The romaine lettuce E. Coli outbreak, now at 98 sick in 22 states, remains difficult for the FDA and CDC to track, the two organizations acknowledged on a Friday conference call.
Thus, the Centers for Disease Control and Prevention's advice of the last week — do not eat any romaine lettuce from the Yuma, Arizona, region — remains in place.
Dr. Stic Harris, director of the FDA’s Coordinated Outbreak Response and Evaluation Network, says no other lettuce beyond romaine is in the outbreak and no other romaine lettuce other than that grown in the Yuma, Arizona, region is involved.
While the source for the whole head romaine lettuce part of the outbreak has been identified as Harrison Farm, that covers only the eight inmates sickened at Alaska's Anvil Mountain Correctional Facility. Harrison Farm's last shipments were from March 5 through March 16, meaning any romaine lettuce in that shipment should be tossed on the basis of being more than 21 days old.
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The other 90 sicknesses have come from chopped romaine lettuce. Those sources remain a mystery.
The organizations' joint investigation has narrowed the possible sources down to more than two dozen farms. Harris admitted they don't know where in the supply chain the E. coli contaminated the lettuce. The diversity in the clusters of sick, Harris said, multiplies the roads to search.
"There's the assumption in doing a trace back that each leg is a direct link," Harris said. "In this case, you're looking at a web."
And this is a particularly nasty strain of Shiga-toxin producing E. coli O157:H7. Of the 98 sick, 46 have been hospitalized, 46.9 percent.
"That's higher than we normally see for an E. coli outbreak, which is about 30 percent," said Dr. Matthew Wise, the CDC's deputy branch chief for outbreak response. "The strain in this outbreak tends to cause more hospitalizations."
E. coli can strike two to eight days after eating contaminated food, but tends to hit around three to four days. Then, it's five to seven days of bloody diarrhea and cramps for most people. But, for others, the symptoms can drive the afflicted to the hospital and cause hemolytic uremic syndrome (HUS), a form of kidney failure that can end in death.
In this outbreak, 10 people have developed HUS. No deaths have been reported.
Wise said though the most vulnerable groups for HUS are senior citizens and the young, this outbreak's breadth and hospitalization rate mean everyone should heed all warnings.
Food safety attorney Bill Marler said that out of the 98 cases, four are under the age of 5 and 14 are over 65. Marler said none of the HUS patients were children, while three are over 65. Marler Clark, which says it's the nation's only foodborne illness specialty law firm, represents 56 sick in the outbreak, including eight of the HUS patients.
The case count rose to 14 from Wednesday's update, with Mississippi, Tennessee and Wisconsin getting their first cases. Pennsylvania still has the most cases, 18. But the case count in California has jumped to 16. Idaho has 10. Montana and Alaska each have eight. There are seven in New Jersey. Five each in Arizona and Washington. Michigan and Ohio each have three. New York, Connecticut and Colorado have two each. Virginia, Illinois, Georgia, Mississippi, Tennessee, Wisconsin, Louisiana, Missouri and South Dakota each have one.
Wise acknowledged that this is the largest E. coli outbreak since the 2006 leafy spinach outbreak traced to California's Salinas Valley. That outbreak grew from a farm near a cattle pasture. The cattle and possibly the farm's pigs might've contaminated a nearby stream.
Asked why romaine lettuce is so often involved in E. coli outbreaks, Harris said, "It's not something that's cooked. There is no kill step (for the bacteria)."