The recent nationwide E. coli outbreak related to Freshway Foods’ romaine lettuce has now sickened 33 individuals in 5 states.

The Outbreak

As of May 20, 2010, a total of 26 confirmed and 7 probable cases related to this outbreak have been reported from 5 states since March 1, 2010.   The number of ill persons identified in each state with this strain is: MI (11 confirmed and 2 probable), NY (5 confirmed and 2 probable), OH (8 confirmed and 3 probable), PA (1 confirmed), and TN (1 confirmed).  The reported cases in Tennessee and Pennsylvania do not reflect expansion of the outbreak but retrospective identification of cases using the PulseNet system – these cases are part of the original cluster due to the original implicated lot of lettuce from March.

Among the 30 patients with available information, 12 (40%) were hospitalized.  Three patients have developed a type of kidney failure known as hemolytic uremic syndrome, or HUS. No deaths have been reported.

The bacteria responsible for this outbreak are referred to as Shiga toxin-producing E. coli, or STEC. STECs have been associated with human illness, including bloody diarrhea and HUS. STEC bacteria are grouped by serogroups (e.g., O157 or O145).  The STEC serogroup found most commonly in U.S. patients is E. coli O157.  Other E. coli serogroups in the STEC group, including O145, are sometimes called “non-O157 STECs.”  Currently, there are limited public health surveillance data on the occurrence of non-O157 STECs, including E. coli O145; therefore, E. coli O145 may go unreported.  Because it is more difficult to identify than E. coli O157, many clinical laboratories do not test for non-O157 STEC infection.

Investigators are using pulsed-field gel electrophoresis (PFGE), a type of DNA fingerprint analysis of E. coli bacteria obtained through diagnostic testing to identify cases of illness that might be part of this outbreak.

Confirmed cases are persons with:

1. Shiga toxin-producing E. coli O145 infection, or Shiga toxin-producing E. coli infection with O Group pending, AND
2. an illness onset on or after March 1, 2010, AND
3. a DNA fingerprint matching the outbreak strain; AND
4. an epidemiologic link to the outbreak.

Probable cases are persons with a strong epidemiologic link to the outbreak and

1. Shiga toxin-producing E. coli O145 infection with an illness onset on or after March 1, 2010 regardless of DNA fingerprint pattern, AND/OR
2. hemolytic uremic syndrome; AND/OR
3. a laboratory specimen with evidence of  Shiga toxin 2 [stx2] or Shiga toxin, but toxin type is unknown or pending.

Current Status of the Investigation

Multiple lines of evidence have implicated shredded romaine lettuce from one processing facility as a source of infection in this outbreak.  This evidence includes the identification of the outbreak strain of E. coli O145 from an unopened package of shredded romaine lettuce obtained at an institution that received product from the processing facility linked to the outbreak.  Case-control studies in Michigan and Ohio found significant associations between illness and consumption of romaine lettuce processed at the same facility that processed lettuce consumed by ill persons in New York, Pennsylvania, and Tennessee.

The lettuce processing company  – Freshway Foods – has issued a recall of lettuce produced at their facility as a result of the evidence obtained to date.  An additional recall  was issued by a separate company that received lettuce from the same farm as the processing company linked to the outbreak.

Testing of shredded romaine lettuce from the processing company also identified an E. coli O143 producing Shiga toxin 1, which is different from the outbreak strain.  This strain is not associated with any human illness, and appears to be an incidental finding.

This investigation is ongoing. At this time, local, state, and federal health officials are involved in many different types of investigative activities, including:

• Conducting surveillance for additional illnesses that could be related to the outbreak.
• Conducting epidemiologic studies that includes gathering detailed information from ill persons (cases) and from healthy persons (controls) about foods recently eaten and other exposures.
• Gathering and testing food products that are suspected as possible sources of infection to see if they are contaminated with bacteria.
• Following any epidemiologic leads gathered from interviews with patients, food purchase information, or from patterns of processing, production and/or distribution of suspected products.
• FDA is working closely with its state partners in the investigations at the food processor and at the farm level to determine where in the distribution chain the point of contamination likely occurred.

Public health and agriculture officials in Michigan, New York, Ohio, Pennsylvania and Tennessee, along with CDC and FDA, are actively engaged in this investigation.

Timeline of Infections: Multistate Outbreak of E. coli O145 Infections Associated with Romaine Lettuce — United States, 2010

Public health authorities initially recognized an outbreak of bloody diarrhea in MI due to E. coli O145 on April 16, 2010 that was subsequently linked to other similar clusters in OH and NY. Preliminary information linked these illnesses to a common supplier of romaine lettuce on April 27, 2010. By April 28, 2010, FDA determined that the implicated romaine lettuce production lots were produced in late March from a single farm and accounted for all of the illnesses; these implicated lots were no longer in commerce and no recall was necessary. Subsequent laboratory investigations of romaine lettuce showed at least intermittent contamination on later production days from the processor and triggered preemptive recalls of initially a single contaminated lot, and then all production from the implicated farm. There has been no illness associated to date with these later lots of recalled lettuce.

Clinical Features / Signs and Symptoms

Most people infected with E. coli develop diarrhea (often bloody) and abdominal cramps 2-8 days (average of 3-4 days) after swallowing the organism, but some illnesses last longer and can be more severe. Infection is usually diagnosed by culture of a stool sample. Many clinical laboratories do not test for non-O157 STEC, such as E. coli O145, because identifying it is more difficult than for E. coli O157. Most people recover within a week, but some develop a severe infection.HUS can begin as the diarrhea is improving and can occur in people of any age but is most common in children under 5 years old and the elderly.

I became sick after eating the romaine lettuce – Do I have a case?

Persons who tested positive for the outbreak strain of E. coli O145 have been or will be contacted by their county or state health departments and questioned about the foods they ate prior to becoming ill.

If you tested positive for E. coli O145, and were contacted by your county or state health department and questioned about the consumption of lettuce, then it is highly likely that you are one of persons sickened in this national outbreak.  If so, you are entitled to a E. coli settlement – i.e. full compensation for all of your medical bills, lost wages, and suffering you endured.

Simon & Luke Can Help

The E. coli lawyers at Simon & Luke have represented over 2000 victims of food poisoning, filing hundreds of salmonella lawsuits and recovering hundreds of millions of dollars for our clients.  Call us toll free at 1-888-335-4901 – we are happy to answer your questions free of charge.