.

  • Where in the farm to table continuum is fresh produce most likely to become contaminated? What are the potential sources for produce contamination?
    • FDA's 1998 Guide to Minimize Microbial Contamination of Fresh Fruits and Vegetables (also referred to as the Good Agricultural Practices (GAPs) guide) describes potential sources of microbial contamination in the field and packing house environments and makes broad scope recommendations for how to reduce or minimize opportunities for contamination.

      According to the GAPs guide, areas that should be considered to minimize the potential for the microbial contamination of produce include: agricultural water (e.g., for irrigation or crop protection sprays); wild and domestic animals; worker health and hygiene; the production environment (use of manure, previous land use, and use of adjacent land); post harvest water quality (water used to wash or cool produce) and sanitation of facilities and equipment.

      Our experience in outbreak investigations since 1998 points to the importance of these areas as being significant to avoid contamination of fresh produce at the farm or packinghouse. We also know that there is still a substantial need for additional produce safety research.

      FDA focused on the farm and packing facilities because of a need to raise awareness about food safety at these stages of the supply chain. FDA's 2004 Produce Safety Action Plan, however, recognizes that contamination can happen at any point in the supply chain.

Recall Q & A:

  • What companies and brands are included in the voluntary recalls issued as a result of the current outbreak?
    • On 9/15/06, Natural Selection Foods, LLC, of San Juan Bautista, California announced a voluntary recall of all products that contain fresh spinach with "Best if Used by Dates" of August 17, 2006 through October 1, 2006. (See additional information about brands associated with Natural Selection Foods below). Other companies and brands of fresh spinach and fresh spinach containing products may also be involved in this outbreak; FDA and CDC continue to investigate this possibility.

      Natural Selection Foods, LLC brands include: Natural Selection Foods, Pride of San Juan, Earthbound Farm, Bellissima, Dole, Rave Spinach, Emeril, Sysco, O Organic, Fresh Point, River Ranch, Superior, Nature's Basket, Compliments, Trader Joe's, Ready Pac, Jansal Valley, Cheney Brothers, D'Arrigo Brothers, Green Harvest, Mann, Mills Family Farm, Premium Fresh, Pro-Mark, Snoboy, The Farmer's Market, Tanimura & Antle, President's Choice, Cross Valley, and Riverside Farms.

      On 9/17/06, another company, River Ranch, of California, announced a voluntary recall of spring mix containing spinach. River Ranch obtains bulk spring mix containing fresh spinach from Natural Selections for processing and packaging. The following brand names are included in the River Ranch recall: Fresh N' Easy Spring Mix and Hy-Vee Spring mix containing baby spinach, distributed to retailers in Texas, Iowa, New Mexico, Georgia and Ohio. The River Ranch product included in the recall is packed in 5 oz. bags and 5 oz. plastic trays.

      On 9/19/06 RLB Food Distributors of West Caldwell, New Jersey, announced a voluntary recall that may contain spinach from Natural Selection Foods. All the products recalled by RLB have an "Enjoy Thru date of 9/20/06 or before." The products are:

      • Balducci's Mesclun Mix
      • Balducci's Organic Baby Spinach
      • Balducci's Mixed Greens
      • FreshPro Mesclun Mix
      • FreshPro Organic Baby Spinach
      • FreshPro Mixed Greens
      • FreshPro Salad Mix with Italian Dressing
      • FreshPro Salad Mix with Ranch Dressing

      The recalled products were distributed in:

      • Connecticut
      • New York
      • New Jersey
      • Pennsylvania
      • Maryland
      • Delaware
      • Virginia
      • Washington D.C.

Government Activities Relative To Produce Safety Q & A's:

  • Is the government conducting tests?
    • Yes. The federal (principally CDC and the FDA) and state governments are working together to analyze samples from ill persons and product samples in an attempt to quickly identify the source(s) of the outbreak.

      The outbreak strain of E. coli O157:H7 from ill persons is being "fingerprinted" at public health laboratories around the country, as part of PulseNet (the network of public health laboratories that sub-type bacteria). All E. coli O157:H7 strains associated with this outbreak have the same "fingerprint" (DNA pattern).

      The states are collecting and analyzing samples of suspect foods. FDA has offered assistance to the states analyzing such samples as needed.

  • What steps has FDA taken to reduce the potential for outbreaks, specifically E. coli O157:H7 outbreaks, associated with raw produce?
    • The FDA developed the Lettuce Safety Initiative in response to recurring outbreaks of E. coli O157:H7 in lettuce. The primary goals of the initiative are to reduce public health risks by focusing on the product, agents and areas of greatest concern and to alert consumers early and respond rapidly in the event of an outbreak. On August 24, 2006, the State of California Department of Health Services and Department of Food and Agriculture and the FDA met with industry and academia to further clarify the goals, objectives and the next steps for the Lettuce Safety Initiative. This meeting was facilitated by the Western Institute for Food Safety and Security. This initiative is based on the 2004 Produce Safety Action Plan, intended to minimize the incidence of food borne illness associated with the consumption of fresh produce.

      Since 1995, there have been 19 outbreaks of foodborne illness caused by E. coli O157:H7 for which lettuce or leafy greens were implicated as the outbreak vehicle. Although tracebacks to growers were not conducted (or "not conclusive") in all of the outbreak investigations, a majority of the outbreaks, including the recent outbreak in September of 2005, traced product back to California, many of which were from the Salinas Valley, though not exclusively.

  • Does FDA issue assignments to sample and test domestic and foreign produce?
    • FDA regularly issues assignments to sample both domestic and foreign fresh produce items. Reports of those assignments are posted on FDA's website.

  • Has FDA conducted outreach/education activities regarding fresh produce safety?
    • FDA has the lead for foreign GAPs education/outreach and has been working with a number of food safety partners in other countries, and in the U.S., on a variety of programs targeted at the safety of fresh produce. FDA's produce safety action plan, instituted in 2004 and ongoing, contains four main objectives and many specific milestones to address produce safety, including outreach and education activities. Additionally, FDA has been distributing information materials in English and Spanish on the safe handling of raw produce and fruit and vegetable juices to health educators and state and local health agencies. FDA in conjunction with the Produce Marketing Association and the Partnership for Food Safety Education developed a multi-faceted national produce handling education campaign. Launched two years ago, this education program utilizes the media, food safety advocates and Partnership members to communicate safe handling recommendations about produce to consumers.


Escherichia coli O157:H7

(source: V= http://www.cfsan.fda.gov/~mow/chap15.html)

1. Name Of The Organism: Escherichia coli O157:H7 (enterohemorrhagic E. coli or EHEC)

    Currently, there are four recognized classes of enterovirulent E. coli (collectively referred to as the EEC group) that cause gastroenteritis in humans. Among these is the enterohemorrhagic (EHEC) strain designated E. coli O157:H7. E. coli is a normal inhabitant of the intestines of all animals, including humans. When aerobic culture methods are used, E. coli is the dominant species found in feces.

    Normally E. coli serves a useful function in the body by suppressing the growth of harmful bacterial species and by synthesizing appreciable amounts of vitamins. A minority of E. coli strains are capable of causing human illness by several different mechanisms. E. coli serotype O157:H7 is a rare variety of E. coli that produces large quantities of one or more related, potent toxins that cause severe damage to the lining of the intestine. These toxins [verotoxin (VT), shiga-like toxin] are closely related or identical to the toxin produced by Shigella dysenteriae.

2. Nature Of Acute Disease:

    Hemorrhagic colitis is the name of the acute disease caused by E. coli O157:H7.

3. Nature Of Disease:

    The illness is characterized by severe cramping (abdominal pain) and diarrhea which is initially watery but becomes grossly bloody. Occasionally vomiting occurs. Fever is either low-grade or absent. The illness is usually self-limited and lasts for an average of 8 days. Some individuals exhibit watery diarrhea only.

    Infective dose -- Unknown, but from a compilation of outbreak data, including the organism's ability to be passed person-to-person in the day-care setting and nursing homes, the dose may be similar to that of Shigella spp. (as few as 10 organisms).

4. Diagnosis Of Human Illness:

    CDC Case Definition

    Hemorrhagic colitis is diagnosed by isolation of E. coli of serotype O157:H7 or other verotoxin-producing E. coli from diarrheal stools. Alternatively, the stools can be tested directly for the presence of verotoxin. Confirmation can be obtained by isolation of E. coli of the same serotype from the incriminated food.

5. Associated Foods:

    Undercooked or raw hamburger (ground beef) has been implicated in many of the documented outbreaks, however E. coli O157:H7 outbreaks have implicated alfalfa sprouts, unpasteurized fruit juices, dry-cured salami, lettuce, game meat, and cheese curds. Raw milk was the vehicle in a school outbreak in Canada.

6. Relative Frequency Of Disease:

    Hemorrhagic colitis infections are not too common, but this is probably not reflective of the true frequency. In the Pacific Northwest, E. coli O157:H7 is thought to be second only to Salmonella as a cause of bacterial diarrhea. Because of the unmistakable symptoms of profuse, visible blood in severe cases, those victims probably seek medical attention, but less severe cases are probably more numerous.

    Summary of Notifiable Diseases, United States, 1997:MMWR 46(54)

      map
      Click Image To Enlarge.
      Reported Cases Of Ecoli O157, United States 1997.

      map
      Click Image To Enlarge.
      Reported Isolates Of Ecoli O157, United States 1997.

7. Course Of Disease And Complications:

    Some victims, particularly the very young, have developed the hemolytic uremic syndrome (HUS), characterized by renal failure and hemolytic anemia. From 0 to 15% of hemorrhagic colitis victims may develop HUS. The disease can lead to permanent loss of kidney function.

    In the elderly, HUS, plus two other symptoms, fever and neurologic symptoms, constitutes thrombotic thrombocytopenic purpura (TTP). This illness can have a mortality rate in the elderly as high as 50%.

8. Target Populations:

    All people are believed to be susceptible to hemorrhagic colitis, but young children and the elderly appear to progress to more serious symptoms more frequently.

9. Food Analysis:

    FDA's Bacteriological Analytical Manual Escherichia coli

    Several microbiological methods can be used to isolate E. coli O157:H7 from foods. Unlike typical E. coli, isolates of O157:H7 do not ferment sorbitol and are negative with the MUG assay; therefore, these criteria are commonly used for selective isolation. Sorbitol-MacConkey agar has been used extensively to isolate this organism from clinical specimens. Hemorrhagic colitis agar, a selective and differential medium, is used in a direct plating method to isolate O157:H7 from foods. A third procedure uses Sorbitol-MacConkey medium containing potassium tellurite and Cefixime. It includes an enrichment step and is a new method developed as result of the recent foodborne outbreaks. Rapid methods using a variety of technologies, including recombinant DNA methods, are being developed.

10. Selected Outbreaks:

    Literature references can be found at the links below.

    MMWR 49(40):2000

      On June 15, 1998, the Division of Public Health, Wisconsin Department of Health and Family Services, was notified of eight laboratory-confirmed and four suspected Escherichia coli O157:H7 infections among west-central Wisconsin residents who became ill during June 8--12. This report summarizes the outbreak investigation, which implicated fresh (held <60 days) cheese curds from a dairy plant as the source of infection.

    MMWR 49(15):2000

      In June 1999, the Tarrant County Health Department reported to the Texas Department of Health (TDH) that a group of teenagers attending a cheerleading camp during June 9--11 became ill with nausea, vomiting, severe abdominal cramps, and diarrhea, some of which was bloody. Two teenagers were hospitalized with hemolytic uremic syndrome (HUS), and two others underwent appendectomies. Routine stool cultures from eight ill persons failed to yield a pathogen. Stools subsequently were sent to laboratories at the Texas Department of Health and CDC, where Escherichia coli O111:H8 was isolated from two specimens.

    MMWR 48(36):1999

      On September 3, 1999, the New York State Department of Health (NYSDOH) received reports of at least 10 children hospitalized with bloody diarrhea or Escherichia coli O157:H7 infection in counties near Albany, New York. All of the children had attended the Washington County Fair, which was held August 23-29, 1999; approximately 108,000 persons attended the fair during that week. Subsequently, fair attendees infected with Campylobacter jejuni also were identified. An ongoing investigation includes heightened case-finding efforts, epidemiologic and laboratory studies, and an environmental investigation of the Washington County fairgrounds.

      USDA announcement (12 Aug 1997) and follow-up announcement (15 Aug 1997)

      These reports announce a recall of Hudson frozen ground beef.

    MMWR 46(33):1997

      The same recall investigation reported by the CDC.

    MMWR 46(32):1997

      In June and July 1997, simultaneous outbreaks of Escherichia coli O157:H7 infection in Michigan and Virginia were independently associated with eating alfalfa sprouts grown from the same seed lot. The outbreak strains in Michigan and Virginia were indistinguishable by molecular subtyping methods. This report summarizes the preliminary findings of the outbreak investigations.

    MMWR 46(30):1997

      As part of its commemoration of CDC's 50th anniversary, MMWR is reprinting selected MMWR articles of historical importance to public health, accompanied by current editorial notes. Reprinted below is a report published November 5, 1982, which was the first in MMWR to describe diarrheal illness attributable to Escherichia coli serotype O157:H7 infections.

      Odwalla Brand Apple Juice Products

      The FDA has issued on 31 October 1996 a press release concerning an outbreak of E. coli O157:H7 associated with Odwalla brand apple juice products.

    MMWR 46(01):1997 and MMWR 45(44):1996

      In October 1996, unpasteurized apple cider or juice was associated with three outbreaks of gastrointestinal illness. These reports summarizes the clinical and epidemiologic features of the two apple cider-related outbreaks, one infection the Western US and the other in the Northeast.

    MMWR 45(21):1996

      On July 5, 1995, the Winnebago County Health Department (WCHD) in northern Illinois received a report from the local hospital of five cases of Escherichia coli O157:H7 infection among children who resided in Rockford. Interviews of the children's parents revealed no common food source; however, on June 24-25, they all had visited an Illinois state park with a lake swimming beach. On July 6, the Illinois Department of Public Health (IDPH) closed the swimming beach because of suspected transmission of infection through lake water. While, the source of the outbreak is thought to be waterborne, the article is linked to this chapter to provide updated reference information on enterohemorrhagic E. coli.

    MMWR 45(12):1996

      On June 26, 1995, the Division of Public Health, Georgia Department of Human Resources (GDPH), was notified of three cases of Escherichia coli O157:H7 infection among residents of a community in north Georgia who had onsets of illness within a 24-hour period . Because of the proximity of this community to the Tennessee border, on June 28 GDPH notified the Tennessee Department of Health (TDH) about these cases.

      TDH subsequently identified two confirmed cases with onsets of illness during June 23-24. Both of these cases were among persons residing in eastern Tennessee approximately 100 miles from the community in Georgia, and one occurred in an 11-year-old boy who was hospitalized with hemolytic uremic syndrome (HUS). This report summarizes the investigation of this outbreak, which implicated eating hamburgers purchased at a fast-food restaurant chain as the source of infection.

    MMWR 44(29):1995

      Post diarrheal hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, renal injury, and thrombocytopenia and is associated with infection with Shiga-like toxin-producing Escherichia coli (SLTEC). From January 4 through February 20, 1995, the South Australian Communicable Disease Control Unit of the Health Commission (SACDCU) received reports of 23 cases of HUS among children aged less than 16 years who resided in South Australia. In comparison, during 1994, a total of three cases of HUS was reported in South Australia (1991 population: 1.4 million).

    MMWR 44(27):1995

      During February-March, 1994, four persons in Helena, Montana (1995 population: 24,569), developed bloody diarrhea and severe abdominal cramps. Stool cultures for Salmonella, Shigella, Campylobacter, and Escherichia coli O157:H7 were negative; however, sorbitol-negative E. coli colonies were identified in stools from all four patients. Isolates from three patients were identified at CDC as a rare serotype, E. coli O104:H21, that produced Shiga-like toxin II.

      Although other SLTECs also have been identified in sporadic cases of diarrhea and HUS, the findings in this report document the first reported outbreak of a non-O157 SLTEC in the United States, and the first documentation of illness attributable to Shiga-like toxin-producing E. coli O104:H21. The clinical manifestations of infection in this outbreak were similar to those reported for patients infected with E. coli O157:H7.

    MMWR 44(22):1995

      In 1993, the Council of State and Territorial Epidemiologists recommended that clinical laboratories begin culturing all bloody stools -- and optimally all diarrheal stools -- for E. coli O157:H7. This report describes the investigation of a pseudo-outbreak of E. coli O157:H7 infection that occurred in New Jersey during July 1994 after a year-long increase in the number of laboratories culturing all diarrheal specimens for this pathogen.

    MMWR 44(22):1995

      On August 8, 1994, the Virginia Department of Health was notified that several campers and counselors at a summer camp had developed bloody diarrhea. The outbreak began during the July 17-30 session at a rural camp where activities included frequent overnight trips at which meals were cooked over a campfire. This report summarizes the findings from the investigation, which confirmed E. coli O157:H7 as the causative agent.

    MMWR 44(09):1995

      From November 16 through December 21, 1994, a total of 20 laboratory-confirmed cases of diarrhea caused by Escherichia coli O157:H7 were reported to the Seattle-King County Department of Public Health (SKCDPH). In comparison, three cases were reported during October 1994. Epidemiologic investigation linked E. coli O157:H7 infection with consumption of a commercial dry-cured salami product distributed in several western states. Three additional cases subsequently were identified in northern California.

    MMWR 43(12):1994

      Most epidemiologic investigations of illness associated with E. coli O157:H7 infections have been directed at restaurant-associated outbreaks, and the sources of infection for sporadic cases rarely have been identified. In July 1993, three cases of culture-confirmed E. coli O157:H7 infection among persons residing in a small community in California were traced to consumption of hamburger purchased from a local grocery store; E. coli O157:H7 was isolated from that meat. This report summarizes the investigation of these cases by local and state public health officials.

    MMWR 43(10):1994

      Reports on laboratory screening for E. coli O157 in Connecticut.

    MMWR 42(14):1993

      From November 15, 1992, through February 28, 1993, more than 500 laboratory-confirmed infections with E. coli O157:H7 and four associated deaths occurred in four states -- Washington, Idaho, California, and Nevada. This report summarizes the findings from an ongoing investigation (see next paragraph) that identified a multistate outbreak resulting from consumption of hamburgers from one restaurant chain.

    MMWR 42(04):1993

      During January 1-29, 1993, 230 persons with culture-confirmed infection with Escherichia coli O157:H7 resulting in bloody diarrhea and, in some cases, hemolytic uremic syndrome (HUS) were reported in the state of Washington. Culture results are pending for 80 others with similar illnesses. Preliminary investigations by public health agencies linked cases to consumption of hamburgers from one fast-food restaurant chain. E. coli O157:H7 has been isolated from epidemiologically implicated lots of ground beef; an interstate recall was initiated by the restaurant on January 18.

    MMWR 40(16):1991

      In late July and early August 1990, an outbreak of gastroenteritis occurred among persons who had eaten a meal while attending an agricultural threshing show in North Dakota on July 28-29. At least 70 (3.5%) of the more than 2000 attendees were affected. Analysis of food histories obtained from 157 persons implicated a buffet-style dinner on July 28. Although food samples were not available at the time of the investigation, food history analysis indicated that roast beef served at the dinner was the most likely source of infection.

    MMWR 35(34):1986

      A patient recently died in Seattle with a clinical and pathologic diagnosis of TTP had bloody diarrhea associated with E. coli O157:H7 infection for 1 week before the onset of her other symptoms. This patient's clinical course suggested that E. coli O157:H7 infection may have been related to the development of thrombotic thrombocytopenic purpura (TTP).

    MMWR 32(10):1983

      In November 1982, 31 (8.8%) of 353 residents at a home for the aged in Ottawa, Ontario, Canada, became ill with gastrointestinal symptoms. Cases occurred over an 18-day period. None of the usual enteric pathogens (Salmonella, Shigella, Campylobacter, Yersinia, or Amoeba) were found in stool specimens obtained from the 31 affected residents. Escherichia coli O157:H7 was isolated from the stools of 17 patients.

    MMWR 31(43):1982

      Since the beginning of August 1982, stool isolates of Escherichia coli serotype 0157:H7 have been identified at CDC from specimens obtained from four patients in two states. The four patients with sporadic cases in which E. coli was isolated from stools and 24 of the remaining 25 patients with sporadic cases had eaten hamburgers from a variety of sources (including homes and/or local or national-chain restaurants) within the week before they became ill. Additionally, as part of its commemoration of CDC's 50th anniversary, MMWR is reprinting selected MMWR articles of historical importance to public health, accompanied by current editorial notes.

    Morbidity and Mortality Weekly Reports

      For more information on recent outbreaks see the Morbidity and Mortality Weekly Reports from CDC.

11. Education And Background Resources:

    Loci index for genome Escherichia coli O157:H7

      Literature References Can Be Found At The Links Below.

      Available from the GenBank Taxonomy database, which contains the names of all organisms that are represented in the genetic databases with at least one nucleotide or protein sequence.

    USDA (Aug 11 1998)

      USDA Urges Consumers To Use Food Thermometer When Cooking Ground Beef Patties

    Preventing Escherichia coli O157:H7 infections

      A CDC information brochure.

    "Produce Handling and Processing Practices" (1997) Emerging Infectious Diseases 3(4).

      In the past decade, outbreaks of human illness associated with the consumption of raw vegetables and fruits (or unpasteurized products produced from them) have increased in the United States.

      Pathogens such as Listeria monocytogenes, Clostridium botulinum, and Bacillus cereus are naturally present in some soil, and their presence on fresh produce is not rare. Salmonella, Escherichia coli O157:H7, Campylobacter jejuni, Vibrio cholerae, parasites, and viruses are more likely to contaminate fresh produce through vehicles such as raw or improperly composted manure, irrigation water containing untreated sewage, or contaminated wash water.

      Treatment of produce with chlorinated water reduces populations of pathogenic and other microorganisms on fresh produce but cannot eliminate them. Reduction of risk for human illness associated with raw produce can be better achieved through controlling points of potential contamination in the field; during harvesting; during processing or distribution; or in retail markets, food-service facilities, or the home.

    CDC Escherichia coli O157:H7 FAQ'S

      Frequently Asked Questions about Escherichia coli O157:H7.

    Emerging Infectious Diseases (1995)1(2)

      A monograph on E. coli O157:H7, written Dr. Feng of FDA/CFSAN

    USDA's E. coli O157:H7 risk assessment

      The overall goal of this risk assessment is to assess the likelihood of human morbidity and mortality associated with E. coli O157:H7 in ground beef in the United States. The risk assessment identifies the occurrence and concentration of this pathogen at specific points from farm-to-table and will assist FSIS in reviewing and refining its risk reduction strategy for E. coli O157:H7 in ground beef. In addition, the risk assessment will identify future research needs.

12. Molecular Structural Data:

    None currently available.

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Current Information

On Friday, September 29th, the FDA lifted its consumer warning on most fresh spinach. The warning has been changed to only cover spinach that was recalled earlier in September by Natural Selection Foods of San Juan Bautista, California. While the FDA has given the green light to consumers as far as fresh spinach is now concerned, California farmers are expected to "to get serious about fighting E. coli in their fields."

By Wednesday, October 4th the investigation made a possible turn towards the criminal. Federal agents searched Natural Selection Foods LLC plant and Growers Express in California for possible evidence of criminal neglect on the part of the plants. While there is no indication that the recent contamination was in any way the cause of willful tampering, conviction does not require for a company to know that their products are contaminated.

No announcements have been made on what was sought for or seized at the two plants. However enough preliminary evidence was on hand for the signing of a warrant.

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